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Strategic partner updates for November 2014

11 November 2014

Health and Social Care update from our work as Strategic Partner (SP) to the Department of Health, NHS England and Public Health England.

Disability Rights UK leads a user-led consortium as one of 22 strategic partners in the voluntary sector. Our name is ‘Win-Win Alliance – disabled people leading change’. This programme is commissioned by our system partners, the Department of Health, NHS England and Public Health England. As strategic partner we are well placed to raise particular challenges facing our members of disabled people’s user-led organisations. We also ensure that information and opportunities to engage with system partners reach our members through this and other updates, forums, meetings and discussions.

Strategic Partners are now looking ahead to 2015/16 and starting to develop our collective offer to DH, NHSE and PHE, including some common themes that we should prioritise to work together around. For our consortium WWA (Win-Win Alliance - disabled people leading change) we have suggested to focus on local/regional action (to see what works and then spread and upscale it) and policy development with the following priorities:

  1. By user-driven commissioning: Strengthening direct outwards accountability of services towards those who use these services:
  2. Supporting people with lived experience to co-produce experience and outcome measures on the basis of which providers would be paid to a significant degree (eg 20%)
  3. Transferring lessons from self-directed support by Personal (Health) Budget holders (in health and social care, employment, across life domains) to mainstream commissioning plans, integrated personal commissioning and across equality characteristics
  4. Gathering and implementing new engagement models and help aligning systems and processes accordingly, eg Accessible Information Standards, writing peer support into commissioning contracts, co-produced delivery.
  5. Marrying up patient and public involvement within inclusive communities where disabled people can be leaders by experience

An example that we have put forward which captures some of the aspects involved above is the following: 

Promoting human rights perspective to enhance informed choice on cancer screening uptake by people with learning disabilities

When it comes to inviting patients for cancer screening, GPs can sort out people with learning disabilities from their list - just because engagement with people and their fears may be considered too burdensome and time-consuming in the absence of incentives or sanctions. Rather than create Screening Liaison Nurses across England we want to co-create - as part of a new national procurement exercise - payment profiles for referring GPs and screening providers by which say 20% of that contractual income would be linked to them achieving minimum scores on indicators of experience and outcomes (NOT simply activity or uptake of screening episodes which would disregard the accumulation of negative experiences and outcomes).  

This month’s update includes reflections on the events and workplan of the ‘Win-Win Alliance – disabled people leading change’ (lead on commissioning ), and on how this will support local user-led organisations and finally news, plans and insights on addressing health inequalities and patients and service users driving integration and commissioning. http://disabilityrightsuk.org/policy-campaigns/health-and-social-care-reforms

What’s happening in partner areas - supporting or kick-starting new & evolving ULOs, user-driven commissioning?

Disability Rights UK and Shaping Our Lives together have continued to co-facilitate a procurement exercise for mental health services for 0-25 year olds with a CCG by involving children and young people and carers (C&YP & carers) in real time in all stages from July to December 2014, from setting out ITT questions through to bidder evaluation stage. As part of this, C&YP & carers have a set 20% stake in the decision-making on the successful provider bidder and also in subsequent annual contract variations. To this end, C&YP & carers designed their own ‘presentation’ for bidders, using a powerful mix of lived experience stories, poetry and acting, challenging the providers to respond to requests – before going on to score with the user of peer moderation and clarification questions the different bids for the substantial five year contract. This is a remarkable milestone in user-driven commissioning in the statutory NHS sector.  

Our local partner SPECTRUM in Southampton has published a very interesting 30th anniversary edition (celebrated on 6 November)  http://www.spectrumcil.co.uk/wp-content/uploads/4-SPECTRUM-NEWS-30th-Anniversary-Edition-2014.pdf  . Two items on local projects stand out. An article on supporting or kick-starting new & evolving ULOs (because the more we are the better informed will the whole system of care and support be) and another article on user-driven commissioning – unlike

in the Win-Win Alliance’s work with the CCG above, the core contract for homecare was apparently not directly influenced by disabled people in Southampton. On the other hand, there was an impressive emphasis on peer-delivered add-on services which was somehow missed out by our own work with the CCG (perhaps due to the inescapable focus on statutory processes).  

The Strategic Partners last met on 13 October:

1. Our WWA consortium partner Shaping Our Lives presented with the Helplines Partnership on the perspectives helplines bring, including web portals providing collectives spaces and additional anonymity to meet peers and talk about experiences. An example given was that of OCD Action who have supported peers to pick up coping skills from each other – this has been part of a pilot so has not been made an integrated choice offer of  commissioned care pathways (which is what the WWA would seek). 

Some innovative models have been picked up by John Lewis to support distressed staff, which is obviously an interesting partnership between a charity and a cooperative.

2. National Voices, an umbrella body for health and social care providers, presented on their work on person-centred coordinated care and what they call their ‘narrative’ on which providers assess themselves: I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me. There has been a lot of behind the scenes work on this narrative but the organisation itself concluded that it  still needs to make the transition from commissioning-led to becoming more demand-led (i.e. rooted and driven by what people want with people acting for and by themselves).  

3. Further details were given on a consultation on the Workforce Race Equality Standard and the Equality Delivery System (EDS). Disability Rights UK has previously responded to those proposals as part of the NHS Standard Contract consultation. Our concern is that relevant data need to be captured for disabled staff as well when it comes getting into the NHS, staying on and getting on (after an accident for example). We are now calling for an initiative for research and development to focus on disabled staff as well through our membership of the Equality and Diversity Council (EDC) subgroup on workforce and leadership.   

Further news: 

Care Act 2014: statutory guidance for implementation

The Department of Health has published the statutory guidance to support implementation of Part One of the Care Act 2014: https://www.gov.uk/government/publications/care-act-2014-statutory-guidance-for-implementation

A Government response to the consultation on the draft regulations and guidance has also been published: https://www.gov.uk/government/consultations/updating-our-care-and-support-system-draft-regulations-and-guidance

Finally, the Care Act Factsheets have been updated: https://www.gov.uk/government/publications/care-act-2014-part-1-factsheets

There will soon be a presentation uploaded on the Care Act from Sue Bott who will also offer training for interested members. 

The NHS Five Year Forward View

The NHS Five Year Forward View was published on 23 October 2014 and sets out a vision for the future of the NHS. It has been developed by NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. Patient groups such as Disability Rights UK through the Win-Win Alliance – disabled people leading change, clinicians and independent experts have also provided their advice to create a collective view of how the health service needs to change over the next five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services. 

To read more and download the document, go to: http://www.england.nhs.uk/ourwork/futurenhs/

Our specific contributions to this are around making the case for a ‘right to peer support’ to break down the boundaries between the statutory and the voluntary systems. We want peer support to be recognised as an integrated element of new commissioned care pathways, and at least this the potential of this was reflected in plans for “independent peer-to-peer communities to emerge” – so watch this place!

Gearing Up for Personal Health Budgets Programme (Round 2)

Invitation to apply

Some of the people who rely most on NHS services now have the ‘right to have’ their care delivered through a personal health budget. Around 60,000 adults eligible for NHS Continuing Healthcare, and children who receive continuing care, can have more control and flexibility over the way their health budget is best used to meet their own personal health outcomes. It marks an important step forward for the NHS in getting serious about the personalisation of care for people living with long term, disabling or life limiting health conditions, and they would like to invite third sector colleagues to support them to ensure that personal health budgets are implemented well. 

In April 2014 round one of the Gearing Up for Personal Health Budgets Programme invited third sector, community and voluntary sector organisations to bid to take part in a development programme to support them to offer advice and guidance to people eligible for NHS Continuing Healthcare who wanted to find out more about personal health budgets. Gearing Up has got off to offering opportunities for organisations to reach out to eligible people who are interested in finding out more and engaging with NHS commissioners in their area. The programme has supported organisations to learn about personal health budgets and how they work, work with regional mentors and hear from people with lived experience of having a personal budget and how this has worked for them. 

Twenty eight local voluntary support organisations and three mentoring organisations have been involved so far and NHS E would now like to invite organisations to bid for a second round with a further 40 places. In addition they welcome invitations to bid to organisations to bid to offer mentoring support to the Gearing Up projects. They are looking for approximately 5 organisations to offer mentoring to local projects across a patch or region and one organisation to offer mentoring and development support to the programme nationally. Each organisation will receive a small grant of £10k. 

Aim and objectives of the programme

The Gearing Up Programme has been set up to equip local third sector organisations with more knowledge and connections around personal health budgets so they can be ready to tell people about them as more people become interested, which includes a small grant of £10k to give them capacity to take part.

The programme will help ensure:

  • That voluntary sector organisations are able to help people and families get good sense of what should be expected from the NHS, and equip them with the information and policy to help them get a personal health budget in line with established national best practice
  • That, for a small number of people and where necessary, voluntary sector organisations can support eligible people to get a personal health budget, including offer some advocacy and mediation support where needed.
  • That voluntary sector organisations work to develop productive relationships with CCGs and support them to introduce personal health budgets well.
  • That voluntary sector organisations support the development of local partnerships. We have asked Gearing Up participants to get in touch with their local CCG personal health budget leads. Through the Gearing Up programme, the voluntary sector organisations will be well placed to provide support to individuals who are eligible for personal health budgets. This additional capacity is intended to support CCGs when introducing personal health budgets

Applications are invited from third sector, voluntary and community sector organisations to apply:

  • To join the Gearing up for Personal Health Budgets Programme. Please complete an application form
  • To be a national or regional mentoring organisation. Please submit a proposal outlining how you will meet the criteria outlined below.

Please refer the specification and application form by following this link http://www.personalhealthbudgets.england.nhs.uk/News/item/?cid=8826

Applications and proposals should be returned to england.personalhealthbudgets@nhs.net by 12 noon on Monday 1 December 2014.

If you have any questions about the Gearing Up Programme please contact Alix Crawford at alix.crawford@nhs.net. 

Better care plans to help elderly and reduce hospital visits

The Better Care Fund will help join up local health and care services to improve care and reduce A&E admissions. Better care plans, which will also provide more dignity for older people and reduce the length of stay in hospital, are funded by the government’s £5.3 billion Better Care Fund. It was originally set at £3.8 billion but has increased significantly following additional local investment.

For more detail, go to: https://www.gov.uk/government/news/better-care-plans-to-help-elderly-and-reduce-hospital-visits

To read the Secretary of State for Health’s speech about preparing the NHS and social care system for the challenges of an ageing population given at the National Children and Adult Services Conference on the 30th October, go to: https://www.gov.uk/government/speeches/better-care-fund-and-improving-care

Next steps towards primary care co-commissioning events

These Regional Roadshows are being held to inform and support CCGs and NHS England teams, as well as other wider stakeholders, on the development of the primary care co-commissioning agenda in light of the next steps towards primary care co-commissioning, as we previously reported on.

The first of these events will take place on 19 November in Leeds between 10.00am and 4.00pm. For more information on this event, go to: http://www.events.england.nhs.uk/all/226 

First ever NHS waiting time standards for mental health announced

The Deputy Prime Minister, Nick Clegg, has announced that treatment for mental health conditions will be brought into line with other NHS services with the introduction of the first ever waiting time standards. Bringing treatment for mental health problems on a par with physical health will end years of discrimination. There will also be £120 million to improve mental health services. To read more, go to: https://www.gov.uk/government/news/first-ever-nhs-waiting-time-standards-for-mental-health-announced 

We had reported and reflected on this last month in our item on the NHS Mandate.

PHE cold weather plan helps you protect your health

Practical things we can all do to minimise the risk to our health this winter have been spelt out in the 2014 Cold Weather Plan for England.

It is estimated that every year there are more than 25,000 excess winter deaths in England, many of which are preventable. The plan, which is published by Public Health England, the Local Government Association and NHS England, offers advice that people can take, before and during the winter, to reduce the risks to health.

The PHE Winter Health Watch website will also launch early November and brings together PHE’s weekly monitoring of winter-related illnesses and deaths.

For the full press release please see:

https://www.gov.uk/government/news/phe-cold-weather-plan-helps-you-protect-your-health 

Changes to GP contract for better patient services

Personalised GP care for everyone

NHS England has agreed changes to the national GP contract. The changes agreed with the British Medical Association include improved provision of online services such as appointments and medical records for patients and named GPs for all patients who take lead responsibility for co-ordination of services. To read more, go to: http://www.england.nhs.uk/2014/09/30/gp-contracts/

For the first time in a decade, every patient in England will get a named, accountable GP, Health Secretary Jeremy Hunt has announced. Under changes to their contract with the NHS, GPs will ensure all 53.9 million people in England will get a dedicated GP personally accountable for coordinating care tailored to their physical and mental health needs. Last year it was initially introduced for all 4 million people aged 75 and over.

To read more, go to: https://www.gov.uk/government/news/personalised-gp-care-for-everyone

There are also more controversial changes such as a number of GP performance indicators which have been removed from the Quality and Outcomes Framework (QOF). We have voiced our concerns about this and will stay on the case. If you experience changes in how your local GPs perform as a result of the changes to the GP contract and the QOF, please let us know on Bernd.Sass@disabilityrightsuk.org 

Care.data ‘pathfinder’ announcement

GP-led clinical commissioning groups in four areas of the country are to help develop the care.data programme as it moves into a ‘pathfinder stage’. The programme – not be confused with the ‘Summary Care Records - will be rolled out in participating GP surgeries in the CCG areas of Leeds North, West and South and East, Somerset, West Hampshire and Blackburn with Darwen.

Tim Kelsey, NHS England National Director for Patients and Information, said: “There are huge benefits to be had from this programme and this is our opportunity to make sure we get it absolutely right. We already collect and share information in so many walks of life. The pathfinder stage is another step on the way to creating a more substantial picture of our nation’s health so we can improve care for patients. Since February we have been listening to the views of the public, GPs and other important stakeholders to hear their concerns about data sharing. We have heard, loud and clear, that we need to be clearer about the care.data programme and that we need to provide more support to GPs to communicate the benefits and the risks of data sharing with their patients, including their right to opt out.”

It is intended that care.data will eventually create a national picture of health patterns so commissioners can study issues such as diagnosis, waiting times and patterns of illness or disease. Under the care.data programme coded medical details held by the GP will be brought together with hospital data at the Health and Social Care Information Centre (HSCIC). At no time will anyone’s name or full address or notes of conversations with their GPs be collected.

The pathfinders will be supported in testing different types of communication with patients in those areas, explaining the benefits and risks of data sharing, and making clear their right to opt out from having their confidential information shared for indirect care. As part of the pathfinder stage, a variety of communications will be tested with patients which will include an individually addressed letter sent directly to every individual or household from their pathfinder GP surgery, a leaflet and other explanatory materials, as well as e mails and texts where the surgery also uses these channels.

To get the benefit of this data it needs to be shared with approved analysts who will have to travel to access it in a secure Data Facility at the Health and Social Care Information Centre (HSCIC). 

PHE’s alcohol, drugs and tobacco division has published a joint strategic needs assessment (JSNA) support pack.

PHE’s alcohol, drugs and tobacco division has published a joint strategic needs assessment (JSNA) support pack on 1 October 2014 to help local areas develop JSNAs and local Joint Health and Wellbeing Strategies (JHWs) that effectively address public health issues relating to alcohol, drug and tobacco use.

The support pack, which now in its third year is reviewed and updated annually, consists of eight resources covering young people’s substance misuse and adult alcohol, drug and, for the first time in 2014, tobacco use.

For each topic area there are good practice evidence-based prompts to support local areas to assess need, plan and commission effective services and interventions. The second component for each topic is a bespoke data pack for every local authority to support needs assessment and commissioning.

To view the support pack, go to: http://www.nta.nhs.uk/healthcare-JSNA.aspx

For its numerous references to the social environment, this may also be a good template for other care areas? Please let us know if you want to share any experiences you have made locally in engaging with the JSNA and/or the Health & Well-Being Board and get in touch with bernd.sass@disabilityrightsuk.org  

Ebola surveillance and contingency planning ongoing in UK

Public Health England is continuing to work with government colleagues to ensure the UK remains alert to, and prepared for, the risk of Ebola. The overall risk of Ebola to the UK remains low.

The UK contingency plans for Ebola have always been based on the assumption that there is a low, but nevertheless real, risk of importing a case of Ebola from West Africa. However, it is important to remember that even if a case is identified here, the UK has robust, well-developed and well-tested NHS systems for managing unusual infectious diseases.

The World Health Organisation (WHO) recommends that the affected countries should conduct exit screening for individuals with unexplained illness consistent with potential Ebola infection. WHO also recommends that Ebola cases or contacts should not undertake international travel, unless the travel is part of an appropriate medical evacuation.

However, entry screening in the UK is not recommended by WHO. There are no plans to introduce entry screening for Ebola in the UK. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people. PHE has provided UK Border Force with advice on the assessment of an unwell patient on entry to UK.

For the full press release see link below:

https://www.gov.uk/government/news/ebola-surveillance-and-contingency-planning-ongoing-in-uk 

New report reveals increase in use of antibiotics linked to rising levels of antibiotic resistance

A new report from PHE found that between 2010 and 2013 there was a 6% increase in the combined antibiotic prescribing of GPs and hospitals. There was also an increase of 12% in the number of bloodstream infections caused by E.coli with varying levels of resistance to key antibiotics for this infection of between 10 to 19%.

These data are from the first annual report of PHE’s English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), published today (10 October 2014).

While the proportion of resistant infections remains the same as that seen in previous years, as the total number of infections has increased so the total number of resistant infections has risen. The report also shows a wide variation in both prescribing habits and antibiotic usage across England.

For the full press release and access to the report, see link below:

https://www.gov.uk/government/news/new-report-reveals-increase-in-use-of-antibiotics-linked-to-rising-levels-of-antibiotic-resistance

The National Housing Federation launches new guide on housing and the local health economy

 Prescription for Success is a new guide which aims to transform the housing sector’s offer to health, enabling them to build a robust business case to commissioners and become a crucial part of the future of the NHS. Through developing innovative community-based services, housing has a vital role to play in reducing the demand on acute health services and tackling health inequalities. This guide, created in partnership with the London School of Economics (LSE), explains how the health economy works, and what commissioners are looking for, including the kind of evidence they expect to see from prospective providers.

Again, if you have examples of positive (and not so positive?) co-operations with housing associations locally, please share with bernd.sass@disabilityrightsuk.org 

For a copy of the guide, visit: http://www.housing.org.uk/publications/browse/prescription-for-success-a-guide-to-the-health-economy/

Get everybody active every day

PHE has co-produced 'Everybody active, every day', an evidence-based approach to improve the nation's health through everyday activity.

The new framework for national and local action addresses the national physical inactivity epidemic, responsible for 1 in 6 deaths and costing the country an estimated £7.4 billion a year.

See more at:

https://www.gov.uk/government/news/get-everybody-active-every-day