RPA Changes – implications for community development and health

1. RPA Changes – implications for community development and health • The new RPA & health structures. • Discuss the implications for community development and health work. • Recommend work for CDHN to help prepare members for the changes. • Barbary Cook, Director, 2nd March 2007

2. RPA Changes – implications for community development and health • CDHN’s influencing policy role • Bringing change at the centre • We do theoretical and 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. RPA Changes – implications for community development and health • Community Development and Health context into which the RPA emerges: • Review of Mainstreaming Community Development: DHSSPS commissioned CDHN to review progress on mainstreaming CD in HPSS: made recommendations on need for strategic leadership at senior level, training, community development strategies, partnership with C&V sector etc. • Rapid and extensive development of community development and health work on the ground (community groups, healthy living centres, BCPP etc). • Shift in UK and NI policy to tackling health inequalities, Investing for Health, Regional Strategy etc., with community development as recognised tool. • RPA changes about public administration changes rather than policy content drivers i.e. saving money and over-management in public sector – not ‘this might be the best way to tackle health inequalities’

4. RPA Changes – implications for community development and health • Overall picture of the changes • DHSSPS – strategic direction, policy, smaller • 5 Trusts – amalgamation of current 19 Trusts (provider) • 1 Health and Social Services Authority – operational responsibility (commissioner) • 7 Local Commissioning Groups (commissioner) • ? Community Commissioning Associations (commissioner) • 1 Patient Client Council

5. Patients & Clients Agencies Blood Transfusion Agency, Guardian Ad Litem, Social Care Council Primary Care/GPs/other Independent Primary Care Providers 5 Health and Social Services Trusts plus the Ambulance Service 1 Patient & Client Council 7 Local Commissioning Groups 1 Health and Social Services Authority RQIA Minister DHSSPS The New Structures

6. New RPA & Health Structures What the DHSSPS says about the new structures: New Systems: • Devolved commissioning – community focus • Performance management • Finance • Public and social health development • Workforce and staff development Enablers: • Service frameworks • Strong information system • Effective professional engagement and leadership • New organisational arrangements • Enhanced public, user and staff engagement • Effective planning processes

7. RPA Changes – implications for community development and health • CDHN’s initial response to RPA changes – four principles: • It is crucial that successful work carried out by members of the HSS on mainstreaming community development approaches not be lost under the RPA changes. • Community development approaches to tackling health inequalities both within Investing for Health and throughout the HSS family must be confirmed and protected. • A community-based user voice must be integrated into the planning and delivery of services via the local commissioning groups. • Partnerships between the HSS family and the community and voluntary sector must be maintained and strengthened to ensure the effectiveness of community development approaches to tackling health inequalities.

8. NEW TRUST CONFIGURATION

9. RPA Changes – implications for community development and health • Questions about the Trusts: • What will happen to the Community Development Units? • Where will responsibility for community development lie in the Senior Management Team? • CDHN has lobbied 4 out of the 5 Chief Execs to say it should be with planning and performance management i.e. high up and that each member of the SMT should be obliged to report on how their department adopts CD approaches. • Community Development Performance Management Framework, produced by Regional CD Managers Group & CDHN. • What are the implications for users, carers and communities of larger Trusts? • How will the Trust continue existing relationships with C&V sector and develop new ones?

10. RPA Changes – implications for community development and health • Agencies • CSA - Functions transferring to new health and social services organisations • NIPEC & MDTA - Functions combined and transfer to new Health and Social Services Authority • MHC - Functions transferring to new Regulation and Quality Improvement Authority • Fire & Rescue Service - Transfer to local government as a regional service • Health Estates Agency - Functions transferring into the new HPSS organisations • RQIA - Remaining • Social Care Council – Remaining • Guardian Ad Litem Agency - Remaining

11. Belfast Inner East North West East West North East South Commissioning • Map of Commissioning boundaries – co-terminous with District Councils • Community Commissioning Associations – presumably co-terminous with LCGs – expected population size 50,000- 70,000

12. What the DHSSPS says about the new structures: • A Local Commissioning Group is: • Committee of the Health and Social Services Authority (HSSA) with delegated power to commission services – accountable to HSSA Board • Primary care led with 15 members, two of which are lay people from the local community • Leader and decision maker for commissioning health and social care services • Functions • Engage and involve local people in the promotion and planning of services • Redesign and improve services • Secure safe and responsive services • Commission public health programmes with partners to reduce health inequalities • Deliver local, national and Ministerial health and social care targets

13. RPA Changes – implications for community development and health What the DHSSPS says about the new structures: • Community Commissioning Associations • Locality based commissioning • Alliance of GPs, other FPS, health and social care practitioners, community and voluntary sector • Commissioners for a distinct population within a LCG area • Sub-committee of an LCG with delegated powers and devolved budgets • Supported to deliver real change • Implementation guidance being developed for April 2007 • Universal coverage

14. RPA Changes – implications for community development and health • CDHN welcomes the following elements in the commissioning proposals: • emphasis throughout the document on public engagement; • strong emphasis on public health and well-being improvement; • the point that partnerships with community and voluntary sector will be an important part of commissioning arrangements; • the intended outcome of enhanced user experience; • the understanding of people’s entitlement as citizens; • the professional leadership programme as envisaged; and • the emphasis on performance management and notes that CDHN and Community Development Managers in Boards and Trusts have developed a community development performance management framework.

15. RPA Changes – implications for community development and health • Areas for improvement/strengthening in the proposals on commissioning: • define the ‘public’ in terms of community engagement and community development; • support the Wanless, ‘fully engaged’ scenario as the goal of engagement • move beyond simple user panels to a range of engagement methods including but not limited to - focus groups, public meetings in community venues, open forums between SMTs and community/ voluntary sector etc. • Community Commissioning Associations • engagement with the community and voluntary sector must be part of CCAs. • community and voluntary sector should play a formal role in CCCAs • CCAs should reflect geographical communities rather than being based on GP practices; • capacity building for C&V included in the professional leadership programme – potential power imbalance. • must ensure coherence between community planning in local government, planning of education services and HSSA commissioning.

16. RPA Changes – implications for community development and health • Timetable • LCG recruitment and selection of independent contractors and lay members – January and February 2007 • Appointments made March 2007 • LCGs in place March - April 2007 • Commissioner Development programme begins April 2007 • An HSSA by April 2008 • Joint Committee by January 2007

17. RPA Changes – implications for community development and health • Discuss the implications for community development and health work. • How will your work be affected by RPA & health changes? • What are the opportunities in the new structures? • What are the threats? • How ill you engage with the new organisations?

18. RPA Changes – implications for community development and health • Recommend work for CDHN to help prepare members for the changes. • For example, seminar on how tog et your services commissioned? • Visit our RPA page on our website • www.cdhn.org/rpa