Voluntary Sector Health Forum 5 August 2014

1. Health and Wellbeing Boards Voluntary Sector Health Forum 5 August 2014

2. What are Health and Wellbeing Boards? • Designed to bring together people and partners required to modernise health and social care by: • Ensuring stronger democratic legitimacy and involvement and accountability to the local community • Strengthening the working relationship between health and social care • Encouraging the development of more integrated commissioning of services • Vehicle for addressing health inequalities

3. What specifically are they meant to do? • Have strategic influence over commissioning decisions across health, public health and social care and support integrated solutions • Have a shared understanding of the health and wellbeing needs of their communities and develop a strategy to best meet these needs • Engage the public and interested communities in decisions about the commissioning and provision of services

4. Operating principles • Provide systemic leadership to improve health and wellbeing outcomes • Be inclusive through membership and links to relevant county and local networks • Be accessible and accountable for shared decisions • Address inequalities through quality integrated services • Identify key priorities across all partners to make the best use of available resources

5. H&WB Strategy (Hampshire) • Starting well – with a focus on transition • Living well • Ageing well • Healthier communities

6. Agreed Priorities for Action Commissioning Services and Support for people with : • long term care and support needs • learning disabilities • mental health needs • complex physical disabilities • NHS continuing care

7. Key Issues • Aligning commissioning processes across partner organisations • Agreeing and signing off joint commissioning intentions • Communicating systemically within localities and across the County • Tapping into existing networks and work streams so as to not duplicate

8. Things we are grappling with • Finance and the lack of it • Communicating with the public and the key messages – • Use A&E sparingly • Fragmented commissioning • Priorities within the transformation process – what is going to have the most impact • How to manage and deploy the Better Care Fund • Knowing what success will look like and agreeing a joint strategy

9. What could be better • Voluntary Sector considered to be a body to be consulted with rather than as partners • Connectedness with sub-groups – sometimes feels like your commenting rather than co-creating • Balancing the rhetoric of integrated commissioning with the reality of individual sovereignty

10. Well Being Strategy identifies four key objectives: • Starting Well: so every child can achieve its potential and will thrive through transition to adulthood • Living Well: empowering people to fall ages to live healthier lives • Ageing Well: supporting people to remain independent, in control with timely access to high quality services • Healthier Communities: helping communities to be resilient, strong and support those who may need extra help

11. Our Vision • Avoiding unnecessary cost in the system, moving to lower cost solutions • Preventing dependency and demand for longer term publically funded services • Delaying people’s dependency on long term health and social care interventions

12. Our Vision We have adopted the National Voices definition of integrated care as meaning person-centred, co-ordinated care reflected in the statement: “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” We are working together to ensure the services that we commission meet our strategic aims and programme objectives.

13. Our Strategic Framework

14. Our Plan

15. Re-shaping and Developing the Healthand Social Care Market • Independence is the expectation with support at home in the community empowering people to manage their own health and well being • Care is co-ordinated around individuals and targeted to their specific needs and they will know about and be able to access information, care and support in their local community to keep them at home • Proactive and “joined-up” case management reduces the likelihood that people will have to rely on more specialist services and rapidly regain their independence when they do • Experience of care is positive with the appropriate services available where and when they are needed • Outcomes improve reducing premature mortality and reducing morbidity

16. Re-shaping and Developing the Healthand Social Care Market In Phase 1 we will ensure we address the three key challenges: • Avoiding unnecessary cost in the system, moving to lower cost solutions • Preventing dependency and demand for longer term publically funded services • Delaying people’s dependency on long term health and social care interventions.

17. The Plans will deliver the followingchanges • Our CCG and Social Care Commissioners will commission and procure jointly • Investment and procurement will support integrated care delivery • Our Community Providers will implement new models of service delivery that they have co-produced, drawing on assistive technologies where this is appropriate to do so • Our General Practitioners will be collaborating in wider networks focused on populations of 20 – 50,000 within agreed geographical areas to deliver primary care at scale • Investment in Integrated Care Teams will deliver 7 day working with care co-ordinated around individuals • Access to high quality emergency care with services delivered locally where possible, central where necessary will be sustained • The volume of emergency and planned care activity in hospitals, nursing and residential care homes will be reduced

18. Summary • Keep people well, supported by effective care co-ordination • Implement a sustainable model of primary care and integrated care teams embedding key characteristics of risk stratification and proactive case management; shared decision making; lead professional; standard operating procedures; strong partnerships at a local community level; strong clinical leadership • Moving to 7 day services operating a round the clock “pull model” where the community resources take the lead in helping people navigate the system • Individuals will be supported to participate in their care including using personal health budgets • Care pathways e.g. dementia, wound care, falls will be reviewed • Commissioning a robust approach within teams to ensure programmed review and right-sizing care and support packages is routine • Enhanced psychological support will be available for people with long term conditions

19. Summary • Manage proactive intervention • Through primary care based urgent care access; Rapid Advice and Assessment Units; Integrated Geriatrician; Targeted therapies and End of Life Care • Developing approaches to share data in real time so that people can make the best choices • Support recovery • Redesigning the intermediate care model including reablement and personal care • Developing and supporting the care market so that skilled carers work in synergy with clinical teams and enable people to retain their independence

20. Summary • Respond to the Care Bill - early joint priorities to meet the Care Bill’s ambitions for integration will include: • Developing a joint strategy to meeting the needs of carers who will gain new rights to receive a service under the Care Bill • Ensuring that early intervention and prevention services operate effectively to reduce or delay the demand for more expensive social care • Developing an effective knowledge base and more accessible information/advice resources to support individuals to navigate through the social care and health system in a more seamless way

21. Conclusion • Clear strategy – need to work through and agree the how • We will need to be bold to grasp the broader transformation agenda and address reducing spend in acute care • Working with the public to engage them better • Potential to make a real difference – offer solutions