1. Hackney Devolution Pilot: An Update Health and Wellbeing Board 4 November 2015 1

2. What we will cover today Share how our thinking has developed since the report to the HWB was produced: Emerging vision and draft proposal Our devolution asks Proposals for governance and new workstreams to develop our ideas further Describe what will happen in the coming weeks 2

3. Why are we exploring being a devolution pilot in Hackney? There are plans to transform health and care systems nationally and within London These will deliver significant changes over the next 2 years in how integrated health and social care operates We think it will help us address the financial challenges ahead and find a way to protect finances and access transformation funding Devolution offers opportunities for ways of working that meet local areas’ needs with local commissioners, providers and patients/service working together to deliver real localism Hackney partners have expressed an interest in becoming a London devolution pilot and a short-term group has been meeting with representatives from across the partnership, to progress the proposal further. 3

4. Who are the local partners? Local people (residents, service users, patients and carers) 4

5. What do we want? 5

6. We do not want to… Privatise services Break up the NHS Lose our high performing local hospital Have a model developed elsewhere imposed on us 6

7. What are the building blocks? Putting patients at the heart of service design and decisions-making Starting with adults, a focus on prevention and early intervention, living well at home and avoiding unnecessary use of hospital care or other long-term care Redesigning services with patients/service users to improve care by reducing fragmentation, delays and duplications currently experienced by patients and carers Our current partnerships, e.g. One Hackney and City, mental health alliances New ways of paying for care that make the best use of our resources and lead to better patient experiences and improved outcomes The ability to re-invest any savings back into local health, social care and wellbeing services. 7

8. How can devolution help us? Some of the freedoms we need: Financial flexibilities We want to explore new ways of paying for care, along with incentives for prevention, early intervention and better care overall Additional local powers We want new local powers, such as planning powers, to improve public health and to address the social determinants of health and reduce health inequalities New commissioning powers We want to be able to commission more services locally Common regulatory system We want a simpler way of regulating our integrated health and social care system Estates We plan to work across the partners to explore how we can best make use of our collective estates to deliver our vision. 8

9. What if we do nothing? Possible moves towards a single CCG covering Hackney, Tower Hamlets, Newham and Waltham Forest Exposure to the financial challenges facing Barts Health Less local control Possible Challenges to the independence of the Homerton 9

10. What happens in the next few weeks? 10

11. What is our timetable if we become a pilot? 11

12. How will we take our plans forward? 12

13. How will we take our plans forward (2) Develop a detailed involvement plan including workshops, focus groups etc. Work through existing patient/User/resident forums Develop a detailed implementation plan Communicate our plans and latest thinking widely to all stakeholders This is an exciting opportunity which will involve huge amounts of work. We will only get it right by making sure that everyone who wants to, is able to help design and shape the model and the design! 13