community involvement in commissioning

PPI IS IMPERATIVE FOR SUCCESSFUL COMMISSIONING BECAUSE:

• It’s a financial imperative– Save money – Get pathways used

• It’s a moral imperative– Who’s NHS is it anyway?

• It’s a political imperative– No democratic legitimacy

• It’s a practical imperative– Safer– Better design

• It’s a legal imperative

COMMUNITY INVOLVEMENT AND COMMISSIONING

Dr Brian Fisher MBE

Chair of the Socialist Health Association

WHAT KIND OF INVOLVEMENT?

• Democratic• Participatory

–Influence through engaging with–Individuals–Groups

• Listening Responding

CONSORTIUM GOVERNANCE OPTIONS

• DEMOCRATIC– Democratic elections to the Board– Councillors/LA on the Board (?)

• PARTICIPATORY– HealthWatch on the Board– Other lay people on the Board– Foundation Trust consortium– Lay reps on every key committee– A super patient participation group– Community development

HEALTHWATCH

• Son of LINKs, grandson of Fora, great-grandson of CHCs

• A network of networks and groups• To influence commissioning of health and

SC by understanding key issues for local people.

• Future responsibilities?– Complaints– Shared decision-making

HEALTH AND WELL-BEING BOARD

• Consortium, HW, LA, NHS CB if relevant

• Chaired by LA

• Joint decision-making on commissioning

• Start with Joint Strategic Needs Assessment

• Has the semblance of democratic legitimacy, but no substance

WHAT TO BECOME INVOLVED IN

• The consortium’s agenda– Priorities– Service development– Setting standards – quality in SLAs– Service monitoring– How to spend savings

• The community’s agenda

PROACTIVE DIALOGUE, DEEP AND WIDE

• Experience based design

• Database

• Community development

CONSORTIUMHEALTHWATCH

LOCAL VOLUNTARY GROUPS

HW

HEATH AND WELL-BEING BOARD

COMMUNITY DEVELOPMENT/ORGANISING

• Improves PPI

• Improves health protection

• Tackles health inequalities

• Supports behaviour change

ASSET-BASED COMMUNITY DEVELOPMENT

• People as assets, not problems• Individuals, organisations and statutory services

working together to improve civil life• Both local people and statutory services have

skills that need to be combined for maximum effectiveness – co-production

• Enhancing health promoting/protecting mechanisms

• Strengthening the capacity of indiv and communities

CD Stronger and deeper SNs

RESILIENCE

Health protectionResilience to economic adversityBetter mental health

ENHANCED CONTROL

Can negotiate with servicesMore strength for self-careHealth inequalities reduce

7 STEP MODEL

• Listening event

• Brings together local agencies (health, police, education, SC) and residents

• Partnership

• Forms ‘organizing hub’ for activities and initiatives

• Leaders appear

• Rapid changes in commissioning

HELP - COMMISSIONING @ 9 MONTHS

• Company formed

• Playpark

• GP surgery

• Dental surgery

• Benefits advice

• Tai Chi

• Plans for radical change

HELP – OUTCOMES @ 5Y

• Life expectancy + 6 yrs • Increased Breast Feeding 50% • Postnatal depression rates down 60% • Child accident rate down 50% • 78% reduced fear of crime • Other benefits .. escalated impact of other

Public Health programmes, and changes to services and commissioning

• Estimated savings based on 5% reduction across a basket of conditions = £70k per year for 5000 population.

BIG SOCIETY?

• REDUCED STATE PROVISION • SOCIAL JUSTICE • INCREASED ACCOUNTABILITY • TRANSPARENCY• ENHANCE PUBLIC SECTOR MARKETS • LEADERSHIP BY FRONTLINE PROVIDERS • FUNDING • IMPROVED LOCAL COMMISSIONING • NEIGHBOURHOOD GROUPS MUTUALS AND

COOPERATIVES • CHARITABLE GIVING • VOLUNTEERISM