Policy to Practice

Debra Moore Managing Director

Debra Moore Associates

Welcome and introductions

HousekeepingShape of the day

Policy Context

In this session

Consider current policy context and potential future directions and implications

The Policy Context

• On your table – caption about health?

A New Coalition - values

• Freedom• Fairness• Responsibility

Key messages – increasing choice and control

• Put patients in charge of making decisions about their care, including control of their health records.

• Every patient will be given the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.

Key messages – Public Health• We will give local communities greater control over public

health budgets with payment by the outcomes they achieve in improving the health of local residents.

• We will give GPs greater incentives to tackle public health problems.

• Improving access to preventative healthcare for those in disadvantaged areas to help tackle health inequalities.

• Greater access to talking therapies to reduce long-term costs for the NHS.

• Re-focussing of early intervention programmes such as Sure Start – 4,200 extra Sure Start Health Visitors

• Priority on dementia research and development• New Dentistry Contract• More Support for children’s hospices

Key messages - offenders

• Explore alternative forms of secure treatment based accommodation for mentally ill and drugs offenders.

• A ‘rehabilitation revolution’ – paying independent sector providers to reduce re-offending

Key messages - commissioning• Strengthen the power of GPs as patients’ expert guides

through the health system by enabling them to commission care on their behalf

• The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.

• Responsibility for improving public health for people in their area, working closely with the local authority and other local organisations.

• Local Authority – right to challenge health• Independent Reconfiguration Panels• Publish performance data online

What about Fairness?

Equality Act 2010

• Received Royal Assent on 8th April 2010

• Will simplify all legislation re- discrimination into single Act

• Replaces Disability Discrimination Act

• Offers new forms of protection to ensure that disabled people do not face ‘substantial disadvantage’

Evidence of substantial disadvantage?National

• Bradley• Mansell 1 & 2• Mansell PIMLD• DRC• Mencap • Michaels

Evidence of substantial disadvantage?Proxy Indicators?

• Progress on Green Light• Progress on Offender health for LD• Progress on ‘Mansell’• Number of people in OATS• Employment • ‘Congregate settings’• Healthcare including health checks, HAPs etc• Acute Liaison including mental health

How can we conceptualise the future?

6’s Model6 Core Outcomes to achieve

Each outcome has a set of key principles to guide commissioning and service delivery and examples of the types of evidence for each principle

1.Centredness• Putting the person and their family at the centre – personalised services that

are dignified and respectful of individual needs

• Person centred approaches underpin practice and service delivery• Partnerships are built that promote and support the needs of individuals and

their families• A range of communication tools and approaches are available and employed to

meet individual need• People who use services and their families are involved in service planning and

evaluation at both strategic and individual level• The service can demonstrate that service developments are based on the

needs and wishes of the local population

• Centredness• Community• Citizenship• Commissioning• Competence• Checking

2. Community• Promoting health and wellbeing, focusing on

prevention and early intervention and delivering services close to home

• People are able to access individualised support, close to home and in the least restrictive setting

• Skilled specialist support is available to ensure the availability of early intervention, assertive outreach and crisis intervention

• People should be supported in accommodation that meets their individual needs and promotes health and wellbeing

• Specialist health professionals work in partnership with local authority colleagues to include people with complex needs in opportunities to increase choice and control e.g self directed support

• Partnership working promotes, maintains and facilitates key relationships and the use of mainstream services within the community

• Centredness• Community• Citizenship• Commissioning• Competence• Checking

3. Citizenship

• Increasing choice and control, promoting inclusion and a ‘rights based approach’

• Services are provided that maximise individual choice and control

• People are supported to develop a social network and utilise natural and universal supports

• There is clear understanding, and promotion, of legal and civil rights

• Inequalities are identified and challenged

• Centredness• Community• Citizenship• Commissioning• Competence• Checking

4. Commissioning

• Working in partnership to deliver improved outcomes and reduce inequalities

• Commissioners and health and social care providers work together to promote health and wellbeing and reduce inequalities – ensuring benefit from intiatives such as world class commissioning

• Specialist learning disability services are commissioned to provide support and advice to mainstream health services and social care as well as directly serving those with the most complex needs

• There is access to a range of community based specialist learning disability services • Centredness

• Community• Citizenship• Commissioning• Competence• Checking

5. Competence

• Developing skills and knowledge within services and within people who use services, their family carers and supporters

• Local workforce development strategies are comprehensive and account for the need to develop capacity and capability in the community and in mainstream health and social care

• Workforce development strategies demonstrate the requirement to develop specialist skills and knowledge in both specialist community and in patient settings

• Use of person centred approaches underpin all activity relating to personal and organisational development and service delivery • Centredness

• Community• Citizenship• Commissioning• Competence• Checking

6. Checking• Ensuring services are high quality, clinically effective and safe

• Robust performance systems are in placed that are able to translate policy and best practice into useful metrics and monitor progress and delivery

• People and family carers are at the centre of, and participate in, standard setting, performance monitoring and service evaluation

• Quality is ‘everyone’s business’ and all staff are encouraged to look at the way they ‘measure what matters’ in their work and make best use of person centred plans and health action plans to assess outcomes

• Strategies are in place to protect vulnerable adults

• Centredness• Community• Citizenship• Commissioning• Competence• Checking

Delivery?

Vision and the way forward?

• Not taking a ‘one or the other’ approach to specialist LD and generic mental health services

• Need for parallel developments across both arena’s

• Direction determined by patient needs

• Good, robust arrangements locally• A pathway that enables patients to

get the best of both

Commissioning

“With inequalities high on the political agenda it may be the case that a regional or supra-district focus is required when planning services because of the numbers involved and to ensure expertise and cost effectiveness of services”

(Chaplin et al 2009)