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Barbary Cook CDHN, Director 14 th May 2009 CDHN Networking Event, NICVA

Review of Public Administration Update May 2009. Barbary Cook CDHN, Director 14 th May 2009 CDHN Networking Event, NICVA. Review of Public Administration Update May 2009. CDHN’s influencing policy role Bringing change at the centre

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Barbary Cook CDHN, Director 14 th May 2009 CDHN Networking Event, NICVA

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  1. Review of Public Administration UpdateMay 2009 Barbary Cook CDHN, Director 14th May 2009 CDHN Networking Event, NICVA

  2. Review of Public Administration Update May2009 • CDHN’s influencing policy role • Bringing change at the centre • We do strategic policy work at regional level to open doorways for members • Supporting members to influence policy • Work closely with people on the ground to have coordinated policy impact • Aim is not to overlap with or impede work of member in local areas - role as facilitator

  3. Review of Public Administration Update May2009 • Testing the system – principles of community development approaches • Goal of the system must be to have users, carers and communities as co-designers, co-planners and co-providers of services • Responsibility for and direction of community development approaches should be mainstreamed throughout the health and social care system and not placed solely within one body/agency • ‘Communities’ should be included along with the language on patients, clients and carers (social model, not just treatment) • Role of C&V sectors is core to system, again must be supported and resourced • Tackling health inequalities is key • Must be strong role for social care • CDHN welcomes the involvement of local government. However, CDHN believes that this should not be a replacement for either the maintenance of lay representatives in commissioning or working in equal partnership with users, carers and communities.

  4. NEW TRUST CONFIGURATION (LCGs and PCC now to follow)

  5. Minister/ Department RQIA Programme and admin Programme and admin Regional Health and Social Care Board Joint Commissioning Plan (regional and local) Public Health agency Commissioners Commissioners Commissioners RBSO LCGs (integrated RHSCB/PHA support) PCC Independent Family Practitioners Services Local Authorities & independent/Private/Voluntary and Community Sectors Trusts Providers Providers Providers Diagram from dual funding model, taken from ‘Working relationship between the Regional Health and Social Care Board (RHSCB) and the Regional Agency for Public Health and Social Well-being (RAPHSW)’ http://www.dhsspsni.gov.uk/mipb-05-09.pdf page 11

  6. Review of Public Administration Update May2009 • CDHN Questions • How will the Public Health Agency influence the policy development in the DHSSPS, the commissioning in the Board & LCGs and the provision by the Trusts, contractors and C&V sectors? • How will commissioning work? I.e. from the Board/LCGs to the Trusts, contractors and C&V sectors. • How will the PCC influence the system? • How centralised or devolved will the whole system really be? • Where will responsibility for community development approaches lie? • How focused will the system be on tackling health inequalities and the wider determinants of health?

  7. Review of Public Administration Update May2009 • Minister • Overall responsibility • Accountable to NI Assembly & Health Committee • Driver of change – strong political drivers appear to include, strong role for local govt reps, public health focus that may be more about health protection than health inequalities (unclear yet), developing a highly centralised system with strong ministerial control • DHSSPS • Smaller, strategic and policy work – operational work out to RHSCB, PHA and RBSO

  8. Review of Public Administration Update May2009 • Health and Social Care Board (RHSCB) • Responsibility for commissioning, resource management and performance management and improvement • Fund directly from DHSSPS and devolved to LCGs when not committed to regional commissioning • But PHA will directly fund initiatives related to core functions of health improvement • '‘A key role of the new RHSCB, working with the RAPHSW (PHA), will be effective engagement with providers, PCC, local government, service users, local communities, other public sector bodies and the voluntary and community sectors.’ (MIPB 05/09, p. 8)

  9. Review of Public Administration Update May2009 • Health and Social Care Board (RHSCB) • Chief Exec, John Compton (as Chief Exec of South Eastern Trust) & Chair, Dr Ian Clements (was on East LCG) • Will there regional commissioning of and commitment to community development approaches? • Non-exec Directors - Mrs Lily Kerr, Trade Union representative member; Mr John Mone, member from a nursing background; and lay members Mr Robert Gilmore, Mr Stephen Leach, Dr Melissa McCullough and Mr Brendan McKeever. • Office in current EHSSB

  10. Review of Public Administration Update May2009 • Local Commissioning Groups (LCGs) • Were 7, now 5 to be co-terminous with Trusts • Posts for new 5 going to be taken from existing ‘HR pool’ • Unclear just how much power they will have relative to Regional Board • Commissioning will…’involve patients/clients/carers and other key stakeholders at local level in planning health and care services to meet current and emerging needs.’ (MIPB 05/09, p. 9)

  11. Review of Public Administration Update March2009 • Membership of LCGs • 4 General Medical Practitioners, • 1 pharmacist, • 1 dentist, • 4 elected local representatives, • 2 social care professionals, • 1 nurse, • 1 public health medicine professional, • 1 Allied Health Professional, and • 2 Health & Social Care related voluntary sector representatives. • No lay reps, as opposed to before • C&V sector rep will be paid 156 a day, but independent contractor will be paid 207 per day plus 277 per day locum allowance • Current draft of The Local Commissioning Groups (Area, Functions and Membership) Regulations (Northern Ireland) 2009 provides that "The persons appointed under paragraph 2(c) must be from voluntary and community organisations with an interest in health and social care within the prescribed LCG area."  • Recruitment in March

  12. Review of Public Administration Update May2009 • Commissioning for post RPA orgs – comprises the following (MIPB 30/09 p. 4): • Assessing the health and social well-being needs of groups, populations and communities of interest; • Prioritising needs within available resources; • Building the capacity of the population to improve their own health and social well-being by partnership working on the determinants of health and social well-being in local areas; • Engaging with patients/clients/carers/families and other key stakeholders at local level in planning health and social care services to meet current and emerging needs; • Securing, through Service and Budget Agreements, the delivery of value for money services that meet standards and service frameworks for safe, effective, quality care; • Safeguarding the vulnerable; • Using investment, performance management and other initiatives to develop and reform services • For more info on co-location etc see this paper at pages 7-11)

  13. Review of Public Administration Update May2009 • Health and Social Care Trusts (provision) • Powerful and have been up and running so many decisions already made, however new commissioners (RHSCB and PHA) have made it clear that all commissioning will flow through them – implications for C&V sector? • Most have revised their health improvement/health promotion/community development mgt structures, but in most places relationships remain • Key question for CDHN – how strong will real commitment to community development be?

  14. Review of Public Administration Update May2009 • Public Health Agency • Was the Regional Agency for Public Health and Social Well-being • ‘will incorporate and build on the work of the HPA but will have much wider responsibility for health protection, health improvement and development to address existing health inequalities and public health issues’ • Reflection of Minister’s commitment to pubic health – but yet to see whether that will emphasise health protection (swine flu) or health inequalities • HPA, IfH, HAZ will ‘go into’ Agency, community development in there too • New Chief Executive, Eddie Rooney & new Chairperson, Mary McMahon

  15. Review of Public Administration Update May2009 • Public Health Agency • Dr Carolyn Harper, Dir Public Health; Mary Hinds, Dir Nursing and Ed McClean, Dir Operations • Tiers 2 being recruited now – key posts that will influence direction – key question – how medical or social will public health be? (Ass Dir posts – PH register) • Non-exec Directors: • Local Government Representative Members Councillor Cathal Mullaghan and Councillor Stephen Nicholl; • Trade Union Representative Member, Mr Thomas Mahaffy; • Lay members, Mrs Julie Erskine, Dr Jeremy Harbison and Ms Miriam Karp and • Member from a social care background, Mr Ronnie Orr. • New pilot health improvement & local government partnerships – pre-empting community planning - Important to find out what’s happening with pilot, who will lead and what formal and informal contacts/structures will there be with C&V sectors

  16. Review of Public Administration Update May2009 • Public Health Agency • Input into commissioning: • Develop and agree joint commissioning plans with RHSCB • Be active and full members of local (LCGs) and regional commissioning teams • Lead on commissioning and service improvement in agreed areas • Monitor impact of commissioning against health and well-being (one of few mentions) • Work with PCC to improve the patient and client experience • Engage in p’ships and community participation working together with providers and other to build capacity • Principle – commissioning should seek to address inequalities ‘The PHA will also create opportunities for the public to be actively engaged in issues which affect and influence their health and well-being...’ (MIPB 05/09, p. 5) Health Improvement paper is strong – MIPB 03/09

  17. Review of Public Administration Update May2009 • GPs independent contractors • Will remain as independent service providers, but also now part of commissioning structures

  18. Review of Public Administration Update May2009 • Patient Client Council • Legislation text has the PCC as representing the ‘voice of the public’ - ‘to provide a strong voice for patients, clients and carers’ • Role of the PCC seems to have been considerably expanded to encompass a strong, and possibly critiquing role in terms of personal and public involvement. • Its goals with regard to holding the other HSC bodies to account with regard to user involvement are focused and the benefits to users could be tangible. CDHN very much welcomes this in terms of the accruing benefits to users. • Our critique of this developing (and growing) role is not that better user involvement is in any way a negative thing, or that the role of the PCC shouldn’t be potent in this regard. Rather, our concern is that the emphasis is squarely on the experience of the user, in terms of treatment and on consultation processes, rather than wider communities in terms of inequalities or the impact of the wider determinants of health or the sharing of decision-making. This paper does not mention health inequalities. (MIPB 53/09

  19. Review of Public Administration Update May2009 • Patient Client Council • New Chief Exec, Maeve Hully (work as patient advocate) & new Chairperson, Mr John Keanie (self-employed, was CExec of Derry City Council) • Non-exec Directors: • Local Government representative members Cllr Elizabeth Adger, Cllr Tim Atwood, Cllr Sean McGuigan, Cllr Marion Smith and Cllr Trevor Wilson; • Trade Union representative member Mrs Janice Smyth; • Voluntary & Community members Mr Brian Compston, Mr Errol Hutchinson, Miss Elaine Kelly, Mrs Rena Shepherd and Ms Koulla Yiasouma; and • Lay members Dr Paul Coulter, Mrs Margaret Harte, Dr Sheila Kelly, Dr May McCann and Prof Hugh McKenna. • 1 regional office in Antrim, 5 local offices, 4 in existing offices of Lurgan, Broughshane, Belfast and Omagh and new one in Newtownards

  20. Review of Public Administration Update May2009 • C&V Sectors • Lay reps as Non-Exec Directors on Boards but none on LCGs, now it’s C&V sector reps • Responsibility for relationships with C&V sectors appears under Director responsibility in Public Health Agency • Need to embed relationships/work with commissioners • New paper on stakeholder engagement in commissioning is strong and refers to CDHN Toolkit on Engagement • Trust work seems to be ongoing – though with some places maintaining strong emphasis on community development, others less so – is PPI same as community development?

  21. Review of Public Administration Update May2009 • Stakeholder Engagement • DHSSPS previously led work on Regional Stakeholder Engagement – will move to PHA – Dir. of Nursing’s responsibility for patient and public involvement • Stakeholder engagement in commissioning (MIPB 158/08) – very strong, if this is the guiding document then we would be fairly relaxed – will it be taken up by all orgs? (has explicit mention of health inequalities)

  22. Review of Public Administration Update May2009 • Local government in HSC • CDHN supports local government involvement • Several issues: • Lack of capacity for CD/HI work? • Merit principle and selection? • Potential conflict of councillors holding more than one post within the HSC system? • Will Councillor be a corporate member or represent the political party? • NILGA gave evidence to Cttee on Bill and said it welcomed the proposals for a stronger and closer role for local government and said that it would mean that ‘the local community will have ownership of the services, feel more involved, have better feedback, and enjoy and improved sense of well-being’.

  23. Review of Public Administration Update May2009 • Thanks! • Any questions? • CDHN • www.cdhn.org • 028 30264606

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