Cornwall VCSE Health Commissioning Improvement Programme

1. Cornwall VCSE Health Commissioning Improvement Programme

2. A Department of Health funded programme being managed by Social Enterprise UK (SEUK) and the Institute for Voluntary Action Research (IVAR)

3. The aim of the pilot is to support Clinical Commissioning Groups and Health & Well-Being Boards to develop constructive and productive partnerships with VCSE’s

4. Third Sector Commissioning programme Phases 1 and 2 (funded by Office for Civil Society) including the Partnership Improvement Programme, which made the following recommendation: • the need to combine understanding with guidance and partnership working, bringing together voluntary and community organisations, social enterprises, public sector practitioners and commissioners to generate mutual trust and understanding.

5. Principal outcomes agreed with DH • CCG’s to have a greater understanding of the value and contribution made by VCSE sector organisations to health services and a greater appreciation of how to work effectively with them leading to best outcomes for patients • HWB Boards to have a detailed understanding of VSCE sector organisations and the distinctive contributions they make towards health-related services and be able to organise and manage their effective involvement • Local VCSE organisations have increased knowledge of local health commissioning goals/processes and be clear about how they can become involved • Cross-sector communication channels will have been improved to ensure that VCSE organisations are able to maximise the potential of their contribution to health

6. What has happened so far? • National scoping exercise • Local research with stakeholders • Identification of shared goals and priorities in Cornwall (diagnostic) • Patient journeys linked to VCSE service delivery • Started mapping commissioner objectives and outcomes against strategy and delivery plans

7. Partnership & engagement

8. What are the main objectives of commissioners now? Are they likely to change? If so, how? • What role do you see the VCSE undertaking in health commissioning, now and in the future • As a board member, where do you see the main opportunities for working with the VCSE sector and what information/action is still needed to make this a reality?

9. Aim of session • To consolidate and share the current position on Health commissioning from both the HWB and VSCB perspectives and provide a forum to explore working together on a reciprocal basis • Possible outcomes • Join up understanding of the commissioning approach being taken forward • Establish common ground between commissioners and VCSE partners by demonstrating the value/gains/benefits of the partnership • Consider practical solutions to the strategic outcomes in the HWB draft strategy and support the development of the delivery plan • To share models of effective working and areas of best practice

10. Public Services (Social Value) Act 2012 All public bodies in England and Wales are required to consider how the services they commission and procure might improve the economic, social and environmental well-being of the area. It is a piece of legislation that will require commissioners to look beyond the price of each individual contract and looking at what the collective benefit to a community is when a public body chooses to award a contract.

11. Local Context Clinical Commissioning Groups (CCGs) Commissioners should consider how voluntary and community organisations can play a role in the delivery of services and, through their expert knowledge, scope the sorts of services and outcomes that communities want and need (Department of Health 2010i) New Health and Wellbeing Boards The voluntary and community sector is a key partner in addressing the wider determinants of health and achieving better public health outcomes for local populations. Organisations will work alongside directors of public health, local authorities, CCG’s, the wider NHS, private businesses, early years services, and schools (Department of Health 2012b).

12. New shared statutory duty to produce a joint health and wellbeing strategy (JHWS) and joint strategic needs assessments (JSNAs); Health and well being board members should determine the scope of the JSNA across multiple public services such as health, housing, environment and economic development, as well as collaboration with voluntary and private sectors (NHS Confederation commissioning tool 2011) • Local Healthwatch • The sector is an important advocate for patients, supporting them to interpret information and make an increasing number of choices (Department of Health 2010f).

13. Why social finance options? • tighter budgets and increased demand; • the need for greater joining-up / integration / collaboration; • increased interest in co-production / co-design with users and personal budgets; and • an appetite for preventative rather than crisis of palliative interventions (aka “fences not ambulances”) • Need for a longer term financial model (as opposed to annual) • NHS reforms such as AQP, individual budgets => competition and enterprise • Care closer to community, prevention, integration => need for investment

14. Why social value approaches, the VCSE sector? • 75% of NHS costs are spent on people with long-term conditions • Less ‘clinical’ forms of help and support can be more effective than clinical approaches • Clinical solutions often fail to reduce demand which is essential given limited resources. • Social value describes the social benefits achieved from public services. • It considers more than financial transaction – includes well-being, health, inclusion and employment. • Change in mindset - moves from seeing communities and people as having needs to one that empowers them and sees them as assets. • Requires us to see that investing in health, like in education, is an investment rather than a cost

15. Why social value approaches, the VCSE sector? • 4 challenges to overcome to get more innovation and social value: • Accommodating disruptive innovations: Need to commission more ‘disruptive innovations, take leaps of faith and to manage the risks that this will invariably entail. • Developing alternative commissioning currencies:Move from visits, admissions to outcomes • Addressing the ‘economics’ of disruptive innovations:  Finding the ‘start-up’ costs, Turning ‘paper savings’ into real reductions in spending which is why social finance is so important. • Identifying the individuals and organisations that can make this happen: It is likely to be social enterprises and the third sector that will be the sources of disruptive innovations. • If we are to develop new and better ways to support people with long-term conditions, there is a pressing need to identify and build relationships with organisations so that the NHS can learn to embrace disruptive innovation.

16. Updates:HWB – Charlotte HillCommissioning – Ian GullundVSCB – Mark Richardson

17. Next steps • Mapping commissioning objectives and outcomes to VCSE service delivery • Invest to transform event and 9th October partnership development session • Dissemination opportunities • Dropboxresources • Final report and events

18. The VCSE as…… • A provider of health services • A source of support for commissioning • A partner in tackling health inequalities • A long-term commissioning partner

19. We need clear outcomes and responsibilities. We can all understand the challenges posed by inequalities, obesity or dementia. We have to be clear about action and delivery. There is no point having a talking shop if we don’t speak the same language. Dr Steve Kell - Chair of Bassetlaw CCG