Transcript Passing the baton – mind the gap!

Commissioning
Children’s Services.
Passing the baton –
mind the gap!
Steve Cropper
Keele University and
Partners in Paediatrics
To Social Services Research
Group – Children’s Services
Birmingham 7th March 2011
Whoops!
Health and Social Care Bill 2011
• strengthening commissioning of NHS services
• increasing democratic accountability and
public voice
• liberating provision of NHS services
• strengthening public health services
• reforming health and care arm’s-length
bodies.
Transition will occur through a carefully designed and managed process, phased
over the next four years … to allow for rapid adoption, system-wide learning, and
effective risk management.
Leadership & Performance timeline: Oct 2010 – Mar 2012
2011
Oct10
2012
Jan 11
Apr11
LG/DH Transition
group provide
assurance on LA
engagement
Dissemination of
Lessons Learned from
Early Implementers
Local Government/
Health & Wellbeing
Bodies
Workshop for potential
early implementers
High Level
understanding of
H&WB’s interactions
with NHSCB & GP
Consortia
options for transfer of
existing pooled budgets
and joint commissioning
arrangements
Identification of
H&WB early
implementers
Jul 11
Majority of places
with H&WB
Arrangements in
place or plans to do
so by Oct’ 2011
Shadow HWB or
emerging joint
arrangements in
place to support role
of DsPH
PCTs and Councils to
begin developing
arrangements for
health improvement
Remaining shadow
H&WB Bds
arrangements in
place
(Subject to
Parliamentary
Approval) Royal
Assent places new
duty on LAs with
social care functions
to establish HWBs in
&accordance with
local needs
Clear understanding
of H&WBs role in
Health Improvement
and Protection
All localities to have
arrangements to transfer
funding from PCTs to LAs.
Ensure ‘GP path
finders’ build correct
links with Councils
from outset.
Oct11
PCTs agreed what
happens with existing
pooled budgets and
contracts for joint
commissioning
Jan 12
Apr12
Shadow H&WB have
begun to refresh
JSNA and agree
working arrangements
for handling shadow
public health ring
fence and GP
consortia allocations
3 SCENARIOS
Revolt or Abdication/Denial:
• Collective response political action (or
perhaps widespread
inertia and apathy)
Responsible Public
Servants: Gradual
engagement through GP
leaders, representatives.
Rules of the new game
worked through – small
scale, incremental
changes + some system
shocks in context of
broader strategy
Melt-down – pace and
extent of change not
achievable; national board
and local leadership at
loggerheads; inertia
thwarts radical action; GP
consortia fail, merge,
change; cases of break-up
of providers
‘…primarily about a cultural change… to genuinely
collaborate throughout the commissioning process.’
Local Strategic Partnership
Children’s Trust + LSCB
CYPP
GP Commissioning
Other hurdles, shocks and wild cards
?knowledge and experience of paediatrics
?awareness of services
“GP’s training should be reviewed to
include the ECM agenda as statutory…”
Deep financial cuts and effects
Personalisation
Thoroughgoing marketisation
……
…..
Public health transfer to LAs
Statutory Health and Wellbeing Board and ?….
• local authorities to coordinate the commissioning of
local NHS services, social care and health improvement
“The Health and Social Care Bill will significantly strengthen
collaborative and integrated working…“ (Govt response Jan11)
Issues – HWB Early Implementers
• How do we set a new direction while ensuring
current programmes through the transition?
• Relationships and knowledge
• Accountability and transparency
• Boundaries and levels
+
• a. Joint Strategic Needs Assessment
• b. Working with elected members
Types of ‘Friendly’ Relations
Easier
• Networking Exchanging information for mutual benefit
• Coordination Exchanging information and altering activities to achieve
mutual benefits and a common purpose
• Cooperation Exchanging information, altering activities & sharing
resources to achieve mutual benefits and a common purpose
• Collaboration
Exchanging information, altering activities, sharing
resources and enhancing the capacity of another to achieve mutual
benefits and a common purpose
Arthur Turovh Himmelman: Communities Working Collaboratively for a Change, 1991
And in Chris Huxham (Ed) (1996) Creating Collaborative Advantage. Sage.
Harder
to develop
and
sustain
Collaborative leadership
What to do, now?
•
Develop GP Comm. understanding & capacity (SHAs, PCT clusters & LAs leading
‘process’)
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•
•
Ease of linkage as essential - organisational maps; who’s who?
Jointness and transparency as principles – no surprises, linked/shared info sites, briefings, news….
Set out authorisation/governance processes
Commissioning maps, agendas and infrastructure
– Best info re ‘children’s program budget’
– What commissioning support capacity is required
•
•
•
•
Strategic
Joint
Support functions
Pragmatism: where to hold initial steady state and where to change
–
–
–
–
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Reasoned advocacy on children’s needs & services – Kennedy + JSNA, existing strategies, etc.
What does the Local Authority currently commission with PCTs?
What works well? What should continue and be built upon?
What else is needed?
Priorities
– Population groups and services eg CAMHS, Safeguarding, Complex/continuing care, Cared for Children
– Commissioning capacity eg linking sector commissioners, community consultation
•
Ensure people are focused on their ‘must do’ contributions and tasks (‘day job’ incl.
partnership responsibilities, and collective learning and identity work)
Hold collective purpose and nerve.
Baton fumbled but scooped up here, here and here…