Newark and Sherwood District Council

APPENDIX A

NEWARK AND SHERWOOD DISTRICT COUNCIL

HEALTH TASK AND FINISH GROUP

Findings and recommendations of the task and finish group’s consideration of health issues affecting Newark and Sherwood

February 2013

FOREWORD

There have been enormous changes in the roles and structures of government bodies and in their capacity to deliver in recent years. The health scene has been particularly challenged by very fundamental change and is faced with complex resource issues. Whilst there may be arguments over the extent to which the government is sustaining the funding of the Health Service in its narrow sense, there can be no doubt that its wider provision is in funding jeopardy. It will, of course, always be the case in this area that the demand and need for resources grows faster than the capacity of the services to deliver, whatever government is in control. This is especially true of an aging population and Newark & Sherwood’s population is older than average.

The Localism Act has extended the District Council’s responsibilities and we now clearly have a general concern for the well-being of our communities. It was clear on this Task group that this concern was real and extended across any political divide. The Group worked effectively together, well supported by officers, to understand the changes that have occurred and are still to come, to listen to the evidence presented and interrogate it, and to engage with the concerns and issues presented by all the organisations we met, both statutory and voluntary. There was a real concern to ensure the most vulnerable were supported and to reduce the disparity of benefit.

The Purpose of this report is to respond to the opportunities that these radical changes may offer. We want the Authority to play a positive role in representing its people and in helping with the delivery of services that meet their needs. We may do this through being a critical friend, through helping with funding of specific projects and through ensuring our policies and practice across the Council complement and do not conflict with health purposes. We believe that there is a common understanding of the desirability of this, both within and beyond the Council, as evidenced by the Partnership Accord. We hope that the Council will respond positively to the ideas we offer and put these into swift action.

We would also like to record our thanks to all the organisations which came to talk to us, for their time, for their commitment to our communities, and for the difference they have already made.

Councillor David Staples
Chairman of Health Task and Finish Group
Vice-Chairman of External Relations and Partnerships Overview and Scrutiny Committee / Councillor Paul Handley
Vice-Chairman of Health Task and Finish Group
Chairman of External Relations and Partnerships Overview and Scrutiny Committee

EXECUTIVE SUMMARY

Amongst its many services and achievements, Newark and Sherwood District Council has a long history of addressing the social determinants of health. The Public Health (Control of Disease) Act 1984 gave local authorities wide ranging public health functions. Under the Health and Social Care Act 2012 significant new public health functions have become local authority (upper tier and unitary authorities) responsibilities that are complemented by the activities of district councils.

The Department of Health, in a briefing published in October 2012 titled “The new public health role of local authorities” describe their vision for public health in local government. The Council has a responsibility to continue to promote a social perspective of health.

The district’s health profile and Nottinghamshire Joint Strategic Needs Assessment identifies a range of health inequalities within the area and specific challenges. The NHS reforms provide a new impetus for partnership working with organisations such as the clinical commissioning groups (CCGs). Decision making is anticipated to be more locally based as 6 general practitioner led CCGs (Ashfield and Mansfield are combined) and a multi-disciplinary health and wellbeing board replace 2 primary care trusts (NHS Bassetlaw and NHS Nottinghamshire County). However, whilst locally there are promising signs, these reforms are in their early stages and are taking place at a time of austerity in public sector funding, rising living costs, declining household incomes, rising expectations and growing population including vulnerable elderly and isolated individuals.

The Council and its arms length housing company, Newark and Sherwood Homes Limited, have a track record of providing services that address the social determinants of health including housing, leisure and environmental health and these are complementary to NHS, social care, voluntary and community services and the care and support provided by individuals. These are set out in our Health and Wellbeing Delivery Plan.

The district council’s External Relations and Partnerships Overview and Scrutiny Committee (ERPOS) established a Health Task and Finish Group to consider these opportunities and issues and make recommendations. The Group’s remit included:

· Developing an understanding of the changes within the NHS, commissioning intentions of the district’s CCGs and Nottinghamshire’s Health and Wellbeing Board

· Considering the extent to which the commissioning plans will meet the needs of local communities, identifying potential gaps and liaising with funders regarding commissioning intentions and future service provision.

· Considering what can be done from a social health perspective to prevent people becoming patients in the first place.

· Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents.

· Formulating recommendations to ERPOS regarding health services, future commissioning projects and service provision.

· Consideration of the implications of changes to hospital transport services (this was considered by ERPOS).

Having considered key documents such as the district’s health profile, Nottinghamshire Health and Wellbeing Strategy and the CCG commissioning intentions and heard evidence from Newark and Sherwood CCG, Nottinghamshire County Council, Newark and Sherwood Homes Ltd, Hetty’s, CASY, Age UK, Think Children, Alzheimer’s Society and Newark and Sherwood Community and Voluntary Service, the Group recommend that:

1. The draft Health and Wellbeing Plan be recommended for endorsement by External Relations and Partnership Overview and Scrutiny Committee and Cabinet. The plan is then to be distributed to partners including the GP practices that are part of the district’s CCGs in order to highlight the alignment of our services with their strategies and commissioning intentions.

2.a That, given the importance of health to the community and, in particular, the Council’s strategic objectives relating to its “People” priority, a Health Working Party is established this year reporting to the proposed Customers and People Committee.

2b. The proposed working party should meet at least quarterly and be open to the public. The remit of the working party should include:

· Reviewing performance of and significant policies and plans developed by East Midlands Ambulance Service (EMAS), the district’s CCGs, Sherwood Forest Hospitals NHS Foundation Trust and Nottinghamshire Health and Wellbeing Board for example the Director of Public Health’s the annual report.

· Reviewing the implementation of the Council’s Health and Wellbeing Delivery Plan.

· Maintaining an overview of the implementation of changes within the NHS and future commissioning intentions of the district’s CCGs and Nottinghamshire’s Health and Wellbeing Board

· Monitoring general conformity with and proposing developments of the Partnership Accord for Health in Newark and Sherwood agreed by Council on 18 December 2012.

· Considering what can be done from a social health perspective to prevent people becoming patients in the first place including relevant Council policies and practices.

· Convening meetings of all relevant agencies to discuss health related issues, concerns, progress with initiatives, benchmarking service provision and local facilities, etc.

· Working with the CCGs to identify opportunities for joint commissioning around specific shared priorities and groups of residents and acting as a critical friend drawing upon the Council’s community leadership role and networks.

· Formulating recommendations to Customers and People Committee regarding health services, future commissioning projects and service provision.

2c. The working party should be made up not so much on political party lines as on an area and type of community basis – it should include councillors who represent rural villages, ex-mining communities and key settlements. The committee should include those who represent the Council on relevant health bodies and have the ability to co-opt appropriate non-voting external advisors invited from organisations such as Healthwatch, CCGs, voluntary and community organisations including Newark and Sherwood Community and Voluntary Service.

2d. Subject to the establishment of the Health working party, it is recommended that Child and Adolescent Mental Health, Dementia and Maternity services should form an early part of the work programme.

2e. That the appropriate Committee under the new constitution considers future and further funding of the district’s Family Intervention Project.

3a. That elected member representation from the Council should be part of the following outside bodies:

· Nottinghamshire Health and Wellbeing Board

· Newark and Sherwood Clinical Commissioning Group (Strategy Group/Stakeholder Reference Group)

· Nottingham North and East Clinical Commissioning Group

· Nottinghamshire County Council, Health Scrutiny Committee

· Local Medical Practice User Groups

· Sherwood Forest Hospitals NHS Foundation Trust

3b. That elected members, appointed by the Council to any of the outside bodies listed in 3a above be required to update the Health Working Party referred to in Recommendation 2a or the proposed Customers and People Committee on a minimum of two times per year.

4. There needs to be a close link with Health Watch when it is fully set up – discussion about how this could work ought to be initiated with Nottinghamshire County Council.

5. That the Council’s lead officer for health issues should be the Director of Communities.

Section 1: Introduction/Background

1.1 District Council’s context

1.1.1 Local authorities are faced with a continual challenge to do more with less. This challenge is more pressing given reductions in public sector funding following the Comprehensive Spending Review 2010. This resulted in the formula grant for Newark and Sherwood District Council being reduced by 28.8% or £2.97-million over the two year period 2011/12 and 2012/13. Taken together with the council tax freeze, this has resulted in a reduction in the council’s annual budget of more than £3-million.

1.1.2 The level of Government funding for 2013/14 has recently been announced. It indicates further reductions in external funding for local authorities in general and for district councils in particular and that the austerity measures are likely to continue to 2017/18.

1.1.3 Within this context, the Coalition Government’s Localism and Big Society concepts encourage innovative approaches to service delivery, a greater focus on outcomes and a smaller role for government at local, regional and national level in service delivery.

1.1.4 Local authorities have a range of legal powers that enable and encourage this change. The Localism Act will devolve greater powers to councils and neighbourhoods give councils a general power of competence and provide new powers to help save local facilities and services threatened with closure, and giving voluntary and community groups the right to challenge local authorities over their services. Meanwhile, the Open Public Services White Paper sets out the Government’s public service reform programme, which aims to ensure everyone has the choice and control of the services they use, by ending what they see as an old fashioned, top down, take-what-you-are-given model.

1.1.5 To achieve this, the White Paper sets out five principles for modernising public services:

· Choice

· Decentralisation

· Diversity of provision

· Fairness

· Accountability

1.1.6 It is clear that over the next few years the Council will require more savings, be leaner and have less capacity, while the policy context signals a shift towards a more varied mix of service delivery and devolution with a sharp focus on economic growth. Accordingly, the Council’s role as a community leader may come increasingly to the fore.

1.2 Newark and Sherwood District Council’s strategic priorities

1.2.1 On March 8, 2012, Council agreed its priorities for the period 2012 – 2016. These, in order of priority, are:

1. Prosperity

2. People

3. Place

4. Public service.

1.2.2 A number of strategic objectives were also approved and these form the broad thrust of activities that will help deliver the above priorities. These are set out in Appendix A.

1.2.3 The Department of Health, in a briefing published in October 2012 titled “The new public health role of local authorities” describe their vision for public health in local government. The Council’s Health and Wellbeing Delivery Plan (see Appendix B), including that of its arms length housing company, Newark and Sherwood Homes Limited, sets out the range of current activities that contribute towards health. There are other strategic issues that could be considered and these are set out below:

Prosperity: This implies a healthy and active workforce. The Council needs to ensure its population is physically and mentally well. Issues of healthy eating, physical activity, freedom from drug abuse and a positive sense of self are fundamental. The Council is already delivering some of this through its leisure centres and range of sporting and cultural development activities.

People: Self-evidently a concern for the welfare of our communities includes a fundamental concern for their health. The Council can demonstrate this through the Partnership Accord on Health in Newark and Sherwood, active scrutiny of health providers and the work of the Health Task and Finish Group.

Place: The Council should continue to be a champion for rural areas. It should also be concerned about the disadvantaged and ensure access to health care is good but also that the factors causing bad health are minimised e.g. planning policy and proliferation of fast food outlets in particular communities. The Council’s scrutiny of EMAS and its failure to address its relative poor performance in certain postcode areas demonstrates active community leadership.

Public Service: As a lower tier Authority, the Council has relatively more councillors with a closer knowledge of their smaller wards. This local knowledge is enhanced by connections with parish and town councils and other local groups. The Council should make more use of this to represent effectively the interests and needs of its communities. The Council should participate in supporting (e.g. Partnership Accord for Health in Newark and Sherwood) and monitoring the quality of health provision – this implies involvement in other agencies with a sharing of information within the Council and a Committee (or working party) set up to monitor performance.