Glasgow City CHP Item No. 18

Transcription

1 EMBARGOED UNTIL DATE OF MEETING Glasgow City CHP Item No. 18 CHP Committee Meeting Date: Wednesday 17 th December, 2014 Paper No 2014/082 Subject: Presented by: Recommendation(s) Summary/ Background Policy/ Legislative Context Progress update on implementation of the Glasgow City Health Improvement Strategic Direction Fiona Moss, Head of Health Improvement (CHP) Nichola Brown, Health Improvement Manager (North East Sector) Members are asked to note progress since the last Committee update presented in June Further detail on any aspect of the update can be supplied. The report provides a review of progress in implementing the Health Improvement Strategic Direction approved by the CHP Committee in October The strategy set out a ten year vision of refocusing health improvement activity within three core components, with the overall aim of reducing health inequalities. Links with Board Planning and Policy Frameworks, Glasgow City Single Outcome Agreement. Financial Implications Managed within the implementation process Human Resources Implications Service User/Carer Engagement Equalities Implications Changes to work programmes rather than posts. Inbuilt to many programmes of the work delivered through the Strategic Direction EQIA for the strategy has been approved and progressed. Partnership Implications GCHP engagement with Community Planning partners and others is described herein FoI/EIR Status tick If not to be made public, exemption (Section/Regulation) to be relied on under Public FoI/EIR legislation must be inserted below. Not Public Contains Personal Data DPA applies Date Report Prepared: 2 nd December 2014

2 Glasgow City Community Health Partnership Report To: Report By: GCHP Committee Fiona Moss, Head of Health Improvement (GCHP) Nichola Brown, Health Improvement Manager (North East Sector) Date: Wednesday 17 th December, 2014 Subject: Health Improvement Implementation Plan 1.0 Purpose of the Report Report on the progress made since June 2013 in implementing the health improvement strategic direction agreed by GCHP Committee in October, Background 2.1 The Committee considered and agreed the strategic direction paper for health improvement within Glasgow City in October, The intent of the strategic direction was to prioritise the programmes of activity for the health improvement capacity within GCHP in accordance with our current understanding of health and health inequalities. 2.2 Through the process a set of working principles were agreed, most notably that the health improvement workforce should be focused on reducing health inequalities, across three key areas of activity Resilience and Mental Health and Well-being Raising Aspiration and reducing poverty Creating a healthy culture in the city (tobacco, alcohol, drugs and obesity) and through a neighbourhood and people focus. 2.3 This is in line with the OTTOWA health model that guides health improvement practice. Most significantly the work programmes on building healthy public policy, creating supportive environments and strengthening community action are those that are informed and driven by a wide range of partnership structures within the City, GGC NHS and nationally. 1

3 2.4 The strategic direction required shifts in practice and recognised that implementation was a developmental process of adjusting some programmes, extending others and potentially stopping others over a period of time rather than whole scale re-alignment. 2.5 The Committee received a progress update in June 2013, highlighting progress and outlining future plans for enacting the strategic direction. Since then, progress has continued via a number of workstreams which are detailed in the following sections. 3.0 Valuing staff 3.1 There has been a programme of staff engagement in all aspects of the implementation plan that has sought to build the capacity and ambition of staff to contribute to improving the impact of prevention across the priority areas. Recognition through the Chairman s and Facing the Future Together Awards reflects on this journey. GCHP Health Improvement were worthy winners at the prestigious annual Chairman s awards, incorporating FTFT success. Glasgow city picked up the following three awards, Improving Health gold winner for the Cervical Screening Social Marketing campaign; Patient Centred Care gold winner for the Caring to Ask Initiative, which encourages all services to promote person centred approaches using a range of tools, Facing the Future Together (FTFT) overall Glasgow city winner was the North East Health Improvement Team for its Sunday Social café supporting people in recovery from addictions, using a volunteer model. 3.2 There are a range of cross sector groups established on discrete aspects of the work, or example on the development and review of the EQIA for the strategy, and on neighbourhood working models. 3.3 A whole staff event is being planned to be held in March 2015, to enable an overview of progress to be shared and to provide further opportunities for staff learning on core aspects of the strategy relevant to all staff e.g. poverty and financial inclusion, employability and others and consider the year ahead. 4.0 Key partnerships for implementation 4.1 The previous Committee progress update highlighted the plethora of partnership structures engaged with Health Improvement in taking forward the priorities. Ascertaining and determining the most effective partnership structures for progressing the Health Improvement strategy is continually reflected upon and adapted, taking into account other key developments such as the infrastructure in the city around Community Planning, as well as the evolving structures for planning in the future Glasgow city Health and Social Care Partnership (HSCP). 2

4 4.2 The key strategic structures involved are shown in the diagram 1, this reflects the citywide partnership infrastructure rather than the sector based infrastructure. The overlap with the city s Strategic Planning Groups recently charged with progressing the HSCP strategic plan is shown in green in the diagram. Diagram1 4.3 Health improvement senior staff will contribute to the development of the HSCP strategic plan through the above highlighted planning structures, the other Strategic Planning Groups (Carers, Disability, Homelessness) and via the development of three locality based inequalities sections. 5.0 Reviews of Programme Activity Education and Oral Health 5.1 Part of realising the strategic direction requires a review of programmes of activity, examining their impact and alignment with the priorities of the strategy. A schedule of questions for existing activity and programmes to be considered through was developed in November The work of GCPH (framework for monitoring and reviewing health and social inequalities in 2010) and a recent Health Scotland review process informed this process. 5.2 Since the last Committee report, two programmes have been reviewed, education based health improvement, and oral health programmes operated in health 3

5 improvement within GCHP. Programme review groups, including staff involved directly in current delivery tool forward the reviews. A common approach was followed, including the production of a Project Initiation Document, mapping of existing activity, examining programme impact and performance arrangements, and involving a wide range of stakeholders including staff engaged in these programmes in the process. 5.3 A paper summarising the recommendations from both reviews was taken to the Staff Partnership Forum (SPF) in September 2014, where it was noted and approved. It was expected that no change to existing structure (line management) or job descriptions would be required as a result of the reviews. Both reviews are at a final stage and recommendations have been shared with staff, at sector management teams and relevant colleagues in the Oral Health Directorate and the Glasgow City Council Education Department. 5.4 Whilst many of the recommendations are programme specific, a consistent outcome of both reviews is that workforce capacity will be created as a result of delivering a more focussed set of activities, whilst continuing to fulfil the required outcomes. Additional capacity will result from delivering some aspects of each programme differently, for example more cross sector or city approaches. The capacity created will be required to deliver on the key priorities within the Strategy. 5.5 Implementation plans have been developed for both reviews to ensure that the recommendations are delivered, with clear accountabilities and timescales. 5.6 The intention for 2015 is to commence a further programme review for the work delivered by health improvement in primary care settings, including pharmacies. This will take into account the challenges posed by the loss of Keep Well and relationships with primary care localities, in the context of a pending HSCP for the city. 6.0 Performance Reporting and Performance Management Framework 6.1 A key factor in determining the success of the Health Improvement Strategy going forward is an effective mechanism for performance management. Work to review existing performance arrangements and develop an overarching performance management framework for the Strategy was undertaken this year. This was set in the context of the Board s Planning and Policy Frameworks, HEAT and other required performance targets and the Single Outcome Agreement. 6.2 The resulting Health Improvement Performance Management Framework was shared with the CHP Performance Scrutiny Group in October The next steps include exploring the creation of a central system for the collation of data as the Framework will capture information beyond the capabilities of the Sharepoint system, and consideration of the performance components that will be considered within the emerging HSCP. 6.3 The cross cutting nature of health improvement will require consideration of how programmes intersect and how this is measured on an ongoing basis; further there needs to be sustained effort in capturing the difference made by health improvement 4

6 beyond capturing quantitative data. Building and assimilation of case studies and tracking changes over time in communities will be important. 6.4 A key measure/indicator has been established for each priority theme which will be reported across the life cycle; early years, children and young people, adults and older people. This means that activity can more easily be reported for the city and sectors for each of these life groups. With the development of the HSCP reporting across these strategic categories will be important for both internal HSCP scrutiny and in our care group audit and wider Community Planning/One Glasgow requirements. 6.5 Within each theme there is also a neighbourhood indicator, again the vision is that health improvement are able to pull off local data on prevention activity taking place through health improvement which can be used for the thriving places reporting to Community Planning and also potentially engagement with the Area Partnerships. This information will also form part of the wider locality dialogue within the HSCP. 7.0 Contribution to the Single Outcome Agreement and Delivery of the Community Planning Function for the NHS 7.1 The Health Improvement Workforce fulfils the vast majority of the NHS statutory duties as a community planning partner in Glasgow city. This includes representation on the twenty one Area Partnerships across the city, contribution to a number city wide and partnership structures detailed in Diagram 1, and a significant contribution to the delivery of the workplan for the Single Outcome Agreement, some highlights follow. 7.2 Neighbourhood working - the city s nine Thriving Places were confirmed in the autumn of In January 2014, Thriving Places Groups were established in each geographic sector, with Health Improvement staff representing the NHS and populating a number of sub groups which are locally determined, for example on community engagement. Each sector team have developed arrangements to align workforce capacity to contribute to the development of Thriving Places. 7.3 Alcohol priority a significant body of work is underway in line with the alcohol priority within the SOA and the healthy culture component of the Health Improvement strategic direction. This builds on a long history of health improvement working closely across the addictions services, the voluntary sector and community volunteers, as well as the wider move towards focussing on a prevention and recovery agenda. This work is captured in the alcohol SOA progress report presented to members. 7.3 Licensing agenda Health Improvement Leads from across the sectors prepared a paper on the issues caused by overprovision of alcohol outlets in the city, and the need for closer working with the Licensing Board. As a result the Alcohol and Drugs Partnership and GCPP approved the funding of a dedicated post to provide evidence to the Licensing Board on the potential health impacts of licensing applications, the first post of its kind in the Board area. More recently a second post has been approved, to work more operationally in supporting community based structures such 5

7 as community councils, to prepare community based evidence to the Licensing Board. Health Improvement are managing and leading on both these aspects. 8.0 Workforce and Budget 8.1 Glasgow CHP will manage 9.1M through health improvement during 2014/15, with 1.7M (19%) of this for health improvement programmes hosted on behalf of GGC NHS. The remaining 7.4 million is a combination of mainstream GGC resources and fixed term allocations from the Scottish Government (and on occasion, others) for the delivery of specified prevention programmes. In 2014/15, fixed term funding accounts for 23% of the city s health improvement budget, this represents a significant income risk in future years. 8.2 A reduction of 9.3% ( 777.4k) in budget has been incurred this year, this represents a mix of reductions in fixed term income ( 399k), efficiencies and changes incurred from the boundary changes with Lanarkshire. In terms of external funding significantly there has been a reduction in allocations for Keep Well ( 200.1k) and the withdrawal of Child Healthy Weight funds ( 149k). Both have been managed by ending external contracts, one with Glasgow Life and the other a third sector organisation. 8.3 Governance arrangements are in place for each of the remaining allocations. Over the years, mainstream and fixed term allocations have been used to jointly fund activity, which has brought complexity in financial management. This has meant that the total available resource varies annually, and as some have been awarded annually for five plus years some of the staff associated with these programmes now have permanency status. Collectively there are 27.5 fixed term staff employed from external funding sources, with 17 of these staff (NW 7, NE 6, S 4) having permanency status. 8.4 Work is ongoing to plan for the next three financial years. Significant pressures are known, notably the Scottish Government disinvestment in Keep Well which will end in March This funding represents 9% of the city s health improvement budget. Partnerships have instigated a process of consideration of efficiency requirements over the next two years, which is being considered in line with financial planning described above. 8.7 Workforce development. There is a continuing programme of work in building and supporting the whole workforce to play their part in realising the strategy. Aspects of this are delivered at a sector level, for practical reasons, but strategic consideration of what will be helpful across all staff is ongoing. Between November 2013 and January 2014, all three sectors delivered staff training and development days on asset based approaches. Further workforce development on equalities and the protected characteristics has been delivered in all three sectors. 9. Recommendations 9.1 Members are asked to note the content of this report and advise of elements for further, more detailed, review. 6