Agenda item

(Mrs. S. Wylie, Director of Health and Environmental Services, attended in connection with this item.)

 

            The Committee was reminded that, at its meeting on 9th June, 2012, it had received a briefing from the Chief Executive of the Belfast Health and Social Care Trust outlining the content of the “Transforming Your Care: A Review of Health and Social Care in Northern Ireland” document which had been published by the Department of Health, Social Services and Public Safety.  Subsequently, the Minister for Health, Edwin Poots, MLA, had launched a consultation document entitled “Transforming Your Care: Vision to Action” which summarised the changes which had been proposed to Northern Ireland’s Health and Social Care System.  At its meeting on 23rd October, the Committee had agreed to receive a further briefing, with a view to informing any response that it might wish to make regarding the proposal.

 

            The Director of Health and Environmental Services reported that it had not been possibly to arrange a suitable date for a further formal briefing before the consultation closing date of 15th January.  However, given the significance of the Transforming Your Care Proposals, Mr. Ian Deboys from the Belfast Local Commission Group was in attendance to make a short presentation on the proposals and answer any questions which the Members might have.

 

            She explained that the document set out far reaching proposals for change across a range of Health and Social Care Services, including mental health services, statutory residential homes, acute services and primary care.  It explored how a focus on prevention, early interventions, integrated care and promotion of personalised care could enable more services to be provided in the community, closer to people’s  homes where possible.  It contained ninety-nine recommendations for improvements in the quality of care and required a shift of resources of £83 million across Northern Ireland from hospital to community-based services.  It was estimated that it would take an investment of £70million in transitional funding to enable a new model of care to be implemented and recognised that quality must be improved within a fixed budget.

 

            The recommendations in the document concerned the following ten areas of care:

 

(1)      Population health and well being;

(2)      Older People;

(3)      Long-term conditions;

(4)      Physical disability;

(5)      Maternity and Child health;

(6)      Family and Child care;

(7)      Mental Health;

(8)      Learning disability;

(9)      Acute care; and

(10)    Palliative and end of life care.

 

            She explained that, while political parties would have an interest as to how all of the above services would be provided for local residents, recommendations regarding public health and well being were directly significant to the role and functions of local government.  Although the Committee had not had the opportunity to discuss the recommendations in detail with the Trust, it was suggested that it might be appropriate to make a short response with regard to the contribution Councils made in improving the health and well being of the population generally and hence contribute to the prevention of ill health and a reduction in the demand for acute health services.  Accordingly, a draft response, which drew from the Council’s previous submission to the Department for Health, Social Services and Public Safety’s consultation on a ten year Public Health Strategic Framework “Fit well – Changing Lives” which had been approved by the Council in November, 2012, had been prepared.  It reflected also the relevance of the Northern Irelands Local Government Association’s draft response to the current situation and would be amended to incorporate any comments or changes determined by the Committee during the meeting.

 

            Mr. Deboys was admitted to the meeting and welcomed by the Chairman.

            With the assistance of visual aids, Mr. Deboys outlined the rationale for the review and its main objectives.  He explained that Transforming Your Care was aimed at Service improvements at preventing ill health; providing more care and services without having to visit a hospital; give more choice about services; being at the forefront of new technology to help people care for themselves and be independent; and make the best use of resources which the Health Service currently had and not cutting services. In order to make changes happen, the following had been undertaken and noted:

 

·         Draft Plans had been written on how the Board would improve services on the ground to deliver Transforming Your Care;

·         Those plans would be amended and finalised once the consultation process had been completed;

·         Making the changes would take time – around three till five years;

·         Some difficult choices lay ahead, with further consultation to be undertaken; and

·         There was a commitment to improving health and social care services and investing money to make it happen, with £19 million having been invested in the current year.

 

            Mr. Deboys then reviewed each of the areas of care and how it was proposed that they would change.  He concluded by summarising the consultation process and indicated that responses were required by 15th January, 2013.

 

            Mr. Deboys then answered a number of questions from the Members, following which the Chairman, on behalf of the Committee, thanked him for attending and he retired from the meeting.

 

            The Committee approved the undernoted comments as the Council’s response to the consultation document:

 

“Belfast City Council Response to Transforming your Care: Vision to Action

 

      Thank you for the invitation to comment on the above consultation document.  Belfast City Council received an initial briefing on proposals emerging from the review by Belfast Health and Social Care Trust and Local Commissioning Group staff in June.  The Council has not however been able to arrange a subsequent briefing offered by Dr George Neill, Chair of the Belfast Local Commissioning Group, within the consultation timeframe. This response is therefore of a general nature but focuses primarily on proposals relating to population health and well-being.  Council Party groups may submit additional comments.

 

      We would wish to draw attention to comments submitted previously by the Council to the DHSSPS in response to its Ten Year Public Health Strategic Framework ‘Fit and Well – Changing Lives’ [See Appendix A]. The Council welcomed the promotion of partnership working to address the wider socio economic and environmental influences on health and wellbeing advocated in the document.  The Council also supported the adoption of a ‘whole government approach’ where the public health framework sits at the heart of government and informs other policies and strategies under development. Importantly, the ‘Fit and Well’ consultation clearly identifies linkages with community planning, delivering social change, employability policies etc as part of an inter-related agenda to improve public health. The Council response to this previous consultation sought to illustrate the considerable provision and co-operative arrangements already in place whereby Belfast City Council continues to seek to improve health and wellbeing opportunities for citizens.

 

      During discussion with the Belfast Health and Social Care Trust and Belfast Local Commissioning Group representatives, health challenges particular to Belfast were acknowledged.  Low health outcomes in the city were attributed to a wide range of factors including multiple deprivation, an ageing population, lengthy stays by some people in hospitals, changes in the workforce and outdated facilities which were not fit for purpose.

 

      Poor levels of health and mortality statistics have been mapped in detail across Belfast.  The correlation between poor health and area statistics showing low incomes, high unemployment and lack of educational achievement is an accepted fact. Such causal relationships, and the fact that detailed local evidence of circumstances exists (though not always shared), makes a clear case for integrated and jointly planned and delivered local solutions.

 

      Opportunity and progress in meeting health demands in the city were also acknowledged during discussions, and commitment given to develop co-operation and leadership through the Belfast Strategic Partnership (BSP). It was recognised that Health and Social Care organisations could not address many of the health issues on their own and that a diverse range of community and voluntary agencies are vital to provide support at local level.

 

      The Council welcomes the approach adopted in developing the Transforming your Care report which emphasises the need to learn from best practice elsewhere while retaining affinity with core NHS principles. Belfast City Council is supportive of the ambitions outlined in the report to:

 

·         be better at preventing ill health

·         provide patient and client-centred care

·         manage increasing demand across all programmes of care

·         tackle health inequalities

·         deliver a high-quality, evidence-based sustainable service

·         support our workforce in delivering the necessary change

·         give our children the best start in life

 

      A summary of general comments concerning the document is outlined below.

 

(i)   Integration of services at a local level

     

      While accepting that the role of Local Government has been recognised in discussion between and through ongoing co-operation with mainstream health organisations in Belfast, it is disappointing to note the lack of any such acknowledgement within the report.  The Council has illustrated previously (in the Fit and Well consultation response) a whole range of contributions Councils make to improving public health and well-being.  These activities range from statutory provision such as Leisure and Food Health responsibilities to specific, innovative new projects aimed to improve the health of families, children and older people and to reduce health inequalities evident in Belfast. 

 

      The document emphasises the need to place the individual at the heart of the model of care and the need to:

 

·         integrate services at a local level

·         provide more community-based services

·         care for people at home when safe and appropriate to

do so

 

      Belfast City Council supports these principles. A key example of where the Council already demonstrates commitment and actions in realising the above ambitions, which are central to Transforming Your Care proposals, is seen through the operation of the Belfast Strategic Partnership (BSP). As part of the re-structuring of health services in Northern Ireland, there was a direct requirement for the new Public Health Agency to work in partnership with local government to address inequalities in health, which are particularly significant across Belfast and can be mapped against deprivation indicators.

 

      In recognising the opportunities presented by the reform of the health service, the Council agreed to work with the Public Health Agency (PHA) and the Belfast Health and Social Care Trust (BHSCT) in establishing a joint Belfast Health Development Unit for the city with co-located members of staff from each of the agencies working together on joint programmes. The new unit was launched by the Minister for the Department of Health and Social Services and Public Safety in March, 2010.

 

      The Council and the Chief Executives of the PHA and BHSCT continued to build on the partnership arrangements and went on to establish the Belfast Strategic Partnership (BSP) for addressing life inequalities, which first met early in 2011. The partnership now has high level representation from statutory, voluntary and community sectors, including representatives of all Council political parties.  Its purpose is to act as the key strategic decision-making forum on agreed inter-sectoral priorities to tackle and influence the root causes of ill health and to reduce life inequalities in the Belfast area.

 

      This is a hugely ambitious task which continues to require the collective action of all partners represented on the BSP and other stakeholders. This example, however, illustrates clearly the approach advocated in “Transforming Your Care” and how Local Government can assist bring about desired changes in service provision at a local level by

 

·         Influencing and informing others to address life inequalities

·         Taking direct action to address life inequalities

·         Measuring and understanding the impact of approaches to addressing life

·         inequalities.

 

      A series of activities are being progressed by the BSP and two of these are outlined briefly below by way of demonstrating roles already played by Belfast City Council.  These clearly reflect the approach advocated and outcomes expected from the ‘Transforming Your Care’ review.

 

(a)  Active Belfast

 

      The Active Belfast approach is a key strand of the council’s work in addressing life inequalities within the city, as part of the framework for action of the Belfast Strategic Partnership.

 

      The Council has established an Active Belfast Partnership which provides a real opportunity to work with key partners to develop joint initiatives and projects to improve the health and wellbeing outcomes for the people in the city.  The partnership has eleven core members including health organisations, government departments, agencies, universities and voluntary groups

 

      The development of the Active Belfast Strategy will provide the opportunity to:

 

·         Demonstrate a commitment to a strategic co-ordinated approach;

·         Develop a shared vision for an active and healthy city;

·         Support new cross-cutting policies, service delivery and citywide activity plans

·         Develop joint planning and delivery of initiatives and projects; and

·         Maximise available resources across a range of organisations.

 

(b) Services for Older people

 

      Belfast has an aging population profile.  In reflecting the needs of older people in the city generally, joint work by the Belfast Strategic Partnership (BSP) highlighted the opportunity to improve healthy and active aging within its programme of work 2011-2015. Part of the work associated with this action is to involve different sectors and organisations across the city, including the voluntary and community sector and those representing older people, in joint planning and delivery arrangements.  

 

      The Council is also a signatory of the ‘Age Friendly Declaration’, the first formal step in the process towards Belfast becoming an Age Friendly City.  This commits Belfast to participating in the World Health Organisation Global Network of Age-friendly cities and to commence a 5 year cycle of continuous assessment and improvement to make Belfast more age friendly and to promote independence in older age.

 

      These projects reflect local political leadership in meeting the needs of the local population.  It is essential that locally elected representatives have an opportunity to convey the needs of their areas in the planning and integration of health related provision

 

      It is essential that role and contributions made by Local Government to the ‘Transforming Your Care’ agenda, as represented in the above examples, are reflected fully in the final strategy

 

(ii)  Community Planning

 

      The Council would also wish to see reference made to how proposals within the report, underpinned by the overarching ambition to provide services at a local level, will be developed within the context of new powers for Community Planning expected to be conferred to local council’s as part of the reform of Local Government.

 

      In anticipation of this new responsibility, Belfast City Council has worked with the Belfast Strategic Partnership, the BH&SCT, PHA and others to develop an agreed thematic approach to Community Planning.  The conclusion of this exercise has been to propose nine key elements required for the successful delivery of any project that uses a Community Planning approach. Such guidelines may help deliver aspirations for integrated local services provision including community based provision, issues which are fundamental to the realisation of the ‘Transforming Your Care’ agenda.

 

      Amongst the key elements identified for Community Planning, which are clearly related to the anticipated role of Council’s in any partnership arrangements to improve health provision and outcomes locally, are

·         Adapting approaches to best fit with such things as existing statutory obligations, pre-agreed commitments, existing structures or thematic initiatives.

·         Meaningful engagement, involving people in all aspects of the approach right from the beginning. An inclusive, participatory approach, that emphasises communication with communities and between partner organisations, is essential to success.

·         A commitment to planning that results in tangible change that benefits people and communities. This involves identifying shared, long term, aspirational outcomes from the outset and mapping causal relationships between outcomes, interventions and indicators to measure impact.

·         Governance arrangements – Under the Local Government Reform proposals, local authorities in Northern Ireland will have political responsibility for leading on Community Planning.  However, leadership responsibilities and commitments by organisations (Statutory & Community and Voluntary sector) and communities are essential.

·         Resourcing - with no additional funding available for Community Planning there will need to be flexible use and sharing of budgets towards agreed joint outcomes. Resources should be committed and reflected in individual stakeholder plans.

 

The most effective and efficient solutions for the transformation of health and social care will require interventions and services that are delivered by a variety of statutory, community and voluntary organisations. For Councils to be successful in delivering a community planning role it is essential that community health and social care requirements are included and planned, designed, delivered and evaluated in an environment that is conducive to shared approaches.

 

(iii) Shared Assets

 

      The need for greater efficiency through sharing assets is clearly recognised in the consultation document. This point was also made in the ‘Fit and Well’ document which emphasised the growing importance of an asset approach; i.e. building on what a community has rather than basing interventions on what it doesn’t have. The Council supports this approach which is being used to guide aspects of the review of the Council Leisure estate in Belfast.  This review has emphasised the need to significantly re-orientate leisure provision towards the delivery of outcomes to address the widespread health inequalities in the city.  The Leisure estate review has been informed by recent research by the King’s Fund which has highlighted smoking; physical inactivity; low consumption of fruit and vegetables; and excess alcohol intake as key factors impacting morbidity and mortality levels.  The assets provided by Council leisure services, for example, the community gardens programme delivered with the PHA, demonstrate the enormous potential of direct local government involvement in addressing health issues and clearly reflects objectives of ‘Transforming Your Care’

 

      Regarding shared physical assets Councils have substantial resource which must be fully utilised in contributing to health improvement locally and regionally.  In Belfast alone, the Council’s Parks and Leisure department owns and manages

 

10 leisure centres

48 parks and open spaces

74 playgrounds

Outdoor fitness gyms

120 sports pitches

12 bowling pavilions

1 golf course

Belfast Zoological Gardens

1 Adventure playground

 

      Focused programmes and activities using the above facilities and aimed towards specific user groups – families, children, older people - continue to improve health and well-being locally.

 

      In a context of delivering more diverse services closer to home, Belfast City Council would cite the shared provision in place at the Grove Well-being centre as another example of where local government provides a complementary role in seeking long term health improvement driven by local need.  The co-location of leisure and General Practitioner (GP) services at the Grove centre enables local patients to be referred to the Council team of health and fitness instructors who are on site and in a position to provide interventions based on the needs of individuals and personal medical advice.

 

      Belfast City Council view the integration and sharing of assets (current and future) across the Public, C&V and Private sectors is critical to meeting local health needs and gaining potential efficiencies for the public purse.  It is essential for Local Government to be directly involved at both a strategic and local level to ensure the desired synergies and efficiencies are achieved.

 

(iv) Need to commit to strategic engagement with LAs

 

      Although the important role of Local Commissioning is referred to, which will provide input for locally elected representatives who are members of such groups, this should not be seen as an acceptable substitute for effective strategic engagement with local government

 

      Belfast City Council would seek assurance that Local Government will be directly involved in decisions regarding the roll-out of proposals, particularly in regard to its responsibilities for Public Health and future role regarding Community Planning

 

(v)  Family and Child Care

 

      Belfast City Council is represented on the Belfast Outcomes Group, which forms part of the NI Children and Young People’s Strategic Partnership.  Again the Council is fully supportive of the integrated approach being pursued and also the appreciation of how early intervention contributes significantly towards the achievement of health and well-being in later years.

 

      The Council would wish to express its view that that the child-centric approach should extend beyond services provided by health organisations and that the input from other organisations who improve the life chances for children and young people should be harnessed.

 

(vi) Urgent care services

 

      The Council notes the need for improvement of General Practitioner (GP) services expressed in surveys used to inform the review and welcomes proposals for GP surgeries to provide integrated care partnerships with multi-disciplinary teams.  It was interested to learn of the good practice example documented, as provided by Shropshire Doctors Co-operative Limited.

 

      Belfast City Council welcomes particularly proposals for GP out of hours services to support Accident and Emergency departments, providing urgent care provision on a 24/7/365 basis.

 

Closing

 

      Belfast City Council takes the view that the comments it has made and approach it advocates in this response reflect closely the underpinning principles expressed in the Transforming Your Care document - particularly as they relate addressing population health and well-being.  Proposals within the document are ambitious and will require measured risk taking.  Any such risk can, however, be minimised through shared planning, shared commitment and shared responsibility.  Such responsibilities must be clearly assigned to enable performance to be managed across all partner organisations.  

 

      The Council looks forward to continued engagement with health organisations and will be pleased to contribute further to help determine both local strategic direction and operational delivery of proposals in the city.”