Commissioning for Wellbeing Time banking and other initiatives in Plymouth Rachel Silcock

Commissioning Strategies Commissioning is defined as: “the full set of activities that local authorities and Clinical Commissioning Groups undertake to make sure that services meet the health and social care needs of individuals and communities” Whole systems/Place based commissioning :  Integrated commissioning, working strategically with providers  The various elements of support and services are part of one whole ‘system’  Create partnerships and share outcomes across the system  Includes the assets and resources of individuals and communities 4 integrated health and social care strategies, – Wellbeing – Children and Young People – Community – Enhanced and Specialised

Pressures on the system The health of people in Plymouth is generally worse than the England average; Higher than average levels of deprivation Inequality in health, driven by social inequalities - between the least and most deprived groups, there is a 7.9 year gap in life expectancy in men and a 5.8 year gap in women. Poor health behaviours cluster in the more deprived socio-economic groups and this also drives health inequalities. There are higher than average numbers of people who smoke and, hence, a higher proportion of smoking-related deaths. There are higher levels of alcohol-related ill health and of drug misuse. High emergency admissions to hospital, especially in winter Mental Health needs higher than in comparator areas Ageing population and an increase in isolation and loneliness

National Policy drivers The Marmot Review (2010) proposed that to improve health for all of us and to reduce unfair and unjust inequalities in health, action is needed across the population A framework for action under two policy goals: to create an enabling society that maximises individual and community potential; and to ensure social justice, health and sustainability are at the heart of all policies. Five Year Forward View for the NHS (2014) – promotes a locally based range of approaches to promoting self-help, community networks, building community capacity

Policy Context continued Adult Social Care Transformation – Putting People First (2007), taking an asset based approach to achieving outcomes Care Act (2014) – Wellbeing Principle, Local Authorities required to prevent, reduce and delay needs, applies to all adults including carers Success Regime and Place Based Care, proposal for Health and Wellbeing Hubs

Plymouth Wellbeing Strategy Wellbeing is the holistic consideration of a person’s life experiences and includes physical and mental health, purpose and meaning, life satisfaction and positive emotions, and relationships In Michael Marmot’s landmark report ‘Fair Society Healthy Lives’ he states: “The extent of people’s participation in their communities, and the added control over their lives that this brings, has the potential to contribute to their psychosocial well-being and, as a result, to other health outcomes”. Plymouth Wellbeing Strategy will seek to create an environment that builds social capital and shift resources towards preventio n

Wellbeing Strategy Two elements of the Wellbeing commissioning framework that fit with time banking: Empowered Communities Strong, safe communities and social capital (community networks and resources)  There will be increased demand and complexity for wellbeing, health and social care services, particularly around the older population, carers, people with dementia and long-term conditions. Supporting our communities to respond to this will be critical to the future wellbeing system. Mental, emotional and social wellbeing  Plymouth has higher levels of common mental health issues than comparator areas. Demographic and population changes may increase loneliness and social isolation, thus impacting on emotional wellbeing, and helping people build resilience to challenges they face is critical.

Timebanking How can it contribute to a reduction in health inequality How can it demonstrate that it can reduce the need for care and support How can it contribute towards reducing loneliness and isolation Can it support recovery from mental ill-health Increasingly seen nationally as a key way to connect people with their community People feeling valued and contributing to their community Enables us to map social capital and assets – individuals and communities

Other initiatives – Health and Wellbeing ‘Hubs’ SPECIALIST Full Range of health, social care and wellbeing services Offer - Minor operations, Primary Care, Advice Information, Access to Services TARGETTED Places where people and services already naturally congregate Offer - Information and Advice, Signposting, Peer Support, Group work, Co-located services, Employment) UNIVERSAL Places where people go for other services Libraries, Pharmacies, One Stop Shop, GP surgeries, Children Centres, Job Centre Offer - Information and advice and signposting A HUB Is not a set building but a network of different resources and services that have a part to play in improving health and wellbeing. They will communicate and work together to provide joined up, quality, consistent information and support Hub services are provided by community members, volunteers, paid staff across public, private, and community / voluntary sectors NO one size fits all – each neighbourhood will have a different network that works and makes sense locally Vision : A collaborative community of different resources working together to deliver an integrated service offer that plays an integral part in improving health and wellbeing, where people and communities are supported in making healthy life choices PRINCIPLES Cooperative Commissioning Framework Community Engagement Framework Success Regime – responds to local need, best use of estates, community involvement Dementia Friendly Promote self management and Self help Utilise new technology Problem solving

Other initiatives – advice and information system redesign, linked to hubs