Health and care structures in London: Where and how can the VCS engage? David Buck Senior fellow in public health and health inequalities, the King’s Fund Health inequalities in London: Developing joint solutions to achieve better health outcomes for all 29 th October 2014

Inequalities in London… and being heard In 2012, presented to the GLA on thoughts on London’s health inequalities, and what needed to change. London has lots of challenges – and opportunities – because of its diversity Its complex health and care structures are challenging for the NHS and its statutory partners, let alone anyone else. But so is the diversity of the VCS for the statutory sector. We ended up asking, “is there a coherent voice for inequalities for London?” This returns to that question, the places to be heard for the VCS, their contexts and the consequences…

Our overall view for London on inequalities The NHS –Systematic, scaled up primary care reaching all –A huge employer making use of immense economic power, commissioning for social value Local authorities –Broad brush behaviour change not enough –Health in all policies –Taking the lead on community asset building Strategic direction? –Taking convergence seriously –Learning from elsewhere, and from London –The right allocations within between

A remarkably complex system… Source:

..and more fragmented funding streams Source:

The main players, and their contexts

NHS England in London Source:

CCGs in London

CCGs, many under lots of funding pressure

…and management cost caps

Health and Wellbeing Boards, our directory Source:

The LGA’s HWB Board priorities summary tool Source:

Public Health England

..and the PHOF Source:

..and other tools Source: and

Reaching the main players…

Diversity, a core VCS strength and weakness Source:

Demonstrating and communicating value Source: their-value/ article?blocktitle=Latest-Resources&contentID=6315#.VE9-NxajcXR

Overcoming the rules of the game Source:

A more diverse, less rigid future for the NHS and health sector?

The Five Year Forward View… Source:

..and new service models, with VCS “fit”?

The London Health Commission 60+ recommendations Some of relevance to the VCS, but not a core focus per se Focus on public health (lifestyles) and innovation in healthcare Urges all to work together and for the Major to appoint a Health Commissioner for London, and to bring CCGs and LAs together into Strategic Planning Groups. Source:

The Social Value Act Blackburn with Darwen has been doing three things to generate social value from its local spend: Developing its own local Social Value Assessment Tool and piloting it within NHS contracts Analysing and maximising local public sector spend with local businesses. Investing in local social enterprises as part of its public services reform. Social Value Assessment Tool: In 2012 Blackburn with Darwen Care Trust Plus (PCT) working with NHS commissioners, the Local Authority and the community and voluntary sector established a group to develop and test a ‘Social Value Self Assessment Tool’. This was designed to enable providers to demonstrate the added social value they were creating. The NHS commissioning team agreed to take the responses to their Social Value Self -Assessment into account when awarding contracts. The Social Value Self-Assessment Tool asks a series of questions over ten domains: 1.Investing in the workplace through access to high quality occupational health 2.Increasing employability and providing high quality employment opportunities for local people 3.Reducing congestion and promoting sustainable travel 4.Increasing prosperity and opportunity in the borough (support for businesses in BwD) 5.Promoting community cohesion and diversity and equality 6.Increasing educational attainment especially in English and Maths 7.Increasing social capital through developing opportunities for volunteering 8.Increasing opportunities to aid people with learning disabilities into employment 9.Carbon Reduction 10.Rehabilitation of offenders/alcohol and substance misuse The tool has been tested with the two of the largest local NHS Trust service provider contracts for public health this year – next year they will be asked to develop an action plan to address any unutilised opportunities for local social value development identified in the assessment. In addition, the prospect of universalising of the tools use across all major local public sector contracts will be explored, along with its use in the PQQ process and to asses competitive tenders. Box 3: Blackburn with Darwen’s approach to social value

The Social Value Act Source:

In conclusion… The health and care system is under funding pressure and more fragmented, in London as elsewhere The upside of this is that there are actually more entry points than before, but that makes it hard to choose which door Understanding commissioner and planners contexts and priorities and using their language ever more important There is some light on the horizon, NHS England Forward View, London Health Commission and supporting mechanisms such as the Social Value Act can be increasingly aligned with the VCS But predicting the future is becoming more difficult, and the VCS will need to be even more resilient and adaptive.