RPA Changes

1
RPA Changes implications for community
development and health

• The new RPA health structures.
• Discuss the implications for community
  development and health work.
• Recommend work for CDHN to help prepare members
  for the changes.
• Barbary Cook, Director, 2nd March 2007

2
RPA Changes implications for community
development and health

• CDHNs influencing policy role
• Bringing change at the centre
• We do theoretical and strategic policy work at
  regional level to open doorways for members
• Supporting members to influence policy
• Work closely with people on the ground to have
  coordinated policy impact
• Aim is not to overlap with or impede work of
  member in local areas - role as facilitator

3
RPA Changes implications for community
development and health

• Community Development and Health context into
  which the RPA emerges
• Review of Mainstreaming Community Development
  DHSSPS commissioned CDHN to review progress on
  mainstreaming CD in HPSS made recommendations on
  need for strategic leadership at senior level,
  training, community development strategies,
  partnership with CV sector etc.
• Rapid and extensive development of community
  development and health work on the ground
  (community groups, healthy living centres, BCPP
  etc).
• Shift in UK and NI policy to tackling health
  inequalities, Investing for Health, Regional
  Strategy etc., with community development as
  recognised tool.
• RPA changes about public administration changes
  rather than policy content drivers i.e. saving
  money and over-management in public sector not
  this might be the best way to tackle health
  inequalities

4
RPA Changes implications for community
development and health

• Overall picture of the changes
• DHSSPS strategic direction, policy, smaller
• 5 Trusts amalgamation of current 19 Trusts
  (provider)
• 1 Health and Social Services Authority
  operational responsibility (commissioner)
• 7 Local Commissioning Groups (commissioner)
• ? Community Commissioning Associations
  (commissioner)
• 1 Patient Client Council

5
The New Structures
6
New RPA Health Structures

• What the DHSSPS says about the new structures
• New Systems
• Devolved commissioning community focus
• Performance management
• Finance
• Public and social health development
• Workforce and staff development
• Enablers
• Service frameworks
• Strong information system
• Effective professional engagement and leadership
• New organisational arrangements
• Enhanced public, user and staff engagement
• Effective planning processes

7
RPA Changes implications for community
development and health

• CDHNs initial response to RPA changes four
  principles
• It is crucial that successful work carried out by
  members of the HSS on mainstreaming community
  development approaches not be lost under the RPA
  changes.
• Community development approaches to tackling
  health inequalities both within Investing for
  Health and throughout the HSS family must be
  confirmed and protected.
• A community-based user voice must be integrated
  into the planning and delivery of services via
  the local commissioning groups.
• Partnerships between the HSS family and the
  community and voluntary sector must be maintained
  and strengthened to ensure the effectiveness of
  community development approaches to tackling
  health inequalities.

8
NEW TRUST CONFIGURATION
9
RPA Changes implications for community
development and health

• Questions about the Trusts
• What will happen to the Community Development
  Units?
• Where will responsibility for community
  development lie in the Senior Management Team?
• CDHN has lobbied 4 out of the 5 Chief Execs to
  say it should be with planning and performance
  management i.e. high up and that each member of
  the SMT should be obliged to report on how their
  department adopts CD approaches.
• Community Development Performance Management
  Framework, produced by Regional CD Managers Group
  CDHN.
• What are the implications for users, carers and
  communities of larger Trusts?
• How will the Trust continue existing
  relationships with CV sector and develop new
  ones?

10
RPA Changes implications for community
development and health

• Agencies
• CSA - Functions transferring to new health and
  social services organisations
• NIPEC MDTA - Functions combined and transfer to
  new Health and Social Services Authority
• MHC - Functions transferring to new Regulation
  and Quality Improvement Authority
• Fire Rescue Service - Transfer to local
  government as a regional service
• Health Estates Agency - Functions transferring
  into the new HPSS organisations
• RQIA - Remaining
• Social Care Council Remaining
• Guardian Ad Litem Agency - Remaining

11
Commissioning

• Map of Commissioning boundaries co-terminous
  with District Councils
• Community Commissioning Associations presumably
  co-terminous with LCGs expected population size
  50,000- 70,000

12

• What the DHSSPS says about the new structures
• A Local Commissioning Group is
• Committee of the Health and Social Services
  Authority (HSSA) with delegated power to
  commission services accountable to HSSA Board
• Primary care led with 15 members, two of which
  are lay people from the local community
• Leader and decision maker for commissioning
  health and social care services
• Functions
• Engage and involve local people in the promotion
  and planning of services
• Redesign and improve services
• Secure safe and responsive services
• Commission public health programmes with partners
  to reduce health inequalities
• Deliver local, national and Ministerial health
  and social care targets

13
RPA Changes implications for community
development and health

• What the DHSSPS says about the new structures
• Community Commissioning Associations
• Locality based commissioning
• Alliance of GPs, other FPS, health and social
  care practitioners, community and voluntary
  sector
• Commissioners for a distinct population within a
  LCG area
• Sub-committee of an LCG with delegated powers and
  devolved budgets
• Supported to deliver real change
• Implementation guidance being developed for April
  2007
• Universal coverage

14
RPA Changes implications for community
development and health

• CDHN welcomes the following elements in the
  commissioning proposals
• emphasis throughout the document on public
  engagement
• strong emphasis on public health and well-being
  improvement
• the point that partnerships with community and
  voluntary sector will be an important part of
  commissioning arrangements
• the intended outcome of enhanced user experience
• the understanding of peoples entitlement as
  citizens
• the professional leadership programme as
  envisaged and
• the emphasis on performance management and notes
  that CDHN and Community Development Managers in
  Boards and Trusts have developed a community
  development performance management framework.

15
RPA Changes implications for community
development and health

• Areas for improvement/strengthening in the
  proposals on commissioning
• define the public in terms of community
  engagement and community development
• support the Wanless, fully engaged scenario as
  the goal of engagement
• move beyond simple user panels to a range of
  engagement methods including but not limited to -
  focus groups, public meetings in community
  venues, open forums between SMTs and community/
  voluntary sector etc.
• Community Commissioning Associations
• engagement with the community and voluntary
  sector must be part of CCAs.
• community and voluntary sector should play a
  formal role in CCCAs
• CCAs should reflect geographical communities
  rather than being based on GP practices
• capacity building for CV included in the
  professional leadership programme potential
  power imbalance.
• must ensure coherence between community planning
  in local government, planning of education
  services and HSSA commissioning.

16
RPA Changes implications for community
development and health

• Timetable
• LCG recruitment and selection of independent
  contractors and lay members January and
  February 2007
• Appointments made March 2007
• LCGs in place March - April 2007
• Commissioner Development programme begins April
  2007
• An HSSA by April 2008
• Joint Committee by January 2007

17
RPA Changes implications for community
development and health

• Discuss the implications for community
  development and health work.
• How will your work be affected by RPA health
  changes?
• What are the opportunities in the new structures?
• What are the threats?
• How ill you engage with the new organisations?

18
RPA Changes implications for community
development and health

• Recommend work for CDHN to help prepare members
  for the changes.
• For example, seminar on how tog et your services
  commissioned?
• Visit our RPA page on our website
• www.cdhn.org/rpa