NHS Reforms – what does it mean for the Nottinghamshire Children’s Trust? Dr Kate Allen – Consultant in Public Health Medicine Irene Kakoullis – Head of Health Partnerships

Outline An overview of the NHS Reforms Health outcomes for children & young people Joint Commissioning Priorities Governance and links with Clinical Commissioning Groups Suggested next steps

Summary of NHS Reforms The transfer of commissioning to Clinical Commissioning Groups (x6 in Notts) and the abolition of PCTs and SHAs by April 2013 NHS Commissioning Board to be established Establishment of Health & Well Being Boards New statutory duties for health improvement to LAs NHS Trusts to become foundation trusts Health and Well Being Strategy Public Health functions to move to LA by April 2013 Public Health England to be established bringing together key regional and national functions eg Health Protection Ring fenced Public Health budget for LA and Public Health to commission key activity HealthWatch

Health & Well Being Board Statutory HWBBs in every upper-tier LA – from April 2013 – (Notts is an early implementer site with a shadow board since May 2011) Duties on Clinical Commissioning Groups and LAs to prepare the Joint Strategic Needs Assessment (JSNA) via the HWBB. A new Joint Health and Wellbeing Strategy, prepared by the HWBB and based on the needs identified in the JSNA The HWBB has a duty to support and promote integrated working between health and social care commissioners including for wider determinants of health e.g. housing. Membership includes DPH, DASS, DCS, Elected Members, District Council Leader reps, and LINks

Joint Strategic Needs Assessment Preparing the JSNA is a core function of health and social care commissioners as a way to assess current and future health and wellbeing needs in an area. Commissioners will each be required to have regard to the JSNA and the Joint Health and Wellbeing Strategy when developing their own commissioning plans. Local agreement to refresh current JSNA by March 2012 (not the CYP chapter)

Joint Health & Wellbeing Strategy The Health & Wellbeing Stategy (HWS) must consider the use of health act flexibilities (e.g. pooled budgets, lead commissioning). The HWS must have regard to the NHS Commissioning Board mandate to ensure consistency nationally Each commissioner must have regard to the JSNA and HWS when deciding their commissioning plans Local agreement to draft HWS by March 2012 The strategy will be developed focusing on life stages with sections dedicated to maternal health, children and young people. Children’s Trust priorities will be included in the strategy.

HealthWatch Ensure that the views and feedback from people who use services, carers and members of the public are integral to local commissioning Provide advocacy and support to people and help them to make choices about services Provide intelligence for HealthWatch England about the quality of providers LINks functions will be included within HW however national research has highlighted many barriers to engaging children and young people[1].[1] [1] Graham Berni (June 2011) ‘LINks’ involvement of children and young people’. National Children’s Bureau

Public Health Transfer of power from central government to local communities Joined up approach through local government via Directors of Public Health Public Health England to lead on health protection & health improvement nationally Ring fenced public health budget Stronger focus on outcomes Healthy Lives, Healthy People – our strategy for public health in England (2010) Healthy Lives, Healthy People – the way forward (2011)

Children’s Health - the scale of the challenge There is a 9% projected increase in the birth rate over the next 20 years. 24% of mothers giving birth in hospitals in the north of the county smoke at the time of delivery - well above the national average. More children and young people with profound disabilities and long- term conditions are living longer and surviving into adulthood. There is a clear relationship between deprivation and emergency hospital admissions. Source: Children and young people’s chapter of the JSNA

A Social Model of Health

Joint Commissioning In recent years, there has been an increased focus on strategic children’s commissioning activity being undertaken jointly, including: The joint assessment of the health and wellbeing needs of the local community - through the JSNA Joint planning to achieve improved outcomes across shared priorities – through the CYPF Plan Developing systems for evaluating services that address these shared priorities Aligning budgets to reduce duplication and improve performance

Current Joint Commissioning Priorities Disability Emotional Health and Well Being Alcohol and Drug Use Teenage Pregnancy Childhood Obesity All priorities have joint commissioning groups and strategies (teenage pregnancy plan soon to be developed)

Nottinghamshire Children’s Trust: Governance Arrangements Teenage Pregnancy Executive

Children’s Trust Governance & COO Representation GroupCurrent Membership Agreed CCG attendance Meeting dates Children’s Trust Network Chaired by Cllr Philip Owen Sam Walters & Phil Mettam Bi annual Children's Trust Executive Chaired by Anthony May Sam WaltersMonthly Disability Joint Commissioning Group Chaired by Sue GillSam Walters Deputy TBC Bi monthly CAMHS Joint Commissioning Group Chaired by Dr Kate Allen Sam Walters Deputy Hazel Buchanan Quarterly Notts Safeguarding Children Board Chaired by Chris Few Amanda SullivanQuarterly

Suggested Next Steps Continued input at Health and Well Being Board via DCS Regular and appropriate engagement with CCGs and their Chief Operating Officers – including representation at CT Joint Commissioning Groups and NSCB Ensure children, young people and family voices are considered in delivery and commissioning of HealthWatch