Commissioning Children’s Services.Passing the baton –

mind the gap!

Steve CropperKeele University and

Partners in Paediatrics

To Social Services Research Group – Children’s ServicesBirmingham 7th March 2011 Whoops!Whoops!

Health and Social Care Bill 2011

• strengthening commissioning of NHS services• increasing democratic accountability and

public voice• liberating provision of NHS services• strengthening public health services• reforming health and care arm’s-length

bodies.Transition will occur through a carefully designed and managed process, phased over the next four years … to allow for rapid adoption, system-wide learning, and effective risk management.

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Leadership & Performance timeline: Oct 2010 – Mar 2012

20122011

Ensure ‘GP path finders’ build correct links with Councils from outset.

Identification of H&WB early implementers

All localities to have arrangements to transfer funding from PCTs to LAs.

Majority of places with H&WB Arrangements in place or plans to do so by Oct’ 2011

PCTs agreed what happens with existing pooled budgets and contracts for joint commissioning

Remaining shadow H&WB Bds arrangements in place

Shadow H&WB have begun to refresh JSNA and agree working arrangements for handling shadow public health ring fence and GP consortia allocations

Workshop for potential early implementers

High Level understanding of H&WB’s interactions with NHSCB & GP Consortia

LG/DH Transition group provide assurance on LA engagement

options for transfer of existing pooled budgets and joint commissioning arrangements

PCTs and Councils to begin developing arrangements for health improvement

Dissemination of Lessons Learned from Early Implementers

Shadow HWB or emerging joint arrangements in place to support role of DsPH

Clear understanding of H&WBs role in Health Improvement and Protection

(Subject to Parliamentary Approval) Royal Assent places new duty on LAs with social care functions to establish HWBs in &accordance with local needs

3 SCENARIOSRevolt or Abdication/Denial:

• Collective response -

political action (or perhaps widespread inertia and apathy)

Responsible Public Servants: Gradual engagement through GP leaders, representatives. Rules of the new game worked through – small scale, incremental changes + some system shocks in context of broader strategy

Melt-down – pace and extent of change not achievable; national board and local leadership at loggerheads; inertia thwarts radical action; GP consortia fail, merge, change; cases of break-up of providers

‘…primarily about a cultural change… to genuinely collaborate throughout the commissioning process.’

Local Strategic Partnership

Children’s Trust + LSCBCYPP

Statutory Health and Wellbeing Board and ?….• local authorities to coordinate the commissioning of local NHS services, social care and health improvement“The Health and Social Care Bill will significantly strengthen collaborative and integrated working…“ (Govt response Jan11)

GP Commissioning?knowledge and experience of paediatrics?awareness of services“GP’s training should be reviewed to include the ECM agenda as statutory…”

Public health transfer to LAs

Other hurdles, shocks and wild cardsDeep financial cuts and effectsPersonalisationThoroughgoing marketisation………..

Issues – HWB Early Implementers

• How do we set a new direction while ensuring current programmes through the transition?

• Relationships and knowledge • Accountability and transparency • Boundaries and levels + • a. Joint Strategic Needs Assessment • b. Working with elected members

Types of ‘Friendly’ Relations• Networking Exchanging information for mutual benefit

• Coordination Exchanging information and altering activities to achieve mutual benefits and a common purpose

• Cooperation Exchanging information, altering activities & sharing resources to achieve mutual benefits and a common purpose

• Collaboration Exchanging information, altering activities, sharing resources and enhancing the capacity of another to achieve mutual benefits and a common purpose

Arthur Turovh Himmelman: Communities Working Collaboratively for a Change, 1991And in Chris Huxham (Ed) (1996) Creating Collaborative Advantage. Sage.

Easier

Harderto develop

andsustain

Collaborative leadershipWhat to do, now?

• Develop GP Comm. understanding & capacity (SHAs, PCT clusters & LAs leading ‘process’)

• Ease of linkage as essential - organisational maps; who’s who?• Jointness and transparency as principles – no surprises, linked/shared info sites, briefings, news….• Set out authorisation/governance processes• Commissioning maps, agendas and infrastructure

– Best info re ‘children’s program budget’– What commissioning support capacity is required

• Strategic• Joint• Support functions

• Pragmatism: where to hold initial steady state and where to change– Reasoned advocacy on children’s needs & services – Kennedy + JSNA, existing strategies, etc.– What does the Local Authority currently commission with PCTs? – What works well? What should continue and be built upon?– What else is needed?– Priorities

– Population groups and services eg CAMHS, Safeguarding, Complex/continuing care, Cared for Children– Commissioning capacity eg linking sector commissioners, community consultation

• Ensure people are focused on their ‘must do’ contributions and tasks (‘day job’ incl. partnership responsibilities, and collective learning and identity work)

Hold collective purpose and nerve.

Baton fumbled but scooped up here, here and here…