Commissioning for Culture, Health and Wellbeing

Ian TearleHead of Health Policy

Directorate of Public Health, NHS DevonWednesday 7th March 2012

Context

Health Map

NHS Reform Timescales

• April 2012 - Health and Social Care Bill due to receive Royal Assent. Health and Wellbeing Boards established to operate in “shadow” form.

• July 2012 - Clinical Commissioning Groups preparing for authorisation – emerging JSNA and joint health and wellbeing strategies to underpin 2012/13 commissioning plans.

• October 2012 - Clinical Commissioning Groups prepare commissioning plans for the first year of authorisation.

• April 2013 - Health and Wellbeing Boards in statutory form. Public Health England established and public health responsibilities transferred to local government.

Public Health Changes

• Local Authority – health improvement function

• Public Health England – health protection and screening

• National Commissioning Board – safeguarding, offender and police health, resilience and emergency planning

• Commissioning Support Organisation – clinical effectiveness

Health and Wellbeing Boards

Aims• to ensure the delivery of improved health and

wellbeing outcomes for the population of Devon, with a specific focus on reducing inequalities

• to promote integration and partnership working between the NHS, social care, public health and other local services and

• to improve local democratic accountability.

Locally Relevant , Needs and Evidence-Based Commissioning

HEALTH & WELLBEING BOARD

What does our population & place look like? – evidence and collective insights

How can we ensure our priorities are translated into locally relevant actions?

Local Action PlansLocal Action Plans

So what are our priorities for collective action, and how will we achieve them together?

Joint Health and Wellbeing StrategyJoint Health and Wellbeing Strategy

So what does that mean they need, now and in the future and what assets do we have?

Joint Strategic Needs AssessmentJoint Strategic Needs Assessment

Commissioning – the focus on outcomes

Supporting Better Outcomes

Public Health Outcomes Framework

• Sets the scope of public health

• Focuses on outcomes not targets

• Alignment & integration across public health, the NHS and social care

• Takes a life-course approach

• Designed to also address the causes of the causes of ill health

Public Health Outcomes

Vision: To improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest

Outcome 1: Increased healthy life expectancy Taking account of the health quality as well as the length of life Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities Through greater improvements in more disadvantaged communities

Public Health Outcome DomainsDOMAIN 1: Improving the wider determinants of health• Objective: Improvements against wider factors that affect

health and wellbeing, and health inequalities

DOMAIN 2: Health improvement• Objective: People are helped to live healthy lifestyles, make

healthy choices and reduce health inequalities

DOMAIN 4: Healthcare public health and preventing premature mortality

• Objective: Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Social Capital

Social capital is the glue that holds communities together and is a combination of:

• civic engagement• neighbourliness (reciprocity and trust in

neighbours)• social networks (friends and relatives)• social support• perceptions of local area

(Office for National Statistics 2008)

Benefits of Social Capital

“….. higher levels of social capital are associated with better health, higher educational achievement, better employment outcomes, and lower crime rates. In other words, those with extensive networks are more likely to be ‘housed, healthy, hired and happy’.“(Cabinet Office 2010)

Wellbeing‘A positive physical, social and mental state; it is not just the absence of pain, discomfort and incapacity. It requires that basic needs are met, that individuals have a sense of purpose, that they feel able to achieve important personal goals and participate in society.

It is enhanced by conditions that include supportive personal relationships, strong and inclusive communities, good health, financial and personal security, rewarding employment, and a healthy and attractive environment.’(Defra 2007)

Social Value

The Demos study offers a help definition for ‘social value’ proposing that it ‘refers to wider non-financial impacts of programmes, organisations and interventions, including the wellbeing of individuals and communities, social capital and the environment’.(Wood and Leighton 2010)

Social Return on Investment

For commissioners, social capital building often links into building social value measurements into procurement processes. There are several different methods for calculating social value, including the Social Return on Investment (SROI) model, which seeks to quantify social benefits achieved against the cost of the investment.

Engaging into the commissioning process

Commissioning themes

• Quality, Innovation, Productivity and Prevention – investing to save

• Reducing vulnerability and dependency

• Avoiding hospital admissions and re-admissions

• Promoting self – care

Commissioning: Prevention Strategy

Devon Prevention Strategy: ‘Promoting Independence and Wellbeing for Adults’ 2011 – 2013 recommendations:

• promoting volunteering and community empowerment• reducing falls and preventing fractures• promoting assistive technologies • developing reablement services and enabling approaches• implementing self care• delivering intermediate care• investing in extra-care housing and community housing

options

Commissioning Challenges

• Identifying priorities• Universal or targeted• Outputs or outcomes• Impact measures: quantative or qualitative• Performance monitoring and reporting• Evaluation