An overview of the NHS - Community Works · 2018-03-28 · Improve sustainability and quality of general practice Access standards for A&E and ambulance waits NHS Constitution targets-

An overview of the

NHS

Angela Baker

Firstly… Who am I and what do I do…

Public Health England – South East

• PHE’s role

• Local Authority

• Wide Workforce

• The public health family

• Policy and strategy

• Assurance over ring fenced grant

2 Fire as a Health Asset 15/2/17

So what is “the system” 2012 Health and Social Care Act changed things….

• PCT’s put CCG’s in

• NHSE created to replace SHA’s

• Public Health into Local Authority

• Commissioning/provider split

• Contracting and performance management

• Cost effectiveness goes up the agenda

• Rationing comes in


https://www.kingsfund.org.uk/projects/nhs-

65/alternative-guide-new-nhs-england


https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england














Fire as a Health Asset 15/2/17 5

Funding Streams


Dept of Health

PHE NHS England

4 REGIONS

15 AREA TEAMS

211 CCG’s

4 REGIONS

9 CENTRE TEAMS

151 Local

Authorities

So what about STP’s…


• PCT’s “failed” because they were too small so

211 CCG’s was always going to be a problem

• Conflict between standard service and meeting

local population needs – postcode lottery

• NHS is significantly overspending

• NHS estate is old and not fit for purpose

• Scale and speed of medical advancement

The details…. STP is a new planning framework for NHS services

Announced in December 2015

STPs are:

Based on regional footprint rather than single organisation

Multi year – from October 2016 – March 2021

Cover full range of NHS provision and expectation that local government care provision will also be part of the framework

Help to close 3 gaps - health & wellbeing, care & quality and finance & efficiency by planning & delivering at scale

Access investment from the Sustainability & Transformation Fund

Includes all Acute Hospital Trusts & Local Authorities, NHS Community & mental health providers

STP to be led by ??

STP Programme Board in place since March 16


Where do they fit?

Devolution

Vanguards

New Models of Care

Integration of health and social care

NHS Constitution

5year forward view for General Practice

So not the only show in town, but probably the biggest!


What are STP’s trying to do?

Health Gap

Quality Gap

Financial gap

About place and people, bringing care into community, getting people to

manage own care


Must Do’s? Develop STP

Return system to financial balance

Improve sustainability and quality of general practice

Access standards for A&E and ambulance waits

NHS Constitution targets- sustained improvement

Cancer waiting times

Mental health targets- EIP, IAPT & dementia

Transforming care for patients with LD

Improvements in quality


Devolution Devolution is the statutory delegation of powers from the central government

of a sovereign state to govern at a subnational level, such as a regional or

local level. It is a form of administrative decentralization. Devolved territories

have the power to make legislation relevant to the area.

Devolved powers of the subnational authority may be temporary and are

reversible, ultimately residing with the central government.

Legislation creating devolved parliaments or assemblies can be repealed or

amended by central government in the same way as any statute.

The Secretary of State for Health has already devolved his powers to NHS

England and therefore responsibility for Health can not be devolved from

NHS England. In Manchester, they have appointed a joint NHS England

appointed Chief Operating Officer to overcome this difficulty


Accountable Care Organisations What are ACOs?

An ACO brings together a number of providers to take responsibility for the

cost and quality of care for a defined population within an agreed budget.

ACOs take many different forms ranging from fully integrated systems to

looser alliances and networks of hospitals, medical groups and other

providers.

ACOs have attracted interest as one way of overcoming fragmented

responsibility for the commissioning and provision of care in the NHS. They

are a practical expression of ‘place-based’ working under which NHS

organisations and their partners agree to collaborate in order to meet the

needs of the population they serve. There has been particular interest in

ACOs in areas of England involved in the new care models programme.


ICS’…


Questions..


But possibly

no answers

http://www.magicalmaths.org/wp-content/uploads/2012/11/questions_answers_8.gif

Coffee, tea and comfort break


Using hooks and

levers to create

influence

So what’s the problem?

Public Health is about doing things with a population to improve health outcomes

So why do we struggle to get our messages heard?

Take a few minutes to think about what the barriers are

18

Barriers to health messaging • Nanny state, don’t tell us what to do

• We don’t have the money

• Its not an Authority priority

• The savings are in the wrong place

• Its someone else's job

• Politically sensitive

• Economically doesn’t make sense

• Social differences depending on initiative

• Technically difficult to measure results

19 Presentation title - edit in Header and Footer

Remember…

Information in itself does not lead to change…

we know this from our behaviour change

evidence so… do not expect information on its

own to change how your system works – YOU

NEED ACTION!


What are your hooks? The hooks are the people that you might wish to

influence.

Who do you want to influence?

take a few minutes to list your stakeholders


The people in your system • Councillors

• CCG’s and more recently STP’s

• Population

• Peers and other LA colleagues

• District/other council organisations

• 3rd sector

• Providers

• PHE and other assurers of the system


Types of people


Logical

Carer

Enforcer

Passionate

Its just logical • Analytical

• Evidence based

• Cool, calm collected

• Emotion doesn’t work

• Independent thinker

• Always asking why

• A thinker not a doer

How can you influence these people?

These people ask “why”


Personal, carer • Enthusiastic

• See the world through others experience

• Sympathetic

• Flexible

• Will see all sides of the situation and be able to put them in others situations

How can you influence these people?

These people ask “do we all agree?”


The enforcer • Loyal

• Dependable, does what they say

• Follows the rule book

• Sensible, punctual

• Caring and concerned

• Helpful

How do you influence the enforcer?

These people will ask “what’s the plan?”


Passionate

• Witty, fun, charming

• Impulsive

• Generous

• Optimistic

• Eager

• Bold

• Risk taker

How do you influence this person?

These people ask “where is the action?”


To recap So far

1. Identify what you think the barriers might be

2. Identify the key players and what personality type that might influence them


Remember

you can only change what you do and how you behave, if you want others to act differently you need to approach it differently

Exercise Identify three key players in your system

• CEO

• Director of Adult Social Care

• Your Boss

What personality type are they?

How can you improve your communication with this person?


What levers do you have at your disposal?


So, what are the levers

• Strategies

• Plans

• Targets

• Dreams

• Evidence

• Identified problems

• Research

• Personal interest

• Processes, Health impact assessment, equity audits and statutory responsibilities

Exercise Take the West Sussex CC strategy

What are the top three priorities ?

“Our three core priorities are:

• giving children the best start in life

• championing the West Sussex Economy

• promoting independence in later life.”

What are your personal public health objectives/priorities? How do they fit?


Exercise continued… Take your priority

• Who do you need to influence?

• What things drive them?

• Can you identify levers that will help you

• What’s your plan?


Discussion What are you going to do differently?

How does it feel?

This is personal, what happens if you think of this broader, as a team?

Personal learning?

Last comments/questions/thoughts?


Contact

[email protected]

Angela Baker,

Deputy Director, Health and Wellbeing

PHE South East


mailto:[email protected]

Documents

An overview of the NHS - Community Works · 2018-03-28 · Improve sustainability and quality of general practice Access standards for A&E and ambulance waits NHS Constitution targets-