LEICESTERSHIRES SHADOW HEALTH AND WELLBEING BOARD: OUR JOURNEY AND PROGRESS TO DATE January 2013 Cheryl Davenport Programme Director

Purpose of the Health and Wellbeing Board Primary purpose is to:- Promote integration and partnership working between the NHS, Social Care, Public Health and other local services; and Improve local democratic accountability.

Leicestershires Starting Point Track record as high performing council Members welcomed a greater role for the council in Health and Wellbeing Chair: –background in the health sector –a strong personal commitment to improving outcomes in partnership Joint Director of Public Health already in place and reporting directly to LA Chief Executive

Laying the foundations (1) Joint Change Programme Board in place, steering transition between NHS and LA Co-location of public health from January 2011 Programme director focusing on H&WB Board development from November 2010 Early engagement between council and CCGs

Laying the foundations (2) Stakeholder mapping, stakeholder engagement plan, development of core stakeholder and media product Early decisions on TOR and membership Agreement to commissioner Board, with clear sub structures for wider engagement Engagement event held to shape substructures

How built early relationships at system level Our early development sessions focused on: Building relationships and trust, understanding roles and expertise, bios –Sharing perspectives on what the end state will look like post 2013, different expectations and risks –Articulating what we wanted the H&WB Board to achieve and what we wanted it to avoid –How to add public value

System Level Themes 4 key themes emerged as the focus for our system level work: Improving health outcomes Improving service integration Improving efficiency and balancing the economy Organisational transition The Shadow Board developed 8 strategic priorities under themes 1-3, based on existing JSNA evidence and strategic priorities of partners Organisational Transition - remit of our Joint Change Programme Board.

Our Initial Strategic Priorities: Increasing life expectancy and reducing inequalities 2.Reducing the prevalence of smoking 3.Reducing the harm caused by alcohol and drugs 4.Reducing the prevalence of obesity and physical inactivity

Our Initial Strategic Priorities: Improving the care of older people with complex needs and enabling more older people to live independently 6.Improving the care of adults and children with complex needs and their carers, including those with: –Mental health needs –Complex disability needs 7.Shifting investment to prevention and early intervention 8.Making urgent care systems for adults and children work

Shadow H&WB Board Members (1) Cabinet Lead Members for: –Health (Chair) –Adults and Communities –Children and Young People 2 representatives of each of the Clinical Commissioning Groups (GP Consortia) within the local authority area Directors of: –Public Health –Adults and Communities –Children and Young People

Shadow H&WB Board Members (2) 2 LINk representatives (Local HealthWatch, when established) The Chief Executive of the PCT Cluster (NHS Commissioning Board, when established) 2 District Council representatives 1 Police representative

Relationship Building with CCGs (1) February 2011: Introductory meetings for the LMC, CCGs, the Council March – May 2011: GP clinical leaders, operating managers and their wider teams join transitional work and governance arrangements at an early stage e.g. –H&WB Board implementation –Development of joint commissioning –Local Health Watch pathfinder

Relationship Building with CCGs (2) June/July 2011: Development sessions for CCG leaders on: The role of local government Working with members The councils 2011/12 business plan Safeguarding Joint Commissioning priorities– e.g. Dementia

Key to success in building relationships between board members Early informal opportunities for board members to build trust individually with the Chair and each other Strong foundation of respect and understanding of each others expertise and perspectives from participating in development sessions.

Relationship building with Districts District councillors on H& WB Board Elected member H&WB champions in each district Regular meetings between DPH and district council CEs Regular meetings with district councillor health champions Co-location of PH staff in district council offices.

Relationship building with others Quarterly meetings: Chair of the H&WB Board with Chair and CE of main local NHS providers. Introductory meetings with the council for LDC, LOC, LPC focused on: –How oral health needs, eye health needs, and the pharmaceutical needs assessment can be better integrated with the JSNA –How the H&WB Board can access the advice and expertise of other primary care professionals Connections with Voluntary Action Leicestershire

What the Shadow Board achieved in 2011 Development session in April 2011 –introducing the Board, relationship building, shaping our vision Stakeholder engagement event in May 2011 Board Meetings held in public in April, June, September, December Initial strategic priorities agreed in June 2011 Substructure finalised in September 2011 Stakeholder bulletin and website in place Development session December 2011 –to align commissioning intentions for 2012/13

Some of the other issues we addressed in 2011 Membership and balance of the Board Agenda and workplan via an executive steering group Adding value, not duplicating Identifying early wins and longer range work Improving our stakeholder engagement plan Respecting differences in organisational requirements, language, styles Understanding Board members come from different perspectives and experiences: ensuring board materials/business is accessible to all Clarity on relationships with other groups/boards Developing our substructure

Our Early Wins Sports and physical activity commissioning £1m disabled facilities grant Joint plan for social care allocations (reablement, dementia etc.) Multiagency dementia strategy (across 3 CCGs and 3 LAs) High profile locally, regionally and nationally of our successful approach to NHS/LA transition in Leicestershire, including the leading edge work of the Shadow H&WB Board

Our Progress in 2012 (1) In 2012 the Board met in public in March, May, October and December The Board held development sessions on the following subjects: –February: Frail Older People Strategy and Emerging Vision for Health and Social Care in Leicester, Leicestershire and Rutland; –April: Joint Strategic Needs Assessment; –August: Priorities for the Health and Wellbeing Strategy –November: Commissioning Intentions for 2013/14

Our Progress in 2012 (2) The Board now has a fully operational sub structure with supporting Boards leading work on: –Integrated Commissioning –Staying Healthy –Substance Misuse –Health Protection The Board also has a well-established steering group which sets the forward workplan and agenda for the Board, and supports all the preparatory work, including the development sessions. The Board also has a well-established group which led the work to refresh the Joint Strategic Needs Assessment

Our Progress in 2012 (3) The main focus of the work of the Board in 2012 has been to: –Refresh and publish the Joint Strategic Needs Assessment (JSNA) for Leicestershire and engage with a wide range of stakeholders in this process. –Identify and agree local priorities from this assessment –Develop and publish our first Health and Wellbeing Strategy and engage with a wide range of partners in this process –Oversee the delivery of workplans from the substructure groups –Prepare for statutory status of the Board with effect from April 2013.

Our Progress in 2012 (4) The Health and Wellbeing Board has also covered a number of other important topics this year, for example: –Local CCG commissioning strategies and authorisation –The vision for local Healthwatch –Local emergency planning arrangements –The implications of the Adult Social Care White Paper –Cancer mortality rates in Leicestershire –The Annual Report of the Director of Public Health, which focused on older people –Future Special Educational Needs provision for Children –The Better Care Together programme - planned changes in healthcare services across the sub-region –The introduction of the NHS 111 telephone number (a national development)

Key features of our Joint Health and Wellbeing Strategy (1) Based on the evidence and analysis of the JSNA refresh, our Joint Health and Wellbeing Strategy comprises three main components: –A set of commissioning principles which will underpin the commissioning decisions of the Health and Wellbeing Board –Setting out the priorities for health and wellbeing in Leicestershire –Setting out cross cutting themes that will involve close joint work with other boards and other stakeholders

Key features of our Joint Health and Wellbeing Strategy (2) The core of the strategy is to focus our collective efforts on improving outcomes related to these 4 priorities: Getting it right from childhood; Managing the shift to early intervention and prevention; Supporting the ageing population; and Improving mental health and wellbeing The cross-cutting theme within the Strategy is: Tackling the wider determinants of health by influencing other boards

Finalising the Strategy Consultation on the strategy ended on 6 December 2012 The Shadow Health and Wellbeing Board received a report on the outcome of the consultation and final version of the Strategy at their meeting on 14 December The Strategy was approved by the County Councils Cabinet on 18 December 2012

Preparation for Statutory Status (1) The Department of Health has held a consultation on the regulations for Health and Wellbeing Boards Publication of the regulations is expected on 7 January 2013 The regulations are expected to cover a range of matters such as: o Voting, o Delegation of duties including through subcommittees, o Codes of Conduct, o Declarations of Interest, o Clarification about the general provisions related to s.102 committees in Local Authorities and how these will apply to Health and Wellbeing Boards

Preparation for Statutory Status (2) In Leicestershire the following preparations are proposed:- The Shadow Health and Wellbeing Board will hold a development session to consider the local application of the regulations; the Health and Wellbeing Board Steering Group and the County Councils Democratic Services Officers will make the necessary preparations; and A formal paper setting out the implications and actions locally will come to the next Health and Wellbeing Board meeting (21 March, 2013).

Taking it to the next level…. H&WB Board leadership to integrated commissioning and staying healthy priorities CCGs influencing wider determinants e.g. affordable housing plans with district councils H&WB Board system leadership for service reconfiguration More systematic approach to community engagement Improved outcomes Greater investment in prevention through integrated commissioning and system change

For further information about the Shadow Health and Wellbeing Board: Terms of Reference Presentations Stakeholder Briefings Frequently Asked Questions Press releases Meeting dates, agenda, papers Useful links to other NHS transition information To receive our Stakeholder Bulletin or for further information Contact: Rosemary Palmer, Senior Committee Officer