Understanding the NHS reforms: a London borough perspective London Councils Members Event 20 th March 2012 Dick Sorabji Corporate Director Policy & Public Affairs

Health challenge for London boroughs Transfer of public health within DH rules Construct population health strategies that influence purchaser and provider Integrate chronic & elders care pathways across NHS and boroughs Deliver joint commissioning by boroughs and CCGs Manage scale challenges Fix the hospital challenge Speak for London Create Health and Well-being Boards that drive change Local government must not be seen as the weak link in the new regime

Key facts for London health care 16 Foundation Trusts 32 acute trusts 10 mental health trusts 6000 GPs –50%+ are 1-2 person practises 31 Clinical Commissioning Groups 3 Commissioning Support Organisations 32 boroughs & City of London Social care £2.2 billion in London –+4% pa NHS spending: £15 billion pa –Shortfall £3-5.2 billion by April 2016 Life expectancy cut by 9 years in 8 tube stops London is a tale of two cities: World leading health science and outdated provision

Integration: better care for less NHS Future Forum –Mrs Crabtrees complex needs –Jim and the London Homeless Pathway –Ben and his key worker: Mum The Nicholson Challenge can only be achieved making fundamental changes to the way care is delivered. –Health Select Committee 24 th January 2012 London Councils Total Place research 2010 –Chronic Care spend in London £5 billion –£880m modelled potential saving London Councils & Diabetes UK –700,000 by 2030 –Savings from integration: £90m avoided & £90m saved In theory we can have our cake and eat it

Local foundations for health care Public health integration & transformation –Embedded throughout all local public services –Informing a shared population health strategy Joint commissioning and support –Pooling resources to increase value –Capturing horizontal economies Of scale Of marginal cost Of competence –Local focus - personalised approach –Delivering population health strategies Health & Well Being Board set up –A different type of Executive authority –Trusting mutual challenge –Deeper public engagement –Intelligent & authoritative conversation with providers Transforming health outcomes starts locally

A local vision for public health Set up a public health function –Bring over existing public health staff and provision Complex TUPE for 850 staff –Manage split with NCB and PHE Ensure LHIB adds value locally –Pan-London leverage for local added value –3% funding from boroughs Manage financial relations with Dept. Health –£471m transfer in London –Variations £ per head; £4.7m-£29.1m per borough –Funding splits three ways NCB=£2.2b, LG=£2.2b, PHE&DH=£830m A smaller challenge: a vital foundation

Integrated commissioning support assess the need of a population in order to create a platform for procurement….the key vehicle for integration –NHS Future Forum Categories of commissioning support: –Strategic local delivery (67% of spend) –Processing (33% of spend) Spend per head 2011/12 (6 borough analysis) –CCG£25 –Social Care£15:77 –Childrens£5:40 –Public Health£4:75 –Total£50:92 Integrating the thinking process of CCGs and Boroughs not only supports integrated solutions: It could transform financial effectiveness

London: integrated care action Croydon: integrated mental health for elders Lambeth & Southwark: SLIPS older people at risk Tower Hamlets: Taking control of Care mental health & housing project Westminster: complex needs through Central London Community Health Care Trust Camden: Intermediate Diabetes Service Assistive Technology Pilot –Cuts hospital admissions, cuts direct payment costs, increases independence, saving £1m per borough London Re-ablement Programme –£16m savings in first year –Care hours needed cut 20-30% London has a dense patchwork of integration initiatives to build upon

The health challenge of scale Multi-borough solutions –Recognising cross-boundary demographics –Shaping markets for personalised chronic care –Ensuring viable local infrastructure Hospital Trust footprints –Helping to reshape provider offers –Moving back to viability Activating the power of Londons voice –Influencing NCB (et al.) –Protecting Londons unique role in the UK –Answering the Kings Fund challenge: who leads in London? Health & Well-being Boards need to think beyond borough boundaries to transform local health outcomes

HWB Boards: early actions Support CCGs and local GPs above all else Use NHS Social Care allocations to showcase integrated care Support all boroughs with integrated commissioning solutions: –Kingston, West London Alliance …. Work with providers to offer integration with local focus: –NWL Integrated Care Pilot Strengthen public legitimacy of HWB Boards –Build public engagement architecture –Connect up with neighbours and across London Early tangible wins can leverage our larger goals

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