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An overview of the NHS

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. So what is “the system”.

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An overview of the NHS

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  1. An overview of the NHS Angela Baker

  2. 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 Fire as a Health Asset 15/2/17

  3. 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 Fire as a Health Asset 15/2/17

  4. https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-englandhttps://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england Fire as a Health Asset 15/2/17

  5. Fire as a Health Asset 15/2/17

  6. Funding Streams Dept of Health NHS England PHE 4 REGIONS 4 REGIONS 15 AREA TEAMS 9 CENTRE TEAMS 211 CCG’s 151 Local Authorities Fire as a Health Asset 15/2/17

  7. 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 Fire as a Health Asset 15/2/17

  8. 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 Fire as a Health Asset 15/2/17

  9. 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! Fire as a Health Asset 15/2/17

  10. 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 Fire as a Health Asset 15/2/17

  11. 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 Fire as a Health Asset 15/2/17

  12. 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 Fire as a Health Asset 15/2/17

  13. 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. Fire as a Health Asset 15/2/17

  14. ICS’… Fire as a Health Asset 15/2/17

  15. Questions.. But possibly no answers Fire as a Health Asset 15/2/17

  16. Coffee, tea and comfort break Fire as a Health Asset 15/2/17

  17. Using hooks and levers to create influence

  18. 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

  19. 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 Presentation title - edit in Header and Footer

  20. 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! Presentation title - edit in Header and Footer

  21. 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 Presentation title - edit in Header and Footer

  22. 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 Presentation title - edit in Header and Footer

  23. Types of people Logical Enforcer Carer Passionate Presentation title - edit in Header and Footer

  24. 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” Presentation title - edit in Header and Footer

  25. 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?” Presentation title - edit in Header and Footer

  26. 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?” Presentation title - edit in Header and Footer

  27. Passionate • Witty, fun, charming • Impulsive • Generous • Optimistic • Eager • Bold • Risk taker • How do you influence this person? • These people ask “where is the action?” Presentation title - edit in Header and Footer

  28. To recap • So far • Identify what you think the barriers might be • 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 Presentation title - edit in Header and Footer

  29. 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? Presentation title - edit in Header and Footer

  30. So, what are the levers • Strategies • Plans • Targets • Dreams • Evidence • Identified problems • Research • Personal interest • Processes, Health impact assessment, equity audits and statutory responsibilities • What levers do you have at your disposal? Presentation title - edit in Header and Footer

  31. 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? Presentation title - edit in Header and Footer

  32. 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? Presentation title - edit in Header and Footer

  33. 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? Presentation title - edit in Header and Footer

  34. Contactangela.baker@phe.gov.ukAngela Baker,Deputy Director, Health and WellbeingPHE South East Presentation title - edit in Header and Footer

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