Agenda item

Update on the Joint Health and Wellbeing Strategy: Outcomes 4 and 5

Report of the Co-Chairs of the Board concerning Outcomes 4 and 5 of the Joint Health and Wellbeing Strategy

 

·         Outcome 4: People get the help and support that they need and feel is right for them

·         Outcome 5: The health and wellbeing system is innovative, affordable and provides good value for money

Minutes:

The Board considered a report of the Joint Chairs of the Board concerning Outcomes 4 and 5 of the Joint Health and Wellbeing Strategy:

 

·         People get the help and support that they need and feel is right for them; and

·         The health and wellbeing system is innovative, affordable and provides good value for money.

 

 

Tim Furness, the Director of Business Planning and Partnerships, NHS Sheffield Clinical Commissioning Group (CCG), gave a presentation introducing the main aspects of the report.

 

 

Members of the Board discussed the two main themes of the outcome areas, which were, for outcome 4: Person-centred care and support; Self-help; and Engagement and Participation; and for outcome 5: Joint commissioning and whole-system transformation; Prevention and early intervention; and Health and wellbeing workforce.

 

In discussing particular actions under each theme, the Board considered what progress had been made in the past year; the main issues and opportunities for the action and what the Board/ Members of the Board could do over the next year in relation to that action. A summary of the discussion is as follows:-

 

 

 

Sheffield appears to perform poorly on delayed transfers of care from hospital.  This is largely because the Sheffield Teaching Hospital Foundation Trust changed how it defines delayed transfers of care and reported delays in a way which was more accurate but resulted in an increase in the number of delays identified and data which was not comparable with previous years or other areas of the country. The level of performance in relation to transfers was not acceptable and there was a wish to ensure that, where there were alternatives, these were offered, so that people were transferred back home as quickly as possible and were able to be more independent.

 

 

 

In a response to a question, it was noted that there was not a transitions work stream for young people within the integrated care programme, although the work on improving transfers was beginning with a focus on older people and discussions were being held between the Chief Nurse and the Executive Director, Children, Young People and Families and this also formed part of the brief for the Executive Group in relation to mental health. Work on joint commissioning and integration of children’s services was currently outside the integrated commissioning programme.

 

 

 

The volumes of people requiring care was high and increasing and there should be concern with the quality of available care, for example in GP Practices where satisfaction rates may be low. People with long term conditions also needed to be helped to navigate the system.

 

 

 

The issue of delayed transfers of care was a priority for improvement, so that the path for people to return to their home was smooth as possible with a range of services to support them. The formation of the Health and Wellbeing Board represented an opportunity to bring approaches together and to make change. Transition was an area requiring significant change be it through working together or commissioning. It was acknowledged that such change required time to overcome barriers, but there were opportunities to build on good practice.

 

 

A key objective was to tackle health inequalities and Action 4.9, to “Commit to working with partners on a model of active citizenship that promotes health literacy and supports people to look after themselves as well as possible” included ensuring that people had access to services. When there was so much pressure on services (including children’s services and those for older people and mental health), how might we make sure that access and reducing inequality was included in the work on active citizenship? There was also a similar action in the Health Inequalities Action Plan and active citizenship was part of the keeping people well in communities programme and taking a holistic approach. It was about identifying risk and taking appropriate action. The Best Start Strategy would pick up such issues relating to young people.

 

 

 

Action 4.10: (to “Require both commissioners and providers to have effective engagement processes in place that take what service users think into account in all decisions.”) was an area which was improving. However, people sometimes say that although we consult with them, they did not think that what they said was taken on board. It was therefore important to explain to people the reasons why we were unable to include their particular idea. Healthwatch Sheffield would be able to help in this regard and there was more engagement with people. It needed to be demonstrated that what people had said had been heard and, in some cases, there was an explanation of why we hadn’t done what they had asked.

 

 

 

In respect of Action 5.7 (to “Continue to seek greater efficiency from providers, without putting service users’ safety or experience at risk.”), the financial context would be increasingly difficult over the forthcoming year. However, there was some optimism that partnerships would help identify solutions for Sheffield and there were ongoing conversations between commissioners and dialogue was needed with providers and the public (the latter in particular relation to promoting awareness and in helping with conclusions as to potential solutions.)

 

 

Clarity was sought regarding Action 5.3: (to “Establish more preventative and targeted approaches to the provision of health and social care by extending the application of population risk profiling (predicted risk of future health crisis) to enable a closer alignment between services and people’s needs. This should inform the development of integrated care and reablement services to help people stay at home, be healthy for longer and avoid hospital and long-term care.”) as although this was under the prevention theme, the progress outlined in the report as submitted concentrated upon avoidable admissions. It was explained however, that the actions were wider than reducing admissions and the strategy was being considered piece by piece. The focus in the report was on admissions as financial resources needed to be released to achieve financial balance by reducing the demand for hospital care and long term social care. Whereas, in other parts of the Strategy, such as wellbeing, there was a wider focus on prevention. The issue of finance was the subject of the forthcoming engagement meeting in May 2015. 

 

 

The Strategy outcomes were not considered in isolation of one another and issues of need, expectations and affordability were apparent in every outcome area, together with cross cutting themes including inequalities, innovation and affordability. Each outcome was interdependent and there was a wider interdependency between the outcomes of each organisation represented on the Board, such as those within the City Council’s Corporate Plan. Outcome 4 of the Health and Wellbeing Strategy (that “People get the help and support that they need and feel is right for them.”) was reflected in an aspect of the Council’s Corporate Plan which sought to deliver Council Services on behalf of people that they need and at the right place and time. Other themes in the Council’s plan concerned financial security and sustainability. The very fact that organisations in the City have come together, helps each to think about such interdependency and not to take decisions in isolation. Prevention was most important and inevitably impacted upon issues of affordability.

 

 

 

It was recommended that the Board should also consider how in reporting on outcomes, the interdependencies could be seen clearly.

 

 

 

Resolved: that the Board:

 

 

 

(1)  Having discussed the outcome areas in depth, actively supports the recommendations made under each action detailed in the report as submitted.

(2)  Supports the ongoing programme of needs assessment.

(3)  Requests another update on these outcomes in March 2016.

(4)  Requests that consideration is given to how in reporting on all of the outcomes in the Joint Health and Wellbeing Strategy, interdependencies could be clearly identified.

 

Supporting documents: