The Health Act Flexibilities

1
The Health Act Flexibilities

• Carole Bell
• Joint Unit
• Department of Health

2
Government Policy - joining up

• Statutes
• Strategies
• Plans
• Structures

3
Health Act 1999 and Partnership

• Duty of partnership
• Health Improvement Programme
• Partnership provisions
• transfer of money - 28A and 28BB
• JCCs

4
Why Partnership for health?

• Improving the peoples health cannot be done by
  NHS alone-
• - social care
• - housing, and environment
• - crime reduction
• - environmental health
• - education
• - transport and roads
• - leisure facilities

5
Why Partnerships?

• Customer focused whole systems responses designed
  for customers not providers
• better co-ordination of activity, less confusion
• opportunities for greater participation
• synergy of working together
• greater efficiency in the use of resources
• more opportunities for innovation

6
What are the flexibilities?

• pooled budgets
• lead commissioning
• integrated provision
• and- - Section 28A
• - Section 28BB
• - combinations of these

7
Pooled Funds

• flexible use of available revenue resources
• clear aims and outcomes
• agreed level of contributions
• money in fund able to be spent on any of the
  services
• performance measures
• one agency to host pooled fund
• identified staff to assess

8
Delegation of Functions

• Co-ordinated approach to the commissioning,
  provision of services
• single management structure
• transfer of resources and staff
• use of independent sector

9
Money transfers - 28A and 28BB

• HA and PCT transfers to LAs - 28A extended to all
  health related local authority functions
• LA transfers to HAs and PCTs - 28BB - a new power
  - broad functions

10
The opportunities - the extent of the functions-
LAs

• HEALTH RELATED FUNCTIONS OF
• environment
• housing
• social services
• education
• leisure
• transport
• libraries
• and more

11
Opportunities - health functions

• Community services
• acute services, though not surgery
• patient transport, though not emergency
  ambulances

12
Partnerships - the process

• conditions in the Regulations - consultation
• - objectives in the HImP - functions
• - written agreement
• notification
• - local accountability
• - checklist

13
Key issues for local partnerships

• Principle of proportionality
• governance
• workforce
• information sharing
• finance
• best value, clinical governance

14
Where are they being used?

• intermediate care
• services for older people including transport and
  housing, alarm systems etc.
• learning disabilities
• mental health
• child and adolescent mental health
• joint equipment services
• 28A and cycle paths

15
Partnership - potential difficulties

• Territorialism, traditionalism, timidity,
  tribalism, terrorism
• time consuming - to begin and to maintain
• requires TRUST
• potential for bureaucracy
• perceived unclear accountabilities

16
Boundary crossing - The Way Ahead

• Using review processes, best value, joint
  reviews, Commission for Health Improvement
  reviews
• priorities in the Health Improvement Programme,
  and other strategic plans
• problem solving

17
Where to begin?

• put the customer first, not the service provider
• think outside the box
• establish good joint working
• ask the right questions for the right problem
• find a champion
• agree principles and values
• gain clarity of purpose and agreements

18
To achieve-

• Better services, better outcomes through
• innovation
• crossing boundaries between customers,
  communities, public sectors, independent sectors
• www.doh.gov.uk/jointunit/index.htm