1. Department of Health The Role of the DPH and Joint Strategic Needs Assessment George Leahy Head of Public Health Development Department of Health PUBLIC HEALTH IN THE NEW COMMISSIONING WORLD:

2. Department of Health Purpose To discuss the new Commissioning Framework, and in particular JSNA To outline potential challenges for DsPH To explore what support you need, and how to get it

3. Department of Health The Commissioning Framework: Summary Launched March 2007; consultation ends 29 th May Key development in system reform agenda Focus on promoting health and well-being, including prevention of ill-health Stronger focus on commissioning for outcomes to reduce inequalities Emphasises importance of strong partnerships Recognises potential role of third sector

4. Department of Health The Commissioning Framework: Aims 1.A shift towards services that are personal, sensitive to the needs of the individual and focused on maintaining independence 2. A reorientation towards promoting health and well being, and proactive prevention of ill health 3. A stronger focus on commissioning for outcomes, across health and local government, working together to reduce health inequalities & promote equality

5. Department of Health Where we are now Health reform and investment has changed the NHS Clinical outcomes have improved Increasing effectiveness of joint working across health & social care More choice among services, which are delivered closer to home Commissioning for volume and price - not quality and outcomes Too much care in institutional settings Health inequalities remain Focus on treating illness Limited diversity of providers Individual choices still limited, local voices sometimes unheard BUT

6. Department of Health Eight steps to more effective commissioning 1.Putting people at the centre of commissioning 2.Understanding the needs of populations and individuals 3.Sharing and using information more effectively 4.Assuring high quality providers for all services 5.Recognising the interdependence of work, health and well-being 6.Developing incentives for commissioning for health and well-being 7.Making it happen: local accountability 8.Making it happen: capability and leadership

7. Department of Health Understanding the needs of populations and individuals: JSNA Key building block of commissioning process Duty of local authority and PCT –LAA and local targets based on the JSNA Must be focussed on outcomes Must be focussed on the future o3-5 years: improvements in outcomes/reductions in health inequalities o5-15 years: for major infrastructure planning (transport, housing, healthcare facilities) o1 year: contractual changes at frontline / PBC level

8. Department of Health JSNA: What it isn’t, what it can do Need to define scope Not the whole commissioning process Not the plan to deliver changes in service delivery It is a process and a ‘document’ (DsPH must be involved in whole commissioning process) It is the information & evidence to support other parts of the commissioning process: medium & short term Includes Patient and Public ‘voice’ PCT Prospectus & Sustainable Community Strategy –Signals to the ‘market’ that changes in provision expected –Services as they are currently delivered could be decommissioned

9. Department of Health JSNA and the Commissioning Cycle Demography Joint Strategic Needs Assessment the desired health and well being outcomes in 3 – 5 years time for your population Social & environmental context Current known health status of populations Current met needs of the population Patient/Service User voice Public demands Programme of systematic service reviews (NHS / Social Care) Prioritisation framework for annual contracting procurement Medium-term market development: capacity to deliver desired service configuration (Local Government and NHS) Primary Care Investment Commissioning decisions (NHS) Capital Investment Plans (local / regional government and NHS) OUTPUTS (The link to other stages of commissioning) INPUTS (Data/information needed) What decisions will be made by whom? LSP PCT SCS, LAA and Outcome indicators (35/200) PCT Prospectus & outcome metrics chosen Analysis of inequalities - Outcomes - Service Access Programme budgets and outcomes Evidence of effectiveness

10. Department of Health Interpersonal Relationships Statutory guidance Duty on the DPH/DASS/DCS to work together Poor relationships could undermine JSNA and commissioning Do you require support in developing, e.g. negotiation and relationship management skills?

11. Department of Health Prioritisation & Leadership JSNA focuses on outcomes Over the short to medium term Aligned with SCS & LAA cycles What will prevent an agreement on outcomes? How will priorities be set? Will there be any ‘political’/power imbalances?

12. Department of Health Prioritisation & Leadership: Decommissioning What part will you play? How could JSNA support you? How will you maintain PH as a priority? JSNA is “backdrop” & supports prioritisation –annual contracting More importantly… Longer time periods Provides ‘defensible’ process for decisions on priorities This includes building local support for decommissioning (patient/public/political voices)

13. Department of Health Which Model Suits You? DCSDASS DPH DCSDASS