Health, Wellbeing, and Transformation

Health and Wellbeing Board   2^nd July 2014

The most significant papers coming to this Board were the five year plans (2014-19) of the Clinical Commissioning Groups.  There are 6 Clinical Commissioning Groups in Nottinghamshire and they’ve come together to do this planning work by forming three “planning units” – Bassetlaw, Mid Notts and South Notts (which in this case includes Nottingham City).

Each of these planning units has set up Transformation Boards to develop these plans. That word “transformation” is an NHS piece of jargon.  It means the significant changes that are coming down the line in the way that we, the public, will be receiving health and social care services, and changes that will be necessary in the way they are internally organised.

These changes can be summarised by:

1. Much greater integration of health and social care services than we’ve seen to date.  This starts with the use of the Better Care Fund (the £3.8 billion pooled budget, described in a previous blog).
2. Changing how primary care (GPs, community nurses, pharmacists, etc) and hospital services work with each other.  This is (a) to save (mainly NHS) money; and (b) to make sure that services that people receive at home are more “joined up”. The aim is for fewer vulnerable older people needlessly going into hospital when they could be receiving more effective intensive healthcare at home.
3. Promoting healthier lifestyles: the idea is that we should all take greater responsibility for looking after our own health, and that we’re all potentially expert in our own “self care” – if we are given the right health and social care advice and support. This is intended to help reduce rising demand and costs on health and social care, the consequence of an ageing population and more of us living longer with long term ill-health conditions.

I made two points here, on behalf of Healthwatch Nottinghamshire.  Firstly that the 5 year plans of the three “planning units” need to better link into the Health and Wellbeing Strategy for Nottinghamshire which the Health and Wellbeing Board has just produced.  Otherwise a key point of the exercise is lost.

Secondly, if “transformation” means that we will be soon experiencing significant changes in the way we receive health and social care services, then the public needs to know the “how’s and why’s” of this.  The language of these 5 year plans is not designed to do this.  What’s needed is a communications plan that speaks in plain English to the public about the changes that are coming over the horizon.  This is something that the Health and Wellbeing Board should oversee.

The wide influences on our health and wellbeing are shown in two of the other papers that came to the Board.  One was about the effect of poor quality air in parts of Nottinghamshire effecting peoples’ breathing difficulties.  A second one described the new Derbyshire-Nottinghamshire Local Nature Partnership which aims to influence new industrial and commercial and development to better protect surrounding nature and wider environment, thus enhancing our wellbeing.

In the longer run those two papers will have infinitely greater impact on our lives, and the health and wellbeing of our descendants than any 5 year commissioning plans!

For a summary of all of the papers at this Health and Wellbeing Board click here.

The next Health & Wellbeing Board meeting will be taking place on 3^rd September from 2pm at County Hall. I’ll be presenting our Healthwatch Nottinghamshire Annual Report at this one, and the Board will be discussing the Joint Strategic Needs Assessment (JSNA), the Public Health Annual Report, the Voluntary & Community Sector Network Report and workplace health, amongst other things. Public are always invited to observe these meetings, so if you are interested in hearing the discussion then please come along.

April Health & Wellbeing Board – More on the Better Care Fund…

(For a summary of the discussion at the Board please go to the County Council website.)

The main part of the Nottinghamshire Health & Wellbeing Board meeting on 2^nd April was given over to agreeing to the plan for how Nottinghamshire health and social care services intend to use the new Better Care Fund (BCF). This is government money, top-sliced nationally from NHS England budgets (so it’s not new money), and given to local health and social care planners as a “pooled budget”.

Requiring a pooled budget is quite a radical step on the part of the government and in my view is absolutely essential. As a previous blog described, the last 40 years of attempting to better integrate health and social care has failed, and it’s failed largely due to the difficulties of bringing together the respective budgets and agreeing the priorities for their use.

These plans have now been agreed by the 6 Nottinghamshire Clinical Commissioning Groups (or CCGs for short), and the County Council’s Adult Social Services. No mean feat in such a short time-scale! The Nottinghamshire people who are going to be helped by the Better Care Fund services are predominantly older people with physical frailty or mental ill health and young adults with disabilities.

The government has laid down some conditions on the budget over and above it having to be a “pooled budget”. An interesting condition, not surprising with all the concerns about pressure on hospital admissions, is the requirement that health and social care have integrated 7 day services to help people (predominantly older people) being discharged from hospital to return home with adequate services in place, and to prevent unnecessary admissions to hospital at the weekend by providing effective care at home.  This is also a provision long overdue in my view.

The two points I made which have been raised with Healthwatch Nottinghamshire (HWN) were:

1. Was it the intention in the Better Care Fund planning to integrate personal budgets in social care (already well established) with the proposed personal health budgets (coming in this year for people with continuing health conditions and raised with HWN as an issue)? The answer to this was yes.
2. I made the point – something that has frequently come up at meetings attended by HWN – that the BCF plans should include the provision of preventative services in the community for people (particularly for frail older people, people with disabilities and for carers) who were showing early signs of beginning to need help. Unless this was built into the planning of services (particularly with the assistance of the voluntary and community sector), future population pressure demand on health and social care services would almost certainly undo the achievement of more integrated services in the community made possible by the Better Care Fund.

The Board agreed with this point.  A number of GPs representatives at the meeting said that their BCF planning groups (there are 3 planning groups covering Bassetlaw, mid Notts and South Nottinghamshire) were aware of the importance of providing early preventative services for just this reason.

It remains to be see how effective those plans turn out to be.  HWN will be taking an interest in monitoring progress on this, as well as making sure that opportunities are given to people across Nottinghamshire and in different communities to contribute to the implementation of these ambitious plans.

Joining up health and social care – Will it work this time around?

Ada is an 87 year old widow with many health problems, supported by daughter Maureen aged 63. Up to now it feels like she’s been passed from pillar to post across different specialisms of health and social care services. With numerous assessments by many different staff, nobody’s got the whole picture. Services are uncoordinated. She is admitted to hospital after a fall. Finally, and perhaps predictably, she has to move into a care home. Sound familiar?

There’s been talk about improving joint working between health and social services for the last forty years. Numerous government initiatives for local councils and local health bodies to better integrate services for the vulnerable has resulted in talk being stronger than achievement on the ground. There have been good examples locally. They’ve come and gone, depending on the individual actions of local managers and front-line staff.

The latest government initiative is the £3.8 billion Better Care Fund (BCF), some of which is coming to Nottinghamshire and Nottingham for spending between 2014 -16. Is it going to be any more successful? There is a new buzz in the air about a more joined-up health and social care system. I think there are grounds for cautious optimism.

What has to change? Key problems in the past have concerned budgets, professional silos and organisational bunker mentality. It’s been difficult to “pool” health and social care budgets. Now one of the conditions of the BCF is that there is no choice other than to “pool” the local budget between health and social care. Ada would receive jointly funded home-based care with a coordinator who is not now protecting separate budgets.

Organisational cultures have also hindered. Health staff and social care staff, each in their professional silos, tend to work professionally and culturally in different ways. The BCF requires an “accountable lead professional”. Ada will have an integrated care team with one care co-ordinator, whatever their background! As a result she’ll feel more in control with better co-ordination between her GP and social care.

There’s still the potential cliff-edge of hospital discharge if services and Ada’s home are not made ready for her return. Current plans to pay hospitals for arranging better integration back into the community, rather than just paying for in-hospital treatment, will help.

Almost all of us know a member of our family or friend, like Ada, who have directly experienced the consequences of poor joined-up services. We should be expecting better in our time.

Health and Wellbeing Strategy for Nottinghamshire (with a nod to the Dalai Lama)

Out for consultation until Sept 26^th

Have your say…..

• What is “health and wellbeing”?
• Why is it important? (What did the Dalai Lama say?)
• What’s being consulted on?
• What is Healthwatch Nottinghamshire’s role?

What is “health and wellbeing”?

It’s well put in the opening lines of Nottinghamshire’s draft strategy:

“Health is often stated as being an absence of illness or disability.  However, health and wellbeing recognises that a person’s overall feeling of “wellness” includes a sense of physical, mental and social wellbeing and therefore, takes a much wider view of what effects a person’s life experience”

So, health and wellbeing is no longer just about illness, hospitals, doctors, nurses and therapists. The Nottinghamshire strategy takes a much wider view. For example priority 7 (N.B. this is my numbering, they’re not numbered in the draft!) is about safeguarding children, young people and vulnerable adults from abuse.  Another example is priority 9, concerned with improving the quality and affordability of housing in the County – a pretty crucial determinant of health and wellbeing. But this is a Council function and not contained in NHS budgets!

That is where this strategy is different – to be effective it is going to have to cut across different organisations’ individual plans and priorities. This is going to challenge the instinctive reluctance of Health, Councils and the other major agencies to leave their organisational silos. This may prove to be particularly difficult at a time when their budgets are under pressure as never before.  So is it going to be a “close down the hatches” reaction for 2013-15 or, alternatively, can we set out for the more uncharted waters of, as the Cllr Bosnjak, Chair of the Health and Wellbeing Board, describes it:

“The common purpose to work across health, social care and wider communities to improve health and wellbeing opportunities for all”.

Success is going to depend on close working between local government, the NHS, the community and voluntary sector, and independent organisations.

Why is it important?

The Dalai Llama spent a week in Nottinghamshire in 2008 where he was warmly welcomed by County Councillors.  It was a sight to behold: The leader of Tibetan Buddhism strolling down the river Trent Embankment in his red monkish robes with, on each side of him, and his arm firmly through each of their arms, the two women who were then local democratic leaders of Nottinghamshire County Council – Cllr Joan Taylor (Chair) and the Vice Chair, Cllr Ellie Lodziak. The contentment on the Councillors’ faces was palpable.

The Dalai Lama has an interesting take on how we are doing in the West in terms of wellbeing. This is taken from his piece called, “The Paradox of our Age”:

“We have:

More conveniences, but less time;

We have degrees but less sense;

More knowledge but less judgement;

More experts, but more problems;

More medicine, but less healthiness.

We’ve been to the moon and back

But have trouble crossing the street to meet the new neighbour”

 Everyone in Nottinghamshire should be able to enjoy good health and wellbeing but we all know from experience, and it is evidenced in the Joint Strategic Needs Assessment (JSNA), that some groups and communities in the County experience poorer health and wellbeing than others.  The strategy, if it is to be effective, needs to make an impact on these inequalities by placing an emphasis on the most vulnerable and those who have the poorest health.

What’s being consulted on?

There are 3 themes or principles in the strategy:

• Prevention and early intervention
• Supporting independence
• Promoting integration across partners

Under those three there are 16 priorities (you can find what they are at http://www.nottinghamshire.gov.uk/caring/yourhealth/developing-health-services/health-and-wellbeing-board/strategy/)

Do you agree with these 3 underlying themes that shape the overall strategy?
Is there anything in there that you don’t think should be a priority, or there is an area of health and wellbeing that you think has been missed?

These are the ways you can feedback to the planners of the strategy:

• View the consultation document and complete a feedback form on the County Council Website (http://www.nottinghamshire.gov.uk/caring/yourhealth/developing-health-services/health-and-wellbeing-board/strategy/)
• Attend a consultation event, the remainder of which will take place on:

15 August 2013 (10am) at Retford Town Hall
9 September 2013 (10am) Richard Herrod Centre
10 September 2013 (6pm) Rushcliffe Arena
12 September 2013 (6pm) Ashfield Summit Centre
13 September 2013 (2pm) Bridge Community Centre, Newark

(Please book your place via joanne.stewardson@nottscc.gov.uk or 01623 433007)

What is Healthwatch Nottinghamshire’s role?

The strategy is important for Nottinghamshire people because it will influence commissioning decisions about services of the NHS, local government and social care from now all the way up to 2016.  We expect this Nottinghamshire strategy to be a “living document”, i.e. it is likely to develop and evolve over time.  We want the views of consumers coming into Healthwatch Nottinghamshire to contribute to the implementation of this strategy.

Healthwatch sits on the Health and Wellbeing Board, the “overseer” of this strategy. Healthwatch Nottinghamshire will exercise its responsibility on the Board by, amongst other things, keeping an eye on what patients, users and carers are saying about the services that sit under these 16 priorities.  Where necessary Healthwatch will make recommendations to the Board, or to health and social care commissioners, for changes or improvements to those services.

As part of our ongoing support to the strategy, Healthwatch will be attending all of the consultation events listed above. If you have something to say or simply want to learn more, come along and speak to us at one of the events or phone us on 0115 963 5179 and we’ll feed your views into the consultation process.

Health and Wellbeing Stakeholder Network Meeting

Health & Wellbeing Stakeholder Network Meeting 27^th June 2013
Children, Education and Health & Wellbeing

The Health and Wellbeing Stakeholder Network meeting took place in the evening of 27^th June. The central theme was that the success or otherwise of the education of children and young people has a significant impact on their later health and wellbeing. Put another way, children’s health and education outcomes correlate closely with the measure of children poverty and other measures of deprivation.

One way of addressing this long-standing and pernicious problem, and the one now being adopted in Nottinghamshire, is:

a)   to integrate the commissioning of children’s services across Public Health, Education Services, and Early Help Services; and

b)   aim to create a “single door” access point for children, young people, and their families who may need any of these services.

The aim of the latter is to have a single, clear point of access, reduce multiple assessments and care plans, and better integrate services in three new locality teams (Mansfield/Ashfield, Bassetlaw/Newark & Sherwood, Broxtowe/Gedling/Rushcliffe). The school nursing and health visiting service will be brought into the new integrated teams by April 2015.

You might think that this should have happened years ago! But as always, the distribution of finance, the small “p” of politics and the way organisations tend to have their own cultures, has got in the way. Let’s hope that the time is now right!

Health and Wellbeing Board 5th June

Health and Wellbeing Board: 5^th June 2013

It is encouraging that the leaders of Nottinghamshire’s health and social care services are in tune with the national vision for co-ordinated care for all as outlined in the recent national publication ‘Integrated Care and Support – Our Shared Vision’* Almost all of the papers to this month’s Health and Wellbeing Board had a common theme – the improvement of services for patients, carers and service users through better integration of health and social care.  So much so, that at the end of the meeting, when the priorities for the next Health and Wellbeing Strategy for Nottinghamshire was discussed, there was unanimous support for Integration being one of the key priorities.

We had a presentation about the blueprint for the Mid Notts Transformation Programme.   Integration is the key theme for the changes that need to happen and the blueprint is the vision for how health and social care services will look across Mansfield and Ashfield and Newark and Sherwood over the next 3-5 years.  A Citizen Board is already meeting to give a patient/carer/service user viewpoint to the Transformation and to help to plan the wider involvement of local people in developing the initiatives outlined in the plan. Healthwatch will be offering support to the partners to ensure that local people have a real opportunity to contribute and have their say.

A similar initiative to promote integration of services for frail older people is underway in the South of the County, including Nottingham City.  The Strategy and Implementation Group for Nottingham South (SIGNS) has developed a shared set of principles and a shared campaign to improve care for frail older people in the area.  There are three themes to the campaign – Support to Thrive, Choose to Admit and Transfer to Assess and the partners will be developing their proposals under these headings.    This was followed by a presentation about loneliness amongst older people and the impact this has on their health and wellbeing.  Age UK is co-ordinating a national campaign to end loneliness and the Health and Wellbeing Board was asked to support the roll out of the campaign in Nottinghamshire.  This will involve mapping loneliness and implementing a range of initiatives to combat loneliness.  The involvement of older people will be an important element of both these pieces of work and Healthwatch will be supporting this where possible.

Children and young people with disabilities and/or special educational needs were the topic of the next item.  This included an update about the findings of the needs assessment carried out in 2012 and the development of integrated commissioning for children and young people with disabilities and/or special educational needs.  The need for integration and co-ordination of health and social care for this group of children and young people was brought to life by a presentation from a parent who highlighted the number of agencies involved in her daughter’s care and the amount of time spent in attending appointments and co-ordinating the various care and support services.  The Health and Wellbeing Board agreed to sign up to the Disabled Children’s Charter for Health and Wellbeing Boards.

Finally the Board discussed the plan for the development of the Health and Wellbeing Strategy for 2014-17.  The draft strategy will be consulted on over the summer so that it can be considered at the Health and Wellbeing Board in September.

If you would like to view any of the papers from this Health and Wellbeing Board, these are available at http://www.nottinghamshire.gov.uk/dms/Meetings.aspx.

Claire Grainger
Chief Executive

Health and Wellbeing Board 17th April

Health and Wellbeing Board: 17^th April 2013

As Healthwatch Nottinghamshire (HWN) Chair I took our seat at the first ‘live’ Health and Wellbeing Board on 17^th April. All the papers presented I thought had implications for Healthwatch work.  To summarise: The first paper concerned the work of the Transformation Board of the Sherwood Forest Hospitals NHS Foundation Trust. By the end of April a “blueprint” of options for future configuration of the component hospitals and their functions and associated community services, including social care, is to be presented to stakeholders. I proposed that HWN should support the local Community and Voluntary Services and Patient and Public Involvement leads of Health services in the public and patient engagement that will now be required across central Nottinghamshire.

A wide-ranging paper from Public Health (which now sits within Nottinghamshire County Council) was a comprehensive attempt to describe the 20 or so factors that are key in leading many children and young people to becoming vulnerable. It was suggested by HWN that future work is required to better establish the actual numbers of young people in contact with those Nottinghamshire services. Knowing this would make it possible to begin to weight the effectiveness of programmes across and between those many factors.

A third paper from the Adult Social Care “Living at Home” programme concerned the impact on social care of the rising number of frail elderly population requiring either long term residential care or more intensive home care. The paper points out that there has to be “organisational cultural change” in the way hospital doctors, GPs, and social care staff tend to take risk averse decisions on behalf of dependent older people. This leads to over use of residential care rather than enabling more integrated home based care. I was interested to know the sorts of approaches that were being taken to begin to address such a major “cultural” change in the routine practice of care professionals, taken together with the natural concerns of carers.

There seems to be a new energy around the County on joint working initiatives between health and social care.  This is being triggered by the issue described above of the impact of an ageing population leading to greater demand on care – but perhaps different kinds of care as the baby boomer generation starts to need help – and all on reducing or static social and healthcare budgets.

HWN will be engaged in this new thinking and action on social and health care integration which is sensible and effective for consumers, action which is long overdue.