Commissioning for health and wellbeing: opportunities, implications and risks Colin Cox Assistant Director Manchester Joint Health Unit

Key features of framework  Commissioning at a lower level (practice, individual) - flexibility  Focus on promoting health, wellbeing and independence  Payment linked to outcome  Wider community engagement  Greater joint commissioning  Focus on equity  Joint strategic needs assessment

Opportunities  Clear support for diverse third sector and social enterprise  Range of services extended –health improvement –low level support –whatever service users want  Flexible use of NHS resources  Providing a voice

Focus on health and wellbeing  Improving underlying conditions – poverty, work, housing, transport, education  Improving lifestyles – obesity, tobacco, alcohol, physical activity  Tackling health inequality – working with highest risk groups  Wellbeing, not just health – low level support

Barriers  Outcome focus  Plurality and capacity of commissioners  Capacity in VCS  Grants vs. contracts – procurement rules

Improving outcomes Improved health and emotional well being Improved QoL Making a positive contribution Increased choice and control Freedom from discrimination Economic well being Maintaining dignity and respect Be Healthy Stay Safe Enjoy and Achieve Make a positive contribution Achieve economic well being Improving Outcomes Children Adults

Multiple commissioners  PCT, Council, practices, individuals…  Move away from larger contracts  Less predictability of service demand  Need for flexibility and responsiveness  Selling services to individuals not just organisations  Difficult to enter the market

Market capacity  Assumptions made about capacity of third sector –amount of service provision possible –organisational models –skills

“It is too easy to see the voluntary sector as simply a delivery arm, willing to provide public services if the contractual arrangements are right. The reality is rather different. Most voluntary organisations have an interest in public service reform … they will have a role in amplifying the voice of the service user and … will also know that service delivery alone is not enough. Without the development of strong, resilient and empowered communities, the intention of delivering better services will always be frustrated.” Julia Unwin & Peter Molyneux