Local leadership of health reform Alyson Morley Senior Adviser LGA 21 November

Presentation outline Overall context for local government Key elements of the reform agenda Preparing for transition - support offer to HWBs and new partners Critical success factors

What’s the overall context for local government? Overall financial context for local government – 28% reduction Localism Place-based budgets – joining up the public sector to get better services, better outcomes and to do more for less Public health architecture – still awaiting operating framework for PHE, public health outcomes framework, indicative allocations of public health grant Promoting choice, diversity and personalisation

Progress of health reform Bigger than the Bill to create the NHS A bumpy journey through the political process LGA has focused on 4 areas affecting local government 1.Health and Wellbeing Boards 2.Commissioning and provision of NHS services 3.Proposals for public health 4.Patient and public involvement 5.Transitional arrangements

Key elements of the reform 1. Health and Wellbeing Boards (HWBs) HWBs will be the drivers of system reform Minimum membership specified but most areas will go further Main responsibilities –To promote coordination and integration of services –To develop the joint strategic needs assessment –To agree the joint health and wellbeing strategy Duty of cooperation between HWBs, CCGs and NHS Commissioning Board Provide democratic accountability for health and wellbeing commissioning Vital role for districts, town, parish councils and neighbourhood assemblies to direction and delivery

HWBs – developing relationships

Key elements of the reform agenda 2. Commissioning and provision of services More integration of health and social care 80% of NHS spend through clinical commissioning groups Promotion of diversity through ‘any qualified provider’ Leading role for local authorities in setting priorities for commissioning

Key elements of the reform agenda 3. Public health Creation of Public Health England (PHE) – mainly responsible for health protection Public health responsibilities transferred to local government – including employment of Directors of Public health Ring fenced public health budget to LAs from 2013 Focus on outcomes – improved health and reduce health inequalities – not processes or outputs Vital role of districts in delivery of public health

LA Public health responsibilities – 2013 Weighing and measuring children Dental public health Fluoridation Medical inspection of school children Sexual health Seasonal mortality Accidental injury Physical activity Drug, alcohol and tobacco misuse Obesity NHS health check programme Health at work Reducing and preventing health defects Prevention and early intervention Children’s public health (5 – 19) Social exclusion

PHE/NHS CB responsibilities Public Health England Infectious diseases Immunisation Standardisation and bio medicines Environmental hazards Emergency preparedness Health intelligence Nutrition NHS Commissioning Board Screening Children’s public health (0 – 5) Public health of prisoners

Key elements of the reform agenda 4. Patient and public engagement “Nothing about me without me” –Personalisation –Choice –Engagement in needs assessment –Engagement in commissioning Health Watch – the new ‘consumer champion’ for health and care services

Support offer for Health and Wellbeing Boards HWB early adopters – 93% of LAs have signed up National Learning Sets launched on 15 November Community of Practice up and running Support to system leaders Early lessons already being disseminated

Conclusions and critical success factors Relationships not structures Shared culture not silos Outcomes not processes Cascaded leadership and ownership of health Early and ongoing engagement with all stakeholders Quick wins balanced by long-term objectives

Further information For information on LGA policy on health reform:

Questions for small group discussions 1.Do the LGA key messages reflect your concerns? 2.What is your local experience of the health reforms? 3.What is your view of the LGA programme to develop collaborative leadership? 4.Are there any other issues, concerns and questions that you want to address?