1. The Future of Health and Care NHS Confederation Perspective 16 th April 2015 Dr. Johnny Marshall Director of Policy ADDAS SPRING CONFERENCE @marshall_johnny

2. 21 st Century Challenges Rising demand Increasing need Financial constraints Carbon resource constraints http://www.anewdirection.org.uk/blog/three-21st-century- challenges-for-museum-learning @marshall_johnny

3. Projections of GDP Share of Health in OECD Countries

4. @marshall_johnny Embrace data and information to transform health and care Innovate healthcare delivery Build the healthy cities and countries of the future World Economic Forum Sustainable Health Systems Visions, Strategies, Critical Uncertainties and Scenarios A report from the World Economic Forum 2013

5. @marshall_johnny Paradigm Shift New cultures and systems around wellness and population health, rather than simply integration of old. “It is better to beg forgiveness than seek permission.” Grace Murray Hopper

6. “System leadership requires leaders to move away from thinking from an organisational perspective; instead decisions need to be taken on the basis of pursuing improvements in the health and wellbeing of the local population” @marshall_johnny

7. IPSOS MORI 2014 – “Trust me, I’m a doctor!” @marshall_johnny

8. Case study: Kingston HWB Local GPs and councillors had been dissatisfied with mental health services for some time, and used the HWB to articulate the changes they wanted to see. After consulting users, the HWB drew up a commissioning mandate for mental health services, which declared: “The way we plan and oversee local health and social care services is changing.” The HWB went on to confront long-standing difficult issues: for example, it became responsible for jointly commissioning substance abuse services, revising the service specification and awarding the contract to new providers @marshall_johnny

9. The mandate became very powerful, Attempts to resist change proved futile in the face of it. Former NHS Kingston CCG chief officer David Smith (now chief executive of NHS Oxfordshire CCG) said : That showed the real power of GPs and councillors signed up to the same agenda. @marshall_johnny

10. Demonstrate political leadership by encouraging discussions at all levels about the future of health and care services to focus on getting the best outcomes for people with limited money. Align payment mechanisms that support more integrated and outcomes focussed care Develop future workforce to work within the emerging integrated models of care. Making integrated health and social care a reality... Enable shared accountability by introducing a simpler, unified health, public health and social care Outcomes framework Make health and wellbeing boards the focus for joined-up commissioning of primary, secondary and social care. Improve data sharing. A national sector-led programme to support health and social care organisations to adopt participation and self-management approaches for all who would benefit. Extra transitional funds to move to new models of care and longer term financial settlements to provide up-front investment for service change @marshall_johnny

11. Is the structure and culture of your Health and Wellbeing Board conducive to improving the health and wellbeing of your population? @marshall_johnny

12. Are the structure and culture of HWB conducive to improving the health and wellbeing of your local population? It is on the way to being conducive. We are all still young as organisations and governance structures Very staid and embedded in council culture The HWB are led more by the LA's than the NHS The CCG is not treated as an equal partner, the partnership being local authority dominated. [The HWB] has a built in LA majority, so if any issues ever come to a vote the LA will be assured it will win A decent H&WBB with some good members, but nowhere near ready to take responsibility for the NHS locally It is difficult to have a feeling of localism for all areas that the board covers @marshall_johnny

13. The Future of Health and Care Challenge “…. we need to battle for supremacy over outcomes not each other …..” @marshall_johnny