Monday 9 th July 2012

1. Community Leadership Network Annual Conference Delivering Change Together Communities and Commissioners Working in Partnership Monday 9th July 2012

2. Plan for the day • Morning • Introduction to the CLN from Sue Houghton, Community Researcher Basildon • Three speakers: • Freya Lock from DH • Cherry Jones from NHS Swindon • Angela Harrowing from DCLG • Lunch at 1.10pm – 5 Market Place Stalls • Afternoon • Two speakers: • David Gillbert from InHealth Associates • Lord Victor Adebowale from Turning Point • Table discussion and feedback

3. Key Questions for the day - Make notes on your table cloths - • How do you see communities and decision makers/commissioners working more closely together? • What are the challenges and opportunities of involving communities in decision making and delivery of services? • What do you think we can all learn from today?

4. Sue Houghton Community Researcher Basildon Why I became a Community Researcher and Network Member

5. Community involvement in health and wellbeing boards, Joint Strategic Needs Assessments (JSNAs), and Joint Health and Wellbeing Strategies (JHWSs) Freya Lock – JSNA and JHWS Development Lead, DH

6. Context • Health and Social Care Act – now implementation • NHS Commissioning Board Authority operating (shadow form) – will be constituted from October 2012 • Public Health moving to local authorities – transition plans been drawn up and indicative funding announced • Shadow health and wellbeing boards set up • Shadow clinical commissioning groups (CCGs) set up and authorisation starts in July • Healthwatch England (hosted by CQC) to go live in October 2012, and local Healthwatch from April 2013 • Moving to “outcomes-based” system • Outcomes Frameworks for the NHS, public health and adult social care have been published • Commissioning Outcomes Framework, and Child Health Outcomes Strategy under development

8. Health and wellbeing boards • Will be established in every upper-tier local authority from April 2013, as a committee of the local authority • Core membership, with equal leadership: • At least one elected member • Representative from each CCG • Representative from local Healthwatch • Directors of public health, adult social services, and children’s services • Can work with others locally, however that makes sense to them • Core function to undertake Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs) • Assessment of current and future health and social care needs for the area, going wider if they wish • Jointly agreed local priorities – a strategy to meet those needs to inform local commissioning

9. Shared local leadership • Bringing together collaborative leadership of NHS, local authorities and wider public sector spending with the aim of • Greater democratic legitimacy and accountability to local people • Integrating services to better meet individual and community needs • Transforming local services and improving outcomes • The ambition is to: • bring the decisions about services closer to those that use them, • go further than analysis of common problems and to develop partnerships that provide solutions to commissioning challenges, rather than just commenting on what the challenges are.

10. Key challenges for emerging health and wellbeing boards Not being “talking shops” focused on action Avoid becoming a “Christmas tree” for every difficult issue Managing expectations genuinely integrated working takes time, often years How to engage the wider public, not just interested few Building support for the need for transformational change Maintaining enthusiasm quick wins as well as strategic transformation 10

11. Current hot topics CCG authorisation (July, Sept, Oct, and Nov) How can it support ongoing development ofstrong relationshipsHow can CCGs provide evidence of engagement in HWBs and JSNA and JHWS processes Widening the scope of JSNA to develop a “picture of place” Agreeing a “first-cut” JHWS to shape 2013/14 commissioning plans How can health and wellbeing boards support the development of local Healthwatch Developing strong relationships during transition What does good community involvement look like How are health and wellbeing boards accountable in a local system 11

12. How JSNAs and JHWSs fit together • The intention of JSNAs always was to use local evidence of needs to inform the planning of local services and commissioning decisions • by adding the new layer of the JHWS this link is being made easier for local areas and partners • Health and wellbeing boards provide a forum for repositioning JSNAs as truly jointly owned and leading to joint commissioning decisions to serve the whole population • Some emerging health and wellbeing boards tell us that in their area they already use JSNAs to inform their local priorities and underpin their commissioning plans – this is all these process are intended to do, and for these areas these reforms will not feel all that different

13. JSNA & JHWS – the vehicle for shared leadership HEALTH & WELLBEING BOARD Explicit link from evidence to service planning What does our population & place look like? –evidence and collective insight So what does that mean they need, now and in the future and what assets do we have? (a narrative on the evidence – JSNAs) What are we doing now, how well is it working and how efficient is it? (an analysis on our progress) Involvement of partners and the community – transparency and accountability So what are our priorities for collective action, and how will we achieve them together? (JHWS) What services do we need to commission, or de-commission; provide and shape both separately and jointly? (commissioning plans) So what have we achieved? – what difference have we made to people’s lives? (outcomes)

14. What we’re doing to support this • National Learning Network for health and wellbeing boards, including a learning set on JSNAs and JHWSs • Are developing statutory guidance for health and wellbeing boards – focussing on process and principles of JSNAs and JHWSs, not specifying form or content • Also developing a range of co-produced resources with sector leaders to support health and wellbeing boards on areas where they want it most • Feedback from health and wellbeing boards focuses on best practice process around e.g. engagement, asset-mapping etc.

15. Feedback from health and wellbeing boards • Unique to the area – every area’s needs are different • Need for leadership from the health and wellbeing board • joint responsibility for input and action on JSNAs & JHWSs • Not “talking shops” – focused on action, not a “Christmas tree” for every issue • Prioritising what matters locally and where can make an impact • Assessing the full needs of the whole local population, across the life course • Physical health, mental health, social care, wider determinants • Opportunity to tackle inequalities and wider determinants through joint working and influencing others • A wide evidence base of qualitative and quantitative from a number of sources • Also assets can be used to meet these needs • Building on / informing other assessments & strategies Can drive improved evidence in areas where it has been poor in the past • Involve local partners and the community – use expertise of others, but • challenge in engaging the wider public, not just interested few • Local Healthwatch as a conduit to, but not the totality of engagement • JSNAs and JHWSs an ongoing process – part of commissioning cycle • Transparent trail from evidence to decisions made • Can use agreed priorities to influence wider commissioning • They are not ends in themselves – what matters is how they are used

16. Key points for community engagement • You can trap more with honey than vinegar – What can you offer to health and wellbeing boards? • Information and evidence • Access to local people, especially specific groups • A way of addressing identified needs • help engaging the wider public, not just interested few • How can you hold health and wellbeing boards to account? • Through local Healthwatch • Through local councillors • Through the duty to involve the local community

17. How to get involved in your area • Health and wellbeing boards: • Each local authority area will be establishing a shadow health and wellbeing board ahead of 2013, and should be able to give you information of how to get involved – check your local authority website • You can also join the Knowledge Hub for the National Learning Network for health and wellbeing boards to connect with key board members and get involved in discussions: https://knowledgehub.local.gov.uk/home • Local Healthwatch: • Local Healthwatch wont exist until April 2013 (Healthwatch England will be established in October). Some local authorities are establishing 'shadow' local Healthwatch organisations in the interim – until April 13, local authorities are a good point of contact. • From April 2013 onwards, there will be a local Healthwatch in each local authority area, and the contact details will be through the Healthwatch England website (www.healthwatch.co.uk), which has a map with the relevant details (currently of LINks, but in time it will be local Healthwatch).

18. Any Questions? Community involvement in health and wellbeing boards, Joint Strategic Needs Assessments (JSNAs), and Joint Health and Wellbeing Strategies (JHWSs) Freya Lock – JSNA and JHWS Development Lead, DH

19. Connected Care - Swindon Cherry Jones Deputy Director of Public Health NHS Swindon

21. Swindon facts & challenges • 201,000 population • Aging population • Pockets of high deprivation • Life expectancy gap • Males 8.9 years • Females 6.5 years • Current economic climate • Pressure on resources

22. Locality working • put people and communities at the heart of what we do • build trust, respect and relationships • listen to people in their communities • Identify local priorities • Promote community cohesion • Deliver improved services • Build on existing strengths

23. Connected care – community led commissioning • Community influence • Voice and experiences of residents • Better local knowledge • Determine the needs and aspirations of the local community • Gain an insight into community assets

24. The swindon study areas • Central- high level of Black and Minority Ethnic residents • Penhill- highest levels of deprivation, majority White population with many health needs • Taw Hill - new housing full of young families and young couples with far fewer health needs

25. Community researchers • Established a multi agency steering group • 19 local people recruited and trained • Developed the questionnaire • Over 1100 residents took part • community events & drop ins, • visited services and medical centres, • door to door interviewing • engaged with parents at local schools

26. Findings • Central • Greater promotion and coordination of voluntary and charitable groups • More employment and training services • More bins supplied to residents • Penhill • Resume smoking cessation services • Health ambassadors to have a greater focus • More support for carers • Improve communication between housing services and residents • Taw Hill • Support for young parents to socialise • Identification of a community space

27. Cc - the legacy! • CR’s who can use their networks to reach specific community groups • Supports our JSNA process and HWS • Informs commissioning • CR’s • Safe and Warm • Community champions for diabetes • Timebank

28. Connected Care - Swindon Any Questions? Cherry Jones Deputy Director of Public Health NHS Swindon

29. Community Right to ChallengeAngela Harrowingangela.harrowing@communities.gsi.gov.uk0303 444 1349

30. Community Right to ChallengeLocalism Act 2011 A right for voluntary and community bodies, charities parish councils and relevant authority employees, to express an interest in running council and fire authority services, where they believe they can do so differently and better. If an expression of interest is accepted, the authority must carry out a procurement exercise for the service. Authorities must consider how expressions of interest and subsequent procurement exercises would promote or improve the social, economic or environmental well-being of the authority’s area.

31. Expressions of interest • Will you be capable of running the service you want to run? • Do you have sufficient finances? • What service, or part of a service, do you want to run? • How will the outcomes you propose to deliver: • Meet the needs of service users? • Improve the social, economic or environmental wellbeing of the area?

32. Himmat – Working with young people "At Himmat, we have expanded from our original base of Halifax to deliver services elsewhere in West Yorkshire. As a community-led organisation, we have been successful in being awarded contracts to run services such as with the local Youth Offending Team. It hasn't been straightforward establishing ourselves - we're lucky to have strong relationships with our local authority. The new Community Right to Challenge will make it easier for community organisations to suggest new ways of running council services. The 95 per cent attendance record at our Youth Offending Team programme is evidence that community organisations deliver results.“ Mohamed Aslam MBE, BEM, Director, Himmat Limited a community-led organisation

33. Bulky Bob’s Bulky Bob’s A Social enterprise that has contracts with Liverpool City Council and other councils to collect, reuse and recycle bulky household waste. Offers not only efficient waste collection service, but also social, economic and environmental benefits … • Reuses and recycles 65% of furniture and white goods - reduce impact on the environment, saving councils £££ in landfill costs. • Helped over 30,000 low-income families access affordable furniture • Has run training programmes for more than 200 long-term unemployed. Since 2000, 80% of trainees have gone into sustainable employment • Social benefits to the local community 2.5 times the initial investment

34. Fresh Horizons • Runs an efficient library service. Co-locates and runs library alongside other services including advice services and a credit union. • As a result, operates at lower cost than comparable services run by the local authority. • Not dependent on volunteers, but encourage volunteering to increase local residents’ skills and employability. • Range of income sources including management fees for running a community resource centre and service delivery contracts for a range of public services including advice services, and the library itself.

35. Support www.mycommunityrights.org Tel. 0845 345 4564

36. Advice and guidance

37. Community Right to ChallengeAngela Harrowingangela.harrowing@communities.gsi.gov.uk0303 444 1349 Any Questions?

38. LUNCH!! Visit the Market Place Stalls

39. The Rise of the Patient Leader David Gilbert Director, InHealth Associates Co-Director, Centre for Patient Leadership July 2012

41. The role of the lay representative(or patient and public advisor) • The ‘outsider-inside’ • - Community link – externally facing, keeping in touch with local communities and bringing in wider perspectives. Opening the door for others. • - Critical friend – internally facing, flying the patient flag , offering strategic advice from a non-institutional perspective. Asking powerful questions.

42. 3. The Effective Patient Representative learning programmes To support people to be more influential via developing: Qualities Skills Behaviours Understanding Wide range of participants in terms of: Background (e.g. client group, community) Experiences of, and attitudes towards, learning Stage on the ‘involvement journey’ (motivations and expectations) Structure 4-5 monthly, five hour, sessions; 14 participants (2 facilitators) Framework for sessions (Skills; Big picture; Action Learning Sets)

43. Why we need Patient Leaders Patients = creative, solution-focused, innovators Self-leadership is seedbed of broader leadership 1000s of patients want to help improve things NHS turns only to clinical & managerial leaders No learning opportunities for Patient Leaders

44. Who are Patient Leaders? System-facing transformers Community-facing enablers

46. Learning and support for Patient Leaders Personalised learning - Focus on learning plan, inquiry proposal, learning objectives and goals aiding learning transfer Inquiry-based learning - Action research methodology, critical reflection learning through work, practice and taking action, problem solving and thinking skills Community of reflective practitioners - Collaboration, face to face & online, Challenge, dialogue with ‘experts’, support, sharing of findings, checking understanding, critical feedback Using and working with the ‘here and now’ - Mindful of making assumptions, habits and making the unconscious explicit and conscious

47. “As a way of approaching challenges, Action Learning is supportive and empowering and with complementary and excellent facilitators, Action Learning helped develop a positive ethos in our group. Action Learning puts you on the spot and makes you think very hard”. (Jenny Crook, Community Representative)

48. Impact and outcomes Impact on self (confidence, well-being) Enhanced dialogue and better relationships More transparent decision-making Improved service responsiveness Enhanced community well-being

49. “I have found the whole programme to be incredibly powerful and useful. My influencing skills have improved enormously and so has my ability to work strategically”. (Fatima, Community Development Officer, Ealing NHS)

50. “The lessons learned through the course are helping me with the challenges of being the sole patient voice on the Clinical Commissioning Group, a position that feels like David v Goliath sometimes”. (Nicola Kingston, Co-Chair, Lambeth LINk)