Supporting Influence Resources & tools 19 th March 2014 Arlington Centre, NW1

About Regional Voices

Briefings Background- about JSNA+health and wellbeing boards: Influencing Local Commissioning for Health and Care - Guidance for the VCSInfluencing Local Commissioning for Health and Care - Guidance for the VCS And for boards about the VCS s

Supporting influence on HWBs Regional networks Bulletins Share practice Resources –Voting rights –Conflict of interest –Influencing politicians –Influencing the agenda

Manchester Cheshire East Plymouth West Sussex Voting The last resort! Hard to change HWBs can give all members the vote (regulation 6 modifies Local Government and Housing Act 1989 (section 13(1)) LGA recommend it for “parity of esteem” But there is a lot of variation – and it doesn’t just affect the voluntary sector

Evidence Evidence out there the VCS can use /evidence Cabinet Office- unit costs dge_box/toolkit

Approaches Different ways VCS can influence JSNA NA-more-resources

Theme Number of reps Generic51 Older people10 Mental health5 BME4 Disability4 CAB3 Carers3 Volunteers3 Advocacy2 Health2 Hospice2 Young people2 Befriending1 Community rep1 Housing1 Neuro1 Providers1 Self help1 102 reps across the country on 77 health and wellbeing boards, coming from many backgrounds: Developing an online forum to link reps with different issues- as Cornwall and Co Durham may share more than Enfield and Kensington London stats… 28% of VCS reps on HWBs are in London- higher concentration= 29 reps 61% of HWBs in London have reps (higher than average)

developments Follow us on

LGA Self-assessment development tool This tool aims to help boards assess their performance and develop plans to transform public health services and outcomes for local people. Allows boards to evaluate their position using a ‘maturity model', describing what is expected of a ‘young HWB', an ‘established HWB', a ‘mature HWB' and an ‘exemplar HWB'. Boards can use the tool to explore their strengths and opportunities to improve, and inspire their ambition to develop a clear sense of purpose and approach. Why useful for VCS and Healthwatch?

LGA Self-assessment development tool The tool explores promoting partnerships, shared decision making, engaging stakeholders (including transparency and mechanisms that allow stakeholders to contribute), etc Also assurance, learning and self development (e.g. continual reflection); sharing innovation and good practice (e.g. addressing barriers to progress) This tool developed mainly for LA reps but VCS and Healthwatch could use this tool to gauge how well their Boards are doing and where there may be room for improvement. Could liaise with LA reps?

LGA Health and wellbeing boards: a practical guide to governance and constitutional issues Also designed for council members but tells you both about legislation as well as options the boards have re governance and constitutional issues. What might be useful for the VCS and Healthwatch- For example: Ways of working: certain agenda items may lend themselves to participatory style - could include members of the public different board members to present and lead discussion of an issue. Options for the Board that could be explored – e.g. re developing their JSNAs and JHWSs. Example 1): holding informal seminars or public engagement conferences to involve a wide range of participants in initial brainstorming about priorities

LGA Health and wellbeing boards: a practical guide to governance and constitutional issues Case study: Bristol shadow Health and Wellbeing Board hosted a stakeholder conference with board members and other stakeholders including universities and VCS who are not members of the board, to discuss priorities for the board’s first JHWS. VCS organisations in Bristol also organised an event to feed into the development of the strategy. The priorities identified are now being developed by a small strategy group chaired by a GP member of the Health and Wellbeing Board, supported by officers and reporting regularly to the board.

LGA Health and wellbeing boards: a practical guide to governance and constitutional issues In Islington, the HWB has not VCS reps but long term relationship with the VCS – The boards priorities are based on evidence within the Islington JSNA that have been informed by the work with the VCS through targeted focus groups/calls for evidence and residential questionnaires. Accountability and relationships between health and wellbeing boards, other council structures and partnerships: Options: HWBs need to be accountable to the communities they serve. Accountability to patients and the public e.g. through an ongoing engagement strategy, informing the way in which the board works, etc

LGA new Integrated Care Value Case Toolkit This toolkit may be of use when HWBs are looking at better coordination of care. There are several tools that may be of interest to VCS and Healthwatch reps on HWBs. Case studies include NWL and Greenwich: Integrated Care in North West London – claims to have a track record as early leaders of integrated caretaking forward ambitions and innovative integration programmes and two integrated care pilots manage the care of highest risk, most vulnerable patients. Greenwich – Integrated Care value case – One claimed outcome: 64% of people entering the new pathway requiring no further services after completion of the pathway and “there are good opportunities for people to regain their independence and become self caring”

LGA new Integrated Care Value Case Toolkit The LGA Integrated Care Value Toolkit includes a bank of evidence for integrated care, if you want to look something up around integration, chances are there will be something in here for you A report from NESTA Networks that Work: partnerships for integrated care and services shares integration experiences from Earl's Court (Turning Point involved in a one-stop-shop and Lambeth (the Living Well Collaborative that aims to build on provider and service user intelligence in the commissioning of mental health services)

LGA Knowledge hub Knowledge Hub is the public sector's professional social network which local government connect and share online. Knowledge Hub helps LAs find, share and discuss information that's relevant to them and their work. They can join groups to take part in discussion, download documents and work with others using tools such as forums and wikis Connect with other users and keep up to date with what others are up to in LA areas of interest Use the search facility to look through everything on Knowledge Hub to find the information needed

King’s Fund – Health & Wellbeing Boards – One Year On This report examines how the boards have used their shadow year, what they have achieved, and whether they are providing effective leadership across local systems of care. Survey sent to 152 LAs – 70 responses. Of those approx 50% have VCS reps on their boards Some concerns about the leadership role of HWBs. Reports equips the VCS and Healthwatch with knowledge and evidence to hold the boards to account especially with regards to health inequalities Great emphasis placed on health inequalities. Mental health cited as important but out of hours care, carers, quality of services and reconfiguration barely registered as priorities

King’s Fund – Health & wellbeing Boards – One Year On Most state positive relationship with CCGs - state they can influence CCGs but not NHS England– this may make it very difficult to lead the development of integrated care The Kings Fund recommends that “strong and purposeful relationships between CCGs and their respective local authorities – based on partnership not takeover – offer the best prospects for boards to lead the integration and transformation of local services effectively. “

Kings Fund: Making best use of the Better Care Fund Offers an evidence-based guide to aid the discussions between CCGs, LAs and HWBs. Evidence from The King’s Fund and others in number of different areas – e.g. primary prevention; self-care; case management – and emphasises that this evidence “must be interpreted and used with a sound understanding of the key local challenges and the underlying issues that need to be addressed” Important for VCS and Healthwatch - this document can be used to cite evidence of evidence based interventions: e.g. self care – key pointers for evidence including tailoring interventions to the condition and support for informal volunteering (set to increase). With case management – e.g. focus on early action and prevention

Sandra van der Feen Policy Officer, LVSC

Links to resources LGA Self-assessment development tool - LGA Health and wellbeing boards: a practical guide to governance and constitutional issues - Stronger Together: How HWBs can work effectively with local providers – National Learning Network - LGA new Integrated Care Value Case Toolkit Integrated Care in North West London - For example NWL states it has a track record as early leaders of integrated caretaking forward ambitions and innovative integration programmes and two integrated care pilots manage the care of highest risk, most vulnerable patients. -

Links to resources Greenwich – Integrated Care value case - The LGA Integrated Care Value Toolkit includes a bank of evidence for integrated care: NESTA Networks that Work: partnerships for integrated care. Regional Voices’ summary of Integration Pioneer Sites and how they may be working with the VCS in the different regions. Areas featured in London include: Greenwich, Islington, North West London, Waltham Forest and East London and City: LGA Knowledge Hub -

Links to resources The King's Fund webcasts, interviewing commissioners on approaches to integrated commissioning King’s Fund – Health & wellbeing Boards – One year On: Making best use of the Better Care Fund - Kings Fund: Time to Think Differently – Future trends: Kings Fund analysis; what next & future trends timeline (what will affect health care delivery in the future - PHE: Health profiles – “summary health information to support local authority members, officers and community partners to lead for health improvement" - London health facts: