MIDDLESBROUGH COUNCIL

EXECUTIVE REPORT

Health and Well Being Joint Commissioning Group

Executive Member for Public Health and Sport – Cllr Brenda Thompson

Executive Director of Social Care - Mike Robinson

14th December 2010

PURPOSE OF THE REPORT

1The purpose of this report is to propose the merger of the LAA Joint Investment Programme Steering Group and the Healthy Town Programme Board to establish a Health and Well Being Joint Commissioning Group (JCG) for Middlesbrough.

SUMMARY OF RECOMMENDATIONS

2The Executive are recommended to approve:

  • the development of Middlesbrough Health and Well-Being Strategy and receive a further report outlining the structure, content and timetable to complete the strategy;
  • the development of a Health and Well-Being Joint Commissioning Plan;
  • the establishment of a Health and Well Being Joint Commissioning Group (JCG) to implement the Commissioning plan by January 2011.
  • that all future financial decision making related to the current JIP and Healthy Town Programme Board be made by the newly established JCG, from January 2011.

IF THIS IS A KEY DECISION WHICH KEY DECISION TEST APPLIES?

It is over the financial threshold (£75,000)
It has a significant impact on 2 or more wards
Non Key / x

DECISION IMPLEMENTATION DEADLINE

3For the purposes of the scrutiny call in procedure this report is

Non-urgent / x
Urgent report

If urgent please give full reasons

BACKGROUND AND EXTERNAL CONSULTATION

LAA Joint Investment Programme (JIP)

1In 2008, Middlesbrough PCT made available £500k on a recurring and matched funding basis to facilitate joint investment against shared priorities within the LAA, Corporate Plan and Annual Operational Plan between the PCT, Local Authority and other partners where appropriate. The programme was referred to as the Joint Investment Programme.

2The focus of the Joint Investment Programme was to commission outcomes for the shared and agreed priorities within the LAA, Council Strategic Plan and PCT Annual Operating Plan.

3The aim of the JIP was to identify gaps in provision and bridge shortfalls in services through new investment and reinvestment, which would reshape health and social care services in Middlesbrough.

4In order to allocate and monitor the JIP funding in accordance with local priorities, a Steering Group was established, which included representation from a range of strategic stakeholders from Middlesbrough Council and Middlesbrough PCT; at Departmental Head and Director level.

5The JIP has been a success in Middlesbrough with the steering group overseeing a 3-year investment programme with £1.5m PCT funding and matched funding from the Council of £1.25m in 2008/09; £880k in 2009/10; and £890k in 2010/11. Investment has supported the following areas of work linked to LAA priorities:

  • Families First
  • Disabled Facilities Team Grant
  • Integrated Transitions Team
  • Rapid Response team
  • Swimming for over 60s
  • Cycling infrastructure and initiatives in Middlesbrough
  • Middlesbrough Elite Mile
  • Stroke Psychology support services
  • Middlesbrough Healthy Town Programme
  • Active for Life groups

6There will not be another round of Local Area Agreements post March 2011. However, the health and social care priorities for the town have not shifted significantly and are still broadly reflected by current LAA indicators. Furthermore, the JIP steering group has functioned effectively as a joint commissioning team around a focused set of priorities. For these reasons, discussions are taking place within the PCT to secure further funding for 2011/12 to commission successful health and well-being interventions.

7In March 2009, the PCT provided a further £500k funding to develop work to support people being made redundant with a focus on minimising the health-related effects of unemployment and redundancy. The JIP steering group was responsible for overseeing the successful commissioning of this additional programme. The performance and management of this work has been successfully coordinated and managed through the Regenerations Programme team and the JIP steering group will continue to receive updates on performance and outcomes in relation to the redundancy health programme.

Healthy Town Programme Board

8In December 2008, Middlesbrough was awarded ‘Health Town’ status and allocated £4.1 million grant from the Department of Health (DoH), over a three year period, to build on existing work in Middlesbrough and test out ideas on what additional interventions would make local residents more active, eat healthier and adopt helathy lifesyles. A diverse range of 42 projects and activities are currently funded from both the DoH grant and approx £5 million in matched funding. Just over £1 million of this match funding has come from the PCT. The four main themes of the programme are around urban farming/local food growing, physical environmental improvements, active travel and youth. The initiative is backed by a social marketing process and external evaluation.

9A multi-agency Healthy Town Programme Board and Management Team were established to oversee and ensure delivery of the programme. Membership of the Programme Board and Management Team includes representation from the PCT, the Council, the voluntary & community sector and the academic sector.

10The Healthy Town funding ceases in March 2011. The Programme Board and Management Team will continue in their present roles, until that date. Some projects within the Healthy Town Programme will come to a natural conclusion at the end of March 2011. Other projects have been mainstreamed successfully within existing resources. The Programme Board has considered all projects as part of an exit strategy and recommended a limited number of important projects that they would wish to be considered for future funding. This amounts to 5 of the 42 activities.

11However, the decision for further funding can and should only be made alongside other competing priorities to achieve public health and wellbeing outcomes identified in the Joint Strategic Needs Assessment (JSNA).

Equity and Excellence: Liberating the NHS (White Paper)

12The Health White Paper, 'Equity and Excellence: liberating the NHS' represents possibly the most radical restructuring of the NHS since its inception. The Government’s intention to introduce statutory Health and Well Being Boards is relevant to this report.

13The primary aim of the Health and Well Being Boards will be to promote integration and partnership working between the NHS, social care, public health and other local services and improve democratic accountability. Whilst the detail will be published in a White Paper expected December 2010, the anticipated functions can be summarised as follows:

  • Lead the Joint Strategic Needs Assessment
  • Promote integration and partnership across an area
  • Support joint commissioning and pooled budget arrangements
  • Undertake a scrutiny role.

EQUALITY IMPACT ASSESSMENT

14An initial equality impact assessment has been undertaken and is appended to this report. It found that there would be a positive impact on all groups because it will help to improve the quality of activities undertaken to tackle health inequalities across the town.

OPTION APPRAISAL/RISK ASSESSMENT

OPTION 1

15Both the Joint Investment Programme Steering Group and Healthy Town Programme Board will cease in March 2011.

16This would mean there would be no partnership forum to jointly commission health and well being activities to improve outcomes for the residents of Middlesbrough.

17In addition the Council will be at risk of not being fully prepared to respond to the implications of the Health White paper.

OPTION 2

18The JIP Steering Group and the Healthy Town Progrmame Board/ Management Team have both functioned effectively as commissioning bodies over the last 2-3 years. Whilst the detail is still to be published, there will be a clear need to establish an effective commissioning group for Middlesbrough that focuses on health and wellbeing outcomes. It is likely that future Health and Wellbeing Boards will require this commissioning expertise to fulfill its role.

19Given the cessation of the DoH funding for the Healthy Town project in March 2011, the abolition of LAA targets, and the proposed changes in commissioning arrangements in the NHS, it is proposed to:

  • develop a Middlesbrough Health and Well-Being Strategy – a top level strategy for improving the health and well being of all the population (adults, children and families);
  • develop a Health and Well-Being Joint Commissioning Plan;
  • establish a Health and Well Being Joint Commissioning Group (JCG) to implement the Commissioning Plan; and
  • bring all future financial decision making related to the current JIP and Healthy Town Programme into a newly established JCG.

Middlesbrough Health and Well-Being Strategy

20It is proposed to develop a top-level strategy for improving the health and well-being of all the population (adults, children and families).

21The strategy will reflect the priorities identified in the JSNA and set out the overarching vision and priority outcomes for health and wellbeing in Middlesbrough, and bring together all health elements in existing strategies, including:

  • Sustainable Community Strategy
  • Children and Young People Plan
  • Mental Health Strategies
  • MiddlesbroughCouncil Physical Disability Strategic Plan
  • Older Peoples MentalHealthStrategy
  • Obesity strategy
  • Etc.

22The proposed structure, content and timetable to complete the plan will be presented to a future meeting.

Middlesbrough Health and Well-Being Joint Commissioning Plan

23The purpose of the joint commissioning plan will be to map activities against each priority, identify gaps and actions to deliver the strategy.

Middlesbrough Health and Well Being Joint Commissioning Group (JCG)

24The Health and Well Being JCG will have representatives from a number of strategic stakeholders. The precise detail around membership would be delegated to the existing JIP steering group, working with representatives from the Healthy Town Programme Board. It is envisaged that members will be Head of Service/ Director level.

25The role of the JCG will be to ensure the Health and Well Being Strategy and commissioning plan are implemented and delivered by commissioning local services to improve public health and wellbeing against an agreed set of guiding principles.

26It is proposed to establish the Joint Commissioning Group with agreed terms of reference by January 2011. It is anticipated that budgets for public health and well being from the PCT and Council will be aligned and managed through the JCG to deliver the agreed Health and Well Being Strategy and commissioning plan. Terms of reference and governance arrangements will need to be agreed between NHS Middlesbrough and Middlesbrough Council as resources become available for 2011/12.

27Early decisions are required however concerning the future funding for specific JIP projects and the continuation of specific Healthy Town projects. This is dependent on further PCT funding, matched funding from Middlesbrough Council as well as decisions around indicative public health budgets for 2011/12. It is proposed the current JIP Steering Group, with Healthy Town Programme Board representation, assumes these roles and is responsible for interim decision making around joint public health and health improvement investment until the JCG is established. This will ensure continuity and provide assurance around governance and decision making since the existing memorandum of understanding would still apply.

28A Memorandum of Understanding for joint decision-making was produced for the LAA JIP. This required reports on progress in investing the fund, and delivery of individual programmes from the fund to be made to the Executive Teams of the Council and PCT. This process worked well and it is proposed that this Memorandum of Understanding will form the basis of the Terms of Reference for the JCG subject to amendments, to reflect amongst other things the requirements of the emerging changes to Government policy on Public Health.

29At its Executive Board meeting, 27 September 2010, Middlesbrough Partnership agreed to fundamentally review its structure to ensure it met the changing partnership landscape and responded to the coalition government policy. This will include reviewing the role and remit of the existing Health and Social Care Partnership and its relationship with a new statutory Health and Well Being Board. The JCG will be needed in future structures as the statutory Health and Wellbeing Boards assume a joint commissioning function. Until final decisions are made concerning LSP theme groups, the JCG will ensure the current Health and Social Care Partnership is involved in decision making (where appropriate) and kept informed of important decisions.

30The diagram below illustrates the proposed interim governance structure

FINANCIAL, LEGAL AND WARD IMPLICATIONS

31Financial – There are no direct financial implications as a result of this decision.The purpose of the JCG will be to more effectively target existing resources.

32Ward Implications – There are no direct implications to any wards, however the purpose of the JCG will be to target activity to those wards where health inequalities exist.

33Legal Implications – This report is an initial response to the proposals outlined in the Department of Health White Paper – Equity and Excellence: Liberating the NHS 2010

SCRUTINY CONSULTATION

34Not Applicable

RECOMMENDATIONS

35 The Executive are recommended to approve Option 2 to ensure:

  • the development of a Middlesbrough Health and Well-Being Strategy and receive a further report outlining the structure, content and timetable to complete the strategy;
  • the development of a Health and Well-Being Joint Commissioning Plan;
  • the establishment of a Health and Well Being Joint Commissioning Group (JCG) to implement the Commissioning plan by January 2011.
  • that all future financial decision making related to the current JIP and Healthy Town Programme to be made by the newly established JCG, from January 2011.
REASONS

36The process outlined will ensure that Middlesbrough will have appropriate mechanisms to improve the health of its population. It will also ensure that Middlesbrough Council is responding to the proposals set out in the Department of Health White Paper.

BACKGROUND PAPERS

37 The following papers were used in the preparation of this report

  • Report to Executive - 5 March 2009 – Middlesbrough Council and PCT Joint Investment Programme
  • Middlesbrough Healthy Town - Project Initiation document – December 008
  • Department of Health White Paper – Equity and Excellence – liberating the NHS – July 2010
AUTHOR: Kathryn Warnock - Principal Corporate Development Officer

Peter Heywood - Locality Director of Public Health

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