Working
Together
Tim Crayford
Maggie Atkinson
John Dixon
Dr. Tim Crayford
President, ADPH
Director of Public Health & Medical Director,
Croydon NHS Primary Care Trust
Central Government
• ‘Our Health, Our Care, Our Say’
DH 2006
To ensure there is more visible local leadership on health and wellbeing,
particularly on public health issues such as childhood obesity, smoking rates and
health inequalities. It is important that the local authority lead member for
adult social services is able to influence the commissioning decisions of health
and social care bodies, and drive action to reduce health inequalities
by engendering systematic partnership working between NHS bodies, local
authorities and other partners, for example through greater use of joint
appointments, pooled budgets and joint commissioning. We want to see health
and social care services delivered seamlessly around the needs of patients,
families and carers, and local partners able to work together in tackling the
wider causes of social exclusion, worklessness, and vulnerability
Our Health, Our Care, Our
Say
• New powers for Scrutiny (APHR)
• Jointly appointed DsPH
• LDPs to become more aligned with
LAAs
NHS view on commissioning
Assess Needs
Manage
Performance,
Quality,
Outcomes
Review
Service
Provision
Clinical
Decision
Making
Decide on
Service
Priorities
Manage
demand /
access to care
Specify
Services
Shape
Structure of
supply
Strong and prosperous
communities
…by engendering systematic partnership working between NHS
bodies, local authorities and other partners, for example through
greater use of joint appointments, pooled budgets and joint
commissioning. We want to see health and social care services
delivered seamlessly around the needs of patients, families and
carers, and local partners able to work together in tackling the
wider causes of social exclusion, worklessness, and vulnerability
…local authorities will now be under a statutory duty to
(establish) Local Involvement Networks (LINks)
formal arrangements for Directors of Public Health to be jointly
appointed and held jointly accountable by the chief executives of
local authorities and PCTs
Strong and prosperous
communities
• statutory partnership for health and
well-being under the LSP
• Strengthened role for LA Scrutiny esp.
in relation to the DPH and the APHR
• A new Lead Member at local authority
executive level, whom we will expect
to play a leading role on local health
and well-being partnerships
• LAAs strengthened
Pulling it all together
Annual Public
Health Report
(HEAs)
LSP
LAA
6 Domains of
Choosing
Health
JSNA
JSNA
DPH
JSNA
DCSS
DASS
Care Services Ideal
Need
Demand
Want
Efficient delivery
Need
Demand
Want
Current Care Services
Need
Demand
Want
Wellness needs?
Need
Demand
Want
Challenges:
Joint DPH Appointments
•
•
•
•
Variable interpretation
Clearly the right direction
Need to remain NHS-based
?account via the LSP
Challenges:
JSNA Information
•
•
•
•
•
Accessing it
Pooling it
Analysing it – mapping it
Presenting it in a JSNA
Sharing our experiences with it
Dr. Maggie Atkinson
President, ADCS
Director of children’s services, Gateshead
Metropolitan Borough Council
Children’s Services: integrated!
• We are charged with being outcome
focused ......
• not process obsessed or stuck in old
models ......
• Which means a focus on addressing and
narrowing gaps and taking out
inequalities
• We are REQUIRED to work together:
Health's NSFs, Every Child Matters, Our
Health Our Care Our Say
• ...And my friend, Mrs Cannybody.
Who’s she?
• She lives on Ubiquity Street, Anytown,
Everyshire, in social housing, on the minimum
wage
• She's a single parent and a busy woman
• She wants to ask one person for help, guidance,
advice on public services and get a straight
answer:
– where to go
– what to do
– how to get support
• She wants her family to be healthier and better
placed than she is
• She is not interested in who pays your wage, or
mine
• She's interested in ......
• Good ante-natal, maternity and postnatal care for herself
• Advice on her baby, her older child,
her teenage stepchild's smoking,
drinking and risk taking life
choices
• Advice on lifestyles, when finances are
tight and diet, fitness, exercise
• Advice on stress: hers and
others'... and on stopping smoking
• She wants us to .....
• see the person, not the episode or the
casework
• ask her to tell her story once,
• safely share and use what she tells us
• keep our promises that we can help
• think wellbeing and wellness, and
• plan services around helping her attain
them
• join up to support her and her family, and
MEAN IT!
• not make her second guess or be clever or
articulate to get what's needed
Circle of
exchange
Lead
Practitioner(s)
Nurses
Circle of
participation
Teachers,
tutors
Dinner
supervisor
Social
worker
scouts
brownies
guides
Cadets
etc
grand
Doctors,
health
workers
best
friend
Circle of
intimacy
grand
mother
Mum, Dad, carer,
brothers & sisters
others at home
Outreach
workers
People
next
door
Aunt or
uncle
God
parent
cousin
Class
mates
Places
of
worship
Circle of
friendship
father
Football
or other
sports
clubs
Lollipop
person
Advisers,
mentors
People
in
the park
Learning
support
assistant
Parents’
friends
Other children
in school
Baby sitter,
Child minder
Nanny
or
childminder
Education
Welfare
Service
Shopkeepers
Librarian
Educational
Psychologist
Fire
fighters
Community
wardens
Step sibling
Community
of
neighbours
Police
And support
officers
Therapy
services
John Dixon
President, ADAS
Director of Social & Caring Services,
West Sussex County Council
Inequalities and Well-being –
Working Together
John Dixon
Executive Director of Adults and
Children, West Sussex County
Council
and President, ADASS
Adults’ Services – A Changing
Role
• Life Chances of Disabled People – Opportunity
Age
• Independence, well-being and Choice – Our
Health, Our Care, Our Say
• Safe and Prosperous Communities
• Place Shaping and The rise of well-being
• Shift in relationship between state and
citizens
DASS: Joined Responsibilities
50% - Housing
40% - Crime Prevention
Regeneration
Safer Communities
Neighbourhood Services
25% - Culture, Leisure, adult
learning
Most - Health
10% - Children’s as DCS
All our Tomorrows - Revisited
Specialised
interventions
Resource Intensive
Professional gift
relationship
Targeted help to
individuals
Support to Communities
Infrastructure for Community
development and self-help
Sustainability
Customer in
control
Infrastructure for citizens to
support informed safe choices & to
help providers
Housing/Accommodation/Supporting
People
Public Health
Community Health
Transport
Access to Employment/Workforce
Social Inclusion
Lifelong Learning
Community Safety
Regeneration
Effective Joint Commissioning
• All about patient/care pathways
• Best mix for patients of health/social
care/3rd sector input
• From self-care to tertiary care
• Choice and control – from professionals to
users/patients
• Transferring activity & finance within care
pathways: the ‘5%
plus’ test
• Joining the two commissioning frameworks
• Achieving
- user satisfaction
- clinical outcomes
Personalisation, Eligibility &
The Green Paper on Care &
Support
• It’s about Social Justice as much as funding
• Need to agree principles of new settlement first
• Rethink dependency and contribution:
• The two groups : those currently eligible for state
funding
: those outside of the state net
• Those currently funded: not much longer affordable
: to be given control
• Those not now funded : more than half the population
• Transparency and eligibility
• Some help for everyone, and more for those who need it
most
• Public knowledge and affection: NHS vs. social care
• The weakest link in the welfare state: assurance for old
World Class Commissioning
and Putting People First
• Comprehensive understanding of the needs of everyone
in the community
• Planning in partnership with users and carers for services
to meet agreed outcomes through improved choice and
control
• Work with providers and Third Sector to develop services
for independence and well-being
• More intelligent and responsive procurement of services
to improve outcomes.
• Ensure individual purchasing is as near to the person as
possible
• Improving evaluation of service provision as a return on
investment
• Need to join up governance, leadership, basic skills and
knowledge
ADASS Business Unit
Local Government House
Smith Square
London SW1P 3HZ
Tel: 020 7072 7433
Fax: 020 7863 9133
EMAIL: team@adass.org.uk
WEB: www.adass.org.uk