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Staffordshire Health & Well-Being Board

ACHIEVING STRATEGIC OUTCOMESTHROUGH LOCALITY-BASED DELIVERY

Anthony E. GoodwinChief Executive

Tamworth Borough Council(Task & Finish Group Lead)

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CONTENTS

Introduction 2Terms of Reference 4Executive Summary 5Methodology 6Key Findings 7Conclusion 10Recommendations 16Appendices 18Bibliography 22Acknowledgements 23

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1.2 The Oxford Dictionary definition of our keyoutcome: “Well-being” links to a host of synonymsthat many, if not all of us can relate to: – goodhealth, security, prosperity, success, comfort,welfare…… The use of the term is oftenassociated with health and/or care eg., the nursesprimary concern was for the patients well-being…

1.3 Within the context of this report and morespecifically, the Health & Wellbeing Strategy, thefocus is largely the same. However, seeking toimprove well-being outcomes is more aboutinfluencing and improving the social, economic andenvironmental conditions of local communities.

1.4 These actions and through them, the consequentialimprovements across public health outcomeindicators is largely dependent upon the services(statutory and discretionary) provided by districtsand borough councils in two tier areas.

1.5 The insight and evidence collected during this pieceof work clearly demonstrates this case and goesfurther in showing that both the private andvoluntary sectors make significant contributions too.

1.6 The challenge therefore has been to assess thecurrent role of districts/boroughs and widerpartnerships and to identify the means by which thiscan be enhanced whilst maintaining a keen focusupon well-being outcomes. In setting this ‘task’,the Staffordshire Health & Well-being Board hasacknowledged the multifaceted role ofdistricts/boroughs and key partnerships. Asorganisational cultures change, working methodsbecome more flexible and shift towards unifiedapproaches: – joint working, collaboration andultimately – integration; The role ofdistricts/boroughs or the “LOCALITY OFFER” willshift to a multi-dimensional function that willimprove outcomes across:

u Health improvementu The wider determinants of healthu Health protection

1.7 Whether through the direct provision of goodquality social and affordable housing or aninnovative scheme to encourage teenagers to eathealthily, the evidence collected and collated in

support of this report is compelling. Theinnovation, enthusiasm and desire to work togetherfor local communities exists in localities. Thisreport will, through its conclusions andrecommendations argue the case for the “co-creation” of LOCALITY BASED DELIVERYBOARDS.

1.8 The report sets out the wide-ranging views andopinions of those actively engaged in locality-basedcollaborative work and on the potential fordelivering HWB Strategy outcomes.

1.9 In highlighting the contributions made by localauthorities to the well-being agenda it underlinesthe need to better align individual service deliveryoutputs with improved health and/or well-beingoutcomes.

1.10 Furthermore it seeks to address the concernsexpressed by politicians around the “fitness forpurpose” of locality infrastructure, the need forrobust yet proportionate governance andaccountability and the need for democraticlegitimacy.

1.11 Finally, based upon a series of evidence-basedconclusions, it sets out clear recommendations insupport of devolution to localities.

1 INTRODUCTION

1.1 Well-being (mass noun)

“The state of being comfortable, healthy or happy”

LOCAL AUTHORITIES

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2.1 In April 2014, the joint chairs of the StaffordshireHealth & Wellbeing Board (HWBB) wrote to theauthor requesting that he lead a Task & FinishGroup with a view to delivering the followingoutcomes: (letter attached as Appendix 1).

i) To clearly articulate the role of district/borough councils and their broader locality partnerships in the delivery of the Health & Wellbeing Strategy outcomes

ii) To develop an appropriate and proportionate governance arrangement that clearly demonstrates robust lines of accountability

* This would entail vertical connectivity betweenthe tiers of local government and lateralconnectivity across agencies and sectors.

2.2 This report and related attachments sets outproposals that seek to fulfil the task together with aseries of propositions and working principles that ifadopted, form the basis of a transition route fromthe requested ARTICULATION to the morechallenging task of IMPLEMENTATION.

2.3 While not integral to the original task, it was evidentat all stages of this piece of work that how this rolewould be fulfilled was the large, plant eatingmammal with a prehensile trunk in the room.

2TERMS OF REFERENCE2TERMS OF REFERENCE

3EXECUTIVE SUMMARY

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3.1 The Terms of Reference set out in Section 1 are,on the face of it, relatively clear and straight forward.It is not until one considers the management andgovernance infrastructure involved that thecomplex, almost labyrinthine nature of the taskunfolds.

3.2 For the group to have any chance of responding tothe task in a meaningful way it has been necessaryto make a “strategic” assumption. In essence, thisreport focuses upon the role of districts, boroughsand wider partnerships in delivering “ImprovedWellbeing” outcomes. The assumption thereforeis that health and improved care outcomes set outin the strategy will be achieved through theplanning, commissioning and delivery of services byhealth, care and associated professionals.

3.3 That said, it is anticipated that the successful andsustained improvement in wellbeing outcomes willhave a positive and significant impact upon reducingthe number of people entering the health, care andother state systems eg., Criminal Justice.

3.4 Having regard to this, this report seeks to:

u Summarise the key findings in relation tolocality based delivery and key stakeholders

u Propose a series of working principles thatsupport the feasibility, deliverability andsustainability of locality based delivery

u Share the conclusions and views supporting therecommendations

u Propose an extension of the group in order tooversee phased implementation and act as anadvisory board for well-being.

Improvementin wellbeinghas a positiveimpact on

health & crime

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4.1 Following the initial ‘kick off’ meeting, standard task& finish group working principles were employedthroughout. As and when appropriate, the specificskills of team members were utilised to achieveoptimum effectiveness and best use of time.

4.2 The initial task was to secure support and ‘buy-in’from key stakeholders. This was achieved via:

u Meeting all district/borough CEOs

u Writing to all LSP chairs & managers

u Meeting with senior representatives of keystakeholders; OPCC; FARS; Police:voluntary sector; CCGs

(April)

4.3 The next stage involved the collection and collationof baseline information in order to create a pictureof current involvement, engagement, awareness etc.This was achieved via:

u Surveys of local councils

u Surveys of LSPs

u Face-to-face meetings with all LSP managers

u Feedback from Community Safety Managerson “sustainable partnerships”

(April)

4.4 Parallel work was undertaken to look into thepotential barriers, risks and ‘resisters’ to theprinciple of “locality based delivery”.

4.5 Progress report to Health & Wellbeing Board inApril 2014 – this prompted a review of the scope.

(April)

4.6 Agreed to focus upon how locality partnershipscould add value to existing offers through theCommissioning Triangle Model – in order to testthe principles, the author agreed to present to everyLSP or equivalent in Staffordshire.

(May)

4.7 Parallel work was undertaken to draft a ‘processmap’; a Memorandum of Understanding, anoperating model and ‘core’ principles.

(May/June)

4.8 Summarise findings: Analyse the ‘GAP’ betweencurrent and proposed; List issues and options forboard meeting; draft conclusion andrecommendations.

(June)

4METHODOLOGY

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5.1 Second Tier local authorities

5.1.1 The contributions of local authorities to the Health& Wellbeing Strategy outcomes varies across theeight second tier authorities in Staffordshire.

5.1.2 Achieved primarily through the delivery of statutoryand discretionary services, the variations can beattributed to issues such as the scale, scope andsustainability of services; the level of collaborationand engagement with stake holders; communityinvolvement and participation and of course, accessto skills and resources and use of local assets.

5.1.3 Contributions range from high level strategic policymaking eg., Local Plans and housing needsassessments to day to day operational transactionseg., housing allocations, benefit payments andkeep-fit classes.

5.1.4 Variations in ‘awareness’ of how service deliveryaligned with or impacted upon well-beingoutcomes were also evident as was an emergingpattern suggesting why.

5.1.5 Those local authorities with discrete plans,measures and resources dedicated to improvinglocal health well-being outcomes were, in almostevery case, those with a history of “belowaverage” measures in relation to public health

outcome indicators or other indices relating to thesocial determinants of poor health eg., genderspecific measure of life expectancy.

5.1.6 In all such cases, the local authorities had engagedwith public health via Primary Care Trusts (PCTs)initially, and county councils post April 2013. Theimplication being that these authorities had greaterawareness than others and as a consequence, werebetter placed to engage in the emerging agenda ata local level. Whether ‘outcomes’ are achieved viamainstream services, shared working or targetedactivities, the measures of success applied to datehave had limited strategic value and do little toinform future strategy and planning.

5.1.7 Professional associations for housing,environmental health and planning all recognise theimportance of their field of expertise upon healthand well-being. They further advocate the need toalign or create new, combined measures of successthat on the one hand indicate progress within thefield but also measure the effects upon health andwell-being.

u How might the Key Performance Indicators(KPIs) for strategic housing impact uponwell-being outcomes?

u Using the ‘Lifecourse’ model; how can wemeasure the benefit of housing?

KEY FINDING 1. Positive and productive activitiesare improving both health and well-beingoutcomes. However; there is no current means ofaligning and quantifying the direct success againstHWB Strategy outcomes.

KEY FINDING 2. Professional organisationsengaging with public health agenda throughcorporate/individual memberships. RegisteredSocial Landlords (RSLs) actively promoted healthlinks through housing networks.

KEY FINDING 3. Variations exist in fundamentalareas across the local authorities; these include:

u The use of common data and insight whenprioritising

u Understanding of what “commissioning”means and entails

u Uncertainty around who “owns” the healthagenda

u Lack of capacity and skills for anything “new”

u The need for a “shared language”

u Where does this fit with “IntegratedCommissioning”

5.1.8 While not exhaustive; these are the key issuesarising from local authorities.

5KEY FINDINGS

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5.2 Broader Locality Partnerships

5.2.1 Since the current government removed the duty toprepare a Sustainable Community Strategy, thefocus for most local partnerships has been upon“Localism” and making sense of the enablingstatutes for big society to thrive.

5.2.2A consequence of this less prescriptive model is 8locality forums across the county all of which varyin either purpose, representation, access to funding,governance etc.

5.2.3 Based upon the information provided “InConfidence” by partnership officers there isevidence to suggest that the more robust andeffective partnerships are those built around thestatutory “Responsible Authorities Group” (RAG)which in effect, is the statutory membership ofCommunity Safety Partnerships. The coremembership includes members and officers fromboth local government tiers; the Police, FARS,Health, Probation and Voluntary Services. Thepartnership boards are then supported by anofficer group locally.

If the HWBB, public health and others are seriousabout devolving resources and the associatedaccountability for improving well-being outcomesto localities then the local delivery should be via aco-created functioning unit modelled on this coregroup of stakeholders. There is a strong andconsidered rationale for restricting membership:

u Limit the diverse range of interests and helpmanage expectations

u Core RAG members are directly aligned tomain commissioning bodies, ie., county council,CCGs, OPCC, Public Health, District andborough councils

u Core RAG members have experience ofworking within the prevention and earlyintervention agendas

u All have experience of collaborative working;shared priorities and locality based outcomemeasures

u Majority of RAG members have representationon the HWBB

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5.3 Clinical Commissioning Groups (CCGs)

5.3.1 The Accountable Officers of the four CCGscovering Staffordshire were engaged in 1:2:1meetings with Task Group members. Their openand frank responses gave considerable support tothe principle of locality based commissioning andin particular, the focus upon well-being.

5.3.2 There was at this stage a clear consensus formingthat a Locality Commissioning Board built aroundthe core RAG membership and supported by the“host” authority and other locality based resourcescould be crucial in driving the local delivery ofwell-being outcomes.

5.3.3 The responses from CCGs. LSPs and discussionswith district/borough CEOs confirm that additionalsupport would be required and might include:

u A formal mandate yet flexible processes

u Admin & technical* support

u Adequate resources to support the task

u Skills appropriate to those delivering thetask

u Clarity of HWBB role, relationship andexpectations

* These will be factored in to the final conclusionand recommendations.

Localismenables

partnerships tomake Big

Society thrive

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6.1 The Feasibility

The earliest conclusion reached by the group wasthat this exercise was less about articulating therole of but rather examining the feasibility ofHWB strategic outcomes being achieved throughlocality based delivery.

In its efforts to establish a baseline position fromwhich to test both feasibility and sustainability, thefollowing facts were established:

1. Local authorities make a significant contributionto the improvement of well-being outcomesthrough the delivery of statutory and discretionaryservices. These range from strategic/policydecisions to daily transactions/services.

2. Local partnerships add value to the abovecontributions using a variety of methods,funding/resource streams and communityengagement and networking tools.

3. Statutory organisations across Staffordshire arerecognising the value of working through localitiesfor various reasons eg., local knowledge, access tonetworks; community engagement – in short- thebenefit of localism. This has led to the formal

recognition of “devolved accountability“ as a meansof supporting local delivery in a range of outcomefocused activities.

4. Improved outcomes are evident in thoselocalities where the aforementioned bodies havecome together with a shared view upon “whatneeds to be done”. The application of “commonsense for a common purpose” helped to removethe often self-imposed barriers to working incollaboration. The result in many cases has beenthe establishment of delivery or commissioningboards using agreed local frameworks in order toagree solutions; commission services and achieveimproved outcomes.

Example of Commissioning/DecommissioningFramework & Guidance can be accessed from: www.tamworth.gov.uk/sites/default/files/community_docs/Commissioning_Framework_Oct2013.doc

5. “Alongside not aligned” best describes themeans by which progress and achievement iscurrently measured. Local authorities feed a rangeof performance management systems that reflectoutputs and customer satisfaction. However; thereis no correlation between these measures and their

6CONCLUSIONS

We need acommon language,a ‘lexicon’ we canall use andunderstand.

“ “

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broader effect on say Public Health outcomes orlocally agreed well-being outcomes. For example:

u Tamworth Borough Council led anAffordable Warmth Campaign in 2011

a) It achieved its target of XXX contacts;b) It achieved its target of loft insulations;c) It distributed xxx information leaflets;d) It tested every council property for heat loss… and yet...

No mention of the fact that these actions madea significant contribution to the reduction inexcess winter deaths.

Conclusion 1: That the establishment of a LocalityCommissioning Board working to an agreedframework, working principles and lines ofaccountability is feasible.

Conclusion 2: That the feasibility and sustainabilityof said boards would be enhanced if built upon the‘best practice’ example as attached as Appendix 2,and based around core membership that led to thesuccess of Community Safety Partnerships.

Conclusion 3: Neither the strategic outcomes,service delivery outcomes nor commissionedactivity outcomes will provide a clear picture ofrecord of achievement/progress.

While the above outcomes are unlikely to be thesame, there needs to be a golden thread betweenthem. Given that the proposed key objective forLocality Commissioning Boards is to improvewell-being then it makes sense to use it as the key

outcome measure used to assess the impact ofcommissioned activities. There are a number oftools available.

Example of preferred tool; the Outcome Starcan be accessed from: www.outcomestar.org.uk

Conclusion 4: When evaluating the outcomesfrom initiatives/studies of this nature it is customaryto propose some form of “proof of concept” or“pilot” scheme. Given that each locality has someform of working model in place (albeit at differinglevels and varying standards) it is proposed that webuild upon existing models. Some are welladvanced and can be used as “benchmarks”,others will require both leadership and support inorder to function at the optimum level.

6.2 The Deliverability

6.2.1 Having established the feasibility of improving thewell-being outcomes of target populations throughLocality Commissioning Boards, the group’s lensnow focused upon the issues likely to affectimplementation. Key amongst these were:

a) Local partnerships are at different stages ofdevelopment and capability; are comprised ofdifferent groups and organisations and have avariety of skill sets and interests.

b) Some partnerships are further advanced in theirunderstanding and use of commissioning. Thesewill be nominated as “Examplars” and invited tocoach or mentor those partnerships seeking todevelop.

c) Political understanding and perception of ‘what’ theintentions are of this initiative varies as domembers concerns regarding how it may bedelivered.

* Proposals are set out in the recommendationsfor “Peer” support and mentoring forpartnerships. It is further suggested thatLocality Commissioning and related workingmethods be included as subject matters in bothMember and officer leadership training &development.

6.2.2 Having regard for these factors together with theother considerations discussed by the group, it wasconcluded that Locality Commissioning Boardswould make significant contributions to theimprovement of well-being outcomes effectivelyand efficiently through the adoption of agreedworking principles:

P1. Agreed Baseline: In order that each locality hasa consistent and relevant level of baseline datafrom which to identify priorities, it is proposed thatrefreshed eJSNAs and locality profiles* form theagreed baseline. * As produced by the Staffs.Observatory & Public Health Intelligence.

P2. Shared Priorities: Drawn from the agreedbaseline data, each locality will identifycommissioning priorities that will improve well-being outcomes of target areas/populations byadding value to outcomes achieved from bothmainstream and strategically commissionedactivities.

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P3. Aligned outcomes. Member organisationswill seek to align the outcomes planned frommainstream, strategic commissioning and localitycommissioning forming the basis of a localityoutcomes framework which will be a key elementof the performance measures that will be thesubject of governance, accountability and scrutinyevaluation.

P4. Shared measures. With ‘improved well-being’agreed as the primary outcome measure, eachlocality having agreed their shared priorities,specified the services and activities they plan tocommission, produce a register of theircommissioning intentions. These will then beshared with the other locality commissioningboards and strategic commissioners (eg., PublicHealth, OPCC, SCC, CCG) to both inform, avoidduplication and identify joint commissioningopportunities.

Then, using the preferred outcomes measuring tooleg., outcomestar, each locality will have a‘performance’ model linking all elements via theinfamous “golden thread”.

6.2.3The Commissioning Triangle. A simple tounderstand yet effective model that reflects themeans by which well-being outcomes can beinfluenced, commissioned and delivered at a locallevel. (See Page 13 overleaf.)

P5. To influence strategic commissions. Basedupon an almost universal perception that servicescommissioned at a strategic level result in activities“done to” not “done for” a locality. Whether thisis the case or not, the recognition that localitybased organisations are closest to the community

suggests that greater use of that relationship shouldbe applied.

The group concluded that locality boards couldand should have the means to engage with andinfluence strategic commissioners at the pointwhen they are developing specifications if notbefore. This would enable local knowledge to beshared but also create an opportunity to includewell-being as an outcome measure for eachcommission. Whether through Learning and Skills,Jobs and Growth or Crime and ASB improvedwell-being outcomes impact positively throughearly-intervention, prevention, diversionary activitiesor simply making people “feel good”.

Finally on this point, strategic commissioners mustcommit to the principle of ‘pooled resources’ atlocality level. This is not suggesting £xxx bedevolved but rather the principle of aligning ofresources to achieve shared ambitions, jointprojects etc locally is agreed.

P6. Locality based commissioning: Perhaps thepoint against which most localities have madegreatest progress to date. This involves localitycommissioning boards using their baseline data todevelop solutions that will then shapespecifications for the commissioning of servicesdesigned to deliver well-being outcomes. Thelocal outcome measuring tool would then trackprogress and impact on both the local issue butalso the boarder strategic outcome eg., fewerpeople accessing health services.

P7. Local providers: Evidence indicates thatsome localities successfully use voluntary sectorcommissioning for achieving outcomes in targeted

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populations. This point on the triangle proposesan extension of this concept and enables potentialproviders from all sectors to respond tospecifications, submit proposals/bids and deliverlocal services. Examples exist across the county ofvoluntary and public sector organisationssuccessfully delivering commissioned services andimproving local outcomes using this model and theadopted frameworks are referred to elsewhere inthis report.

P8. Accountability: The rationale for theestablishment of LCBs based on a series ofworking principles and not a prescribed, rigidmodel for adoption should be clear – the variationsin preparedness and state in development beingkey.

a) Governance:Accordingly, lines of accountability relative andproportionate to the individual LCB will be agreedand incorporated within the Terms of Reference.They will relate to: The governance requirementsof the HWBB; the local democratic mandate; thepolicies and procedures of the host authority andthe relevant performance and finance managementcontrols.

b) Public accountability:There was clear evidence of the challengesassociated with engaging local people in the workof LSPs. Unless represented on the partnership ora recipient of services, there was a disturbing“indifference” to engagement.

Rather than depart from the core task, arecommendation has been included pressing for areview of this key issue. Understanding the effectof commissioned services or the “so what”question will be key to performance and reviewprocesses.

Strategic Commissioning

KEY STAKEHOLDER GROUPCONSULT & INFLUENCE

COMMISSIONS

Localised Commissioning(Local Services/Solutions)

Strategic/LocalisedCommissioning

(Achieving Local Outcomes)

The Commissioning Boardagrees solutions/preparesspecifications to improve

Local Outcomes

The provider responds tospecifications & delivers Local

Services & Outcomes

Coming together is a

beginning. Keepingtogether is

progress. Workingtogether issuccess.

“

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6.3 CONCLUSIONS – The “Sustainability”

6.3.1 Prior to sharing the groups conclusions on theabove, two quotes offer food for thought:

“Working in genuine partnership is the day jobin this organisation; not something they have todo to save money”

Nicola BulbeckPeer Challenge Board

“Coming together is a beginningKeeping together is progressWorking together is success”

Henry Ford

6.3.2 Nice quotes; great theory however; it is all feasibleprovided that once again, participating organisationsadhere to a set of basic principles.

PS1. To commit to the principles and overarchingpurpose of Locality Based Commissioning.

PS2. To commit to revising and aligning resourcesin order to support the transition from a “work inprogress” to the “working method” in two tierlocal authority areas.

PS3. To commit to the principle of poolingresources, intentions and funding at a strategiclevel.

PS4. To work towards the devolution of resources,accountability, support and funding in order toinvest in locality based delivery.

PS5. To focus upon commissioning for outcomesand to work together to influence and not justspend.

PS6. To commit to the principle of developing thelocality agenda through the alignment with andultimately, the integration of Locality BasedCommissioning across all of Staffordshire’sStrategic Priorities and Workstreams.

PS7. To commit to sustaining LocalityCommissioning Boards by:

u Supporting innovation

u Investing in partnerships

u Training all who require it

u Plan, measure and evaluate all we do

u Maximise the benefits of all resources: Assets;People’ Funding’ Knowledge.

* It is recommended that a Memorandum ofUnderstanding specific to each locality besigned and thereby reflecting these principles.

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6.3.3 LCBs can provide the consistency and security thata safe environment provides. Safe because quitesimply members are all there because theirorganisations share the same ambitions; haveagreed the same priorities; agreed solutions bornfrom collaborative problem solving and a processthrough which services are commissioned toimprove outcomes.

6.3.4 To make best use of their unique position at theheart of local communities, LCBs need to functionat the heart of locality delivery. In doing so, it notonly enhances their influence over a wider range ofcommissioners but also provides the local focusupon well-being outcomes.

HEALTH & WELLBEING BOARDu Improved wellbeing in target population

reduces demand for H&SC servicesu Involvement in activities to support

wellbeing in their own communitycontributes to care plans and supportsdoscharge in H&SC services users

LOCAL ECONOMIC PARTNERSHIPu Involvement in producing activities for wellbeingcan develop work skills and increase aspirationsu Wellbeing activities provide a positivediversion for those experiencingunemployment

LEARNING & SKILLSu Children with high levels of wellbeing

have higher levels of academicachievement and are more engaged inschool

u Keep learning is one of the five ways towellbeing. Therefore, learning activities arealso activities to promote wellbeing

OFFICE FOR POLICE & CRIME COMMISSIONER

u Wellbeing activities are an earlyintervention and positive diversion

u Increased social ties, community trust anduse of community space improves public

confidence and reduces fear of crimeu Involvement of offenders in wellbeing activitiesreduces reoffending

LOCALITY COMMISSIONING BOARDS

Work with communities to understandneeds and assets.

Contribute to Staffordshire JSNA and informstrategic plans.

Commission activities to promote the wellbeing of ourcommunities.

Proportionate universalism - all communities havepotential benefit but resources should be weightedtowards those with greatest need/potential fornegative outcomes.

Achieve through community empowermentand development. The process is asimportant as the activity itself as anintervention to improve wellbeingand enhance personalresponsibility

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7.1 Context: The workstreams and detailed findingsarising from them have provided a highlyinformative profile on the role and contributions ofdistricts/boroughs and their partners in relationHealth & Well-being.

7.2 In order to provide clarify and a genuine focusupon the Health & Well-being Strategy, theconclusions and related recommendations makethe connection between locality based activitiesand well-being outcomes.

7.3 Equally clear are the variations and differentials inexistence at Locality levels. However; it is thecommonalities, shared ambitions and enthusiasmthat provided the compelling case for a pan-Staffordshire approach through locally agreedframeworks ie., No ‘one size fits all’ model.

7.4 The key findings, conclusions and recommendedworking principles are essential to progressingbeyond this point. Furthermore, for therecommendations to have meaning and influence,the Board are asked to agree in principle theevidence base supporting the followingrecommendations.

7RECOMMENDATIONS

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Strategic

1. That District/Borough Councils in Staffordshire beinvited to host and support the establishment of ortransition to a stakeholder group to function as aLocality Commissioning Board (LCB).

2. That the purpose of the relationship betweenLCBs, the HWBB and other strategiccommissioners be the achievement of Well-beingoutcome measures locally through thecollaborative commissioning of services andactivities designed to influence, invest andintervene in local improvements.

3. That strategic commissioning organisationscommit to the principle of collaborativecommissioning; shared intentions and pooledresources in support of LCBs and other emerginglocality and integrated commissioning initiatives eg.,Integrated Commissioning.

4. That strategic commissioning organisationscommit to the principle of incorporating Well-being Outcome Measures within futurespecifications and commissioning plans.

Locality

1. That District/Borough Councils in Staffordshirecommit to the establishment and development ofLocality Commissioning Boards.

2. That the membership, working practices andprinciples be based upon the conclusions andrecommended “best practice” referred to in thisreport.

3. That the relationship between LCBs and theHWBB/Strategic commissioners form the basis ofan agreed Memorandum of Understanding (MoU).

4. That the MoU reflect the agreed localcircumstances, fitness for purpose and resourcelevels for each locality. This will include the well-being outcome measures to be reported toHWBB.

5. That governance and accountability protocolsreflect the nature and status of localactivities/services commissioned.

6. That LCBs commit to the ongoing developmentof skills, knowledge and learning necessary for theefficient undertaking of the agreed function.

Generic

1. That the Task & Finish Group be retained as aLocality Commissioning Advisory Group tosupport the HWBB and Programme Directormanage the developing relationships with LCBs.

2. That the HWBB CEO representative bedesignated as “sponsor” for locality basedcommissioning.

3. That the LCAG work with the ProgrammeDirector to develop:-

a) Training & Development Plans (Officers &Members)

b) Governance & Accountability protocol tosupport each MoU

c) Performance & Outcome reporting measuresfor the HWBB

d) Provide Peer support for LCBs

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Appendix 1 - Letter of invitation

8APPENDICES

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Appendix 2

South Staffordshire Locality Commissioning Partnershipstructure:

The South Staffordshire Locality Commissioning Partnershipbrings together key people to improve outcomes forbusinesses and residents throughout the electoral district ofSouth Staffordshire.

HistoryThe Locality Commissioning Partnership (LCP) is an evolutionof strong partnerships and locality working structures thathave delivered outcomes in South Staffordshire for manyyears. The structure brings together a range of previouspartnership arrangements into one. The LCP was created toaccommodate change occurring around commissioningnationally and county wide, for example with thedevelopment of Police and Crime Commissioners and CCG’s.As a result, the partnership continues to be in a healthyposition where it can continue to deliver outcomes.

StructureThe partnership structure has three key components asshown in figure 1:

Figure 1, Locality Commissioning Partnership Structure

Where resource is required to deliver outcomes, the LCP hastwo routes.

1. An annual Commissioning Prospectus is publishedbased on the LCP’s shared district outcomes. Grantsare awarded on a payment by result basis, contractlengths are 12 months plus and values are in excess of5k. Monitoring is conducted through Upshot, a cloudbased outcomes monitoring tool accessible even onmobile devices. Providers are requested to submit shortvideo clips to populate social media channels includingYouTube. www.southstaffspartnership.co.uk/about-the-partnership/commissioning-funding-and-grant-opportunities.html

2. A Community Budget programme operates to fostercommunity resilience. Communities are given theopportunity to submit there own project proposals toimprove outcomes in there own community. TheCommunity Budget has four funding rounds a year.Grants are awarded for small value projects lasting up to

12 months.www.sstaffs.gov.uk/your_services/your_community/community_funding/community_budget.aspx

The Commissioning Prospectus will be launched in Octoberof each year, scoring will be completed in December andprojects confirmed by early January allowing initiation in April.Community Budget scoring panels will align with the OPCCPeople Power grants. In both instances, budget holders orcommissioners will form the decision making panels. Thebenefit of bringing local commissioners and budget holderstogether on the panels for the district should reduce anyissues around duplication of services and increasecollaborative commissioning.

Insight The Commissioning Partnership creates an annual LocalityProfile that presents the current qualitative research andquantitative data for each of the five localities and the district,compiled from all available information. Uppermost outcomeareas based on data are then produced and consulted upon.These are currently Alcohol, Obesity, Dementia, RuralIsolation and Mental Wellbeing.

Locality Profile: www.southstaffspartnership.co.uk/date-and-intelligence/locality-profiles.html

ConsultationConsultation then takes place with members, customers andthe voluntary sector through an annual reoccurring suite ofengagements called My Place My Say. Every locality is visitedthroughout the year, different age groups are targeted andsocial networking is used to ensure everyone is involved in aconversation with the partnership. In addition, widerpartnership events are hosted at the Council and MasterClasses are held for parish, district and county councillors.

My Lace My Say: www.sstaffs.gov.uk/pdf/MPMS%20Consultations%20Cycle%202014-2014.pdf

Component Key function

1 A Leadership Board that sets the LCP’sstrategic vision. Attended by seniorpoliticians and leading strategic partnerscovering the district. This groupidentifies and influences commissioningat both district and county wide levels.

Influencing

2 A Locality Commissioning Partnershipgroup that defines district outcomes andcommissions in collaboration. Attendedby commissioners covering the district.

LocalityCommissioning

3 Finally, a range of Theme Groups(currently 5) that deep dives into theoutcome area then provides bothrecommendations back to the LCP anddelivers innovative no cost low costsolutions. Attended by both providersand commissioners and draws oncustomer insight.

No cost lowcost, andinnovativeapproaches

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ResourceSouth Staffordshire District Council has undertaken aleadership role for the LCP, pulling key partners togetherthroughout the re-modelling process. The DistrictCommissioning Lead (DCL) performed a key role in linkingthe County Council commissioners and the district together.Having strong trusting relationships and a willingness to dothings differently at all levels have been essential ingredientsto drive forward the LCP. Key staff are all co-located in thesame district office bringing a wealth of knowledge andexpertise together, they include:

Partnership Manager, Transformation Co-ordinator, PublicHealth, DCL, Children’s Commissioner, Community Safety,CPO, CCG, Insight and Comms.

A critical unique resource has been both the PartnershipManager and Transformation Co-ordinator who are both onsecondments from either the County Council or CCG.These roles have helped drive forward change at pace,facilitated the partnership and built the relationships requiredwith countywide commissioners to influence futurecommissioning intentions at a local level.

One of the current challenges for the district is managing thelarge and growing number of locality funds that aim toimprove Health and Wellbeing outcomes. At present, localityfunds come into the district at different times, from differentorganisations, some with short timescales for delivery eachwith there own separate outcomes. Bringing together thesefunds into one prospectus with all commissioners agreeingshared outcomes fosters collaborative commissioning. TheLCP this year has been able to align OPCC, Public Health,District Council and BRFC funds. Next year CCG’s voluntarysector grants will also be aligned now the LCP timescales runconcurrently with the CCG.

Delivery The Locality Commissioning Partnership performs a brokeringrole between all the different county wide commissioners,district partners, providers and residents that enablescollaborative commissioning throughout the district. Thisincludes facilitating partners locally to deliver better outcomestogether, looking also at no cost low cost solutions. Inaddition the partnership actively seeks out county and nationalcommissioning intentions aligned with the five outcomes, forexample the delivery of Dementia Friendly Communities.The partnership also brokers and works with commissionersto improve collaboration locally, for example with CCGvoluntary sector grants.

The voluntary and community sector has a huge role to playin delivering outcomes with businesses and residents in SouthStaffordshire. Village Agents are commissioned through thePartnership, including the CCG to be a person on the groundin each locality working closely with the community toimprove outcomes around wellbeing, for example workingwith young people and the police to create afterschool sportsclubs.

Village Agents: www.staffs.org.uk/villageagents.html

The district is also embarking on a transformational venturecalled The Good Life that will connect communities with oneanother to improve health and wellbeing. The Good Lifebuilds on the existing website that’s full of local informationand the Connect bus service bringing a single positivemessage for people to live a Good Life in South Staffordshire.All outcomes that aim to improve people’s health andwellbeing through the LCP will be branded and deliveredthrough The Good Life.

The Good Life: http://southstaffordshire.thegoodlife.uk.net/

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The Vision, Purpose and Core Values of the LocalityCommissioning Partnership are:

Our visionTo provide an integrated commissioning infrastructure thatdelivers prioritised outcomes based on local need.

Our PurposeThe purpose of South Staffordshire Partnership is to:

u Be the ‘partnership of partnerships’ within SouthStaffordshire providing strategic co-ordination andlinking other plans and bodies at local, sub regionaland regional levels

u Prepare and implement a Community Strategy thatprovides a long term framework for action to benefitall the people of South Staffordshire

u Work with Staffordshire County Council and otherkey partners to develop and deliver and theoutcomes

Our Core Values:

u Sustainability - we are looking at the long-termimplications of current activities while taking intoaccount the wellbeing of future generations as wellas the current generation of residents

u Engagement – we will actively involve the residentsof South Staffordshire in both the development andimplementation of the Community Strategy

u Equality – we will provide services that areaccessible and appropriate to the needs of allirrespective of disability, gender, racial or ethnicbackground, religion or culture

u Diversity – we believe that everyone in SouthStaffordshire deserves to receive excellent servicesthat reflect their individual needs and circumstances

For more information, please contact: Imre Tolgyesi,imre.tolgyesi@staffordshire.gov.uk

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“Leading Connected Staffordshire”(Staffordshire County Council Strategic Plan)

“Living Well in Staffordshire”(Staffordshire HWB 5 Year Plan)

“District Action on Public Health”(District Council Network publication)

Healthier Housing Strategy 2011-2014(Tamworth Borough Council)

Commissioning Frameworks/Best Practice Guides(various)

Housing & Health Bulletins(Learning Information Network)

9BIBLIOGRAPHY

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All Staffordshire Council Leaders & Chief Executives

All Staffordshire LSP/Partnership Managers

CCG Accountable Officers

All Staffordshire LSP/Partnership Board Chairs & Members

Task & Finish GroupAliko Ahmed DPH – Staffordshire County CouncilRob Barnes Director, Tamworth Borough CouncilDanny Cook Leader, Tamworth Borough CouncilAndrew Donaldson Staffordshire County CouncilJohn Fraser Stafford Borough CouncilAnna Hammond SES & Seisdon CCGLucy Heath Public Health Advisor (SCC)Sander Kristel Staffordshire County CouncilTim Leese DCL Staffordshire County CouncilAmanda Stringer Staffordshire County Council TSU (Task & Finish Group – Lead Support Officer)Helen Titterton Lichfield District CouncilImre Tolgyesi South Staffs District CouncilJon Topham Public Health Advisor (SCC)

10ACKNOWLEDGEMENTS

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Staffordshire Health & Well-Being Board

ACHIEVING STRATEGIC OUTCOMESTHROUGH LOCALITY-BASED DELIVERY

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