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Paper 9 - 4 June 1999 Meeting

ASSOCIATION OF HAMPSHIRE AND ISLE OF WIGHT LOCAL AUTHORITIES

4 June 1999

HEALTH IMPROVEMENT PROGRAMMES

Joint Report by HIOW Health Leads

RECOMMENDATION

It is recommended that the action points in paragraph 17 be agreed.

SUMMARY

The first Health Improvement Programmes (HImPs) have been prepared.

Local Authorities have worked in partnership with the Health Authorities and other agencies, and this report draws together some initial reflections.

It also proposes some action points intended to enhance the effectiveness of the local authority input to HImPs.

CONCEPT

1. HImPs are a series of Health Authority area strategies for improving local health and health care. The key components are intended to be:

to assess the health needs of the local population and how these are to be met by the NHS and its partner organisations through broader action on public health

to meet the health care requirements of local people, how local services should be developed to meet them, either directly by the NHS or where appropriate jointly by Social Services

to manage the investment required in local health services to meet the needs of local people.

2. The first HImPs cover the period from 1 April 1999 to March 2000.

3. At its 25 September 1998 meeting, the Association considered an initial paper on the local authority perspective on HImPs. The Association encouraged the sharing of best practice and adopted some guiding principles - which for ease of reference are set out in Annex 1 to this report.

4. This report has been prepared in the light of the experience of partnership working in the context of the four HImPs for the Health Authority areas within Hampshire and the Isle of Wight.

HIMP PREPARATION EXPERIENCE

5. Each Health Authority had a challenging task, within an extremely tight timescale, to lead the preparation of the first HImPs with the other key players, including Local Authorities. At the outset it is right to pay tribute to the commitment and enthusiasm of all concerned in the process.

6. In seeking to draw together the threads of experience, we have looked at:

7. the process for developing the HImPs

8. the content of the HImPs

9. issues identified for future action.

Process

10. Each of the Health Authorities clearly set out with a commitment to an inclusive approach to HImP preparation. Local Authorities and other partner agencies were involved. The specific process varied significantly in each area, and there are indications that some processes were more effective at securing inclusiveness than others. The draft HImPs in the Isle of Wight and Portsmouth and South East Hampshire areas were particularly commended by the Health Service Regional Office.

11. Whilst the appropriate agencies were drawn into the process, it is generally recognised that the links into the community, both in terms of locality and interest, were not achieved as well as they could have been with more time.

12. The timescale for preparation was a short one from what was a standing start, and inevitably Government guidance became available as the process was under way. However, the guidance is now available, this will help understanding of the process for future years.

13. Within Hampshire the Hampshire County Council Corporate Health Group has provided a forum which brings together all three Health Authorities, with the County Council and some District Council staff (from North and Mid-Hampshire). Real progress has been made on shared synchronised objectives reflected in the HImPs. A positive example is the emerging work with District Audit on accident prevention for older people involving all agencies. However, this forum has not yet really engaged either of the Unitary Cities, nor the Districts in the two southern Health Authority areas.

14. There is also a better understanding, both by Local Authorities of the complexities of the Health Service planning process, and by the Health Service agencies of the roles and processes of Local Authorities. The Year 1 HImP process means that most are significantly further up the learning curve, which will undoubtedly facilitate the process in subsequent years.

Content

15. The general view is well summarised in the comments from one Council Chief Executive - "the content is strong on what we are doing now, but less so on wide-ranging future initiatives". Pressures of the timescale, and the nature of the Health Service planning process, have resulted in HImPs which primarily take forward existing Health Service and joint commissioning plans and priorities.

16. Reflecting this, progress in addressing public health issues outside clinical and care settings has been very limited. The challenge now is to include high level strategic measures to improve health in its widest meaning over say 5/10 years involving all types of local authority objectives.

17. There has also been relatively little progress in getting to grips with cross-cutting issues in determining priorities. Such consideration as there has been on priorities, has tended to focus on priorities for using additional resources, rather than a comprehensive examination of options. However, it has to be recognised that the timescale strongly militated against such a comprehensive review in Year 1. Also, the parallel message from Health was to maintain provider stability through the Service and Financial Framework (SAFF) mechanism which therefore minimises service reconfiguration.

18. The developing role of Primary Care Groups has also tended not to be fully reflected in the Year 1 process, although the PCGs were able increasingly to contribute, as they evolved. It is noted that PCG based HImPs are expected to be developed this year.

Future Issues and Observations

19. There are clearly some common threads emerging from the local authority perspective:

16.1 Local Authorities need to integrate their respective inputs with the HImP process more effectively, and therefore a greater synchronisation of Unitary, District and County Council objectives as a precursor would be helpful. This would help avoid any distracting debates between strategic and local priorities by ensuring they are complementary as far as is possible bearing in mind local diversity.

16.2 It is clear that input from departmental and functional areas eg Social Services, Education, Transport etc., has been effective. In the HImP Steering Groups, and the Corporate Health Group, that aspect of the Local Authority voice has been very strong, and heard. However, the Local Authorities' voice on the wider public health context has also been very strong, but as yet has not had a substantial impact across all HImPs (although there have been some encouraging first steps).

16.3 The Corporate Health Group concept could be developed to provide a cross-Health Authority and cross-Local Authority forum, to enhance the integration of the HImP process. The objectives of such a group would need to be sensitively drawn and focussed, in particular to recognise the focus at Health Authority and more local level.

16.4 Reflecting the unique coterminosity of the Isle of Wight, it is possible the Island will be more easily able to achieve integration of LA/Health objectives working on Island issues alone. However, the Health Service is currently considering whether to bring the Island within one of the mainland Health Authority areas.

16.5 The HImP preparation process should become a more comprehensive one. Priorities need to be addressed across the whole range of Health Service, Care and Public Health services.

16.6 The process needs to move beyond one looking primarily at priorities for the use of additional resources (the Year 1 process looked mainly at the icing on the cake, rather than the whole cake).

16.7 The Health Service and Financial Framework (SAFF) and Joint Investment Plans (JIP) can be related to the HImP process in an integrated way. In Year 1 these have been developed separately from the HImP. However, full integration may not be possible given the complexity of the necessary processes, the different time frames, and content. In any event the point made in paragraph 16.5 above applies, and the current reviews of joint planning mechanisms need to accommodate the inter- relatedness of the requisite plans.

16.8 Local Authorities and Health Authorities need to consider how to relate the HImP process to the community context. Local Authorities are particularly well placed to facilitate this. However, PCGs will be developing local HImPs and the boundaries are not coterminous. The need to relate the clinical, care and public health objectives at that local level, as well as at Health Authority area level, is an important one.

16.9 The HImP process has yet really to address health inequality issues in a comprehensive way. This is an important part of "Our Healthier Nation" objectives.

16.10 The links between the Health Authority HImP and the more local Health Alliance (or similar) partnerships will need working through. The challenge is to secure a two-way link, that is both bottom up and top down.

16.11 The links between councils and Primary Care Groups need to be based on strong and effective partnerships at both operational and democratic levels. The related framework needs to facilitate this, but currently does not reflect this as the representative roles of County and Unitary Councils are focused on operational social services and care issues, and those of District Councils are not recognised at all.

16.12 The managing of links with other strategies and identifying common objectives, should not mean subsuming those within the HImP, but boundaries need to be delineated.

17. ACTION POINTS

17.1 Local Authorities should work to ensure the next HImPs reflect a public health, and long term ill-health prevention agenda (a "social model" of health).

17.2 Local Authorities should work towards synchronising their various objectives and towards HImPs reflecting strategic and local issues in a broadly based way. Over time this "synchronisation" should lead to real integration in the context of an increasing number of issues and actions.

17.3 The timescale should be realistic to achieve widespread ownership and support.

17.4 Local Authorities should link with PCGs to ensure Healthy Alliances objectives are reflected in PCG based HImPs.

17.5 The Association should press for Councils to have an increased level of representation on Primary Care Groups to strengthen both operational and democratic/community links.

17.6 Local Authorities should help the HImP processes relate more effectively to community links.

17.7 The potential of, and support for, a cross-Health Authority/Local Authority forum in Hampshire and the Unitary Cities should be assessed. Pending that, the current Corporate Health Group should have strengthened District Council representation.

17.8 Links between Hampshire and Isle of Wight health services be reviewed if the Island's Health Authority were brought within a mainland Health Authority area.

17.9 Participation in the reviews of Joint Planning processes should seek to ensure that all requisite plans can be developed and delivered. Those processes also need to take account of the contribution of Health Alliances and Drug Action Teams and other related cross-cutting working.

TERRY BUTLER
Director of Social Services - Hampshire

CHRIS TAPP
Chief Executive - Eastleigh

ANNEX 1

HEALTH IMPROVEMENT PROGRAMMES - LOCAL AUTHORITY OBJECTIVES

That the context of Local Authorities as 'community leaders' with a responsibility for the well-being and sustainable development of their areas be applied to local health improvement programmes;

(1) in the absence of more specific guidance, Local Authorities in Hampshire and Isle of Wight adopt a set of principles based on those set out in "Our Healthier Nation" (p40, paragraph 3.43) as quoted at paragraph 7 of this report;

(2) that Local Authorities in Hampshire and the Isle of Wight give priority to identifying those areas of local authority activities that contribute to health improvement and work towards ensuring that these priorities are incorporated into local Health Improvement Programmes;

(3) that where these priorities will deliver on the target areas of 'Our Healthier Nation', Health Authorities be requested to ring-fence a percentage of health improvement resources to enable implementation of local initiatives to achieve the health targets set out in local authority led Healthy Cities/Health For All strategies and plans;

(4) that Local Authorities take a lead in community involvement for the Health Improvement Programme and Primary Care Groups (PCGs) in their capacity as community leaders;

(5) that Health Authorities work towards a more comprehensive HImP over the next 3 years with integration of local authority priorities;

(6) that the Association encourages a coherent approach and the sharing of models of good practice.

NOTE: The principles in "Our Healthier Nation" referred to in (1) above -

* give a clear description of how the national aims, priorities, targets and contracts will be tackled locally;

* set out a range of locally-determined priorities and, targets to address issues and problems which are judged important, with particular emphasis on addressing areas of major health inequality in local communities;

* specify agreed programmes of action to address these national and local health improvement priorities;

* show that the action proposed is based on evidence of what is known to work (from research and best practice reports);

* show what measures of local progress will be used (including those required for national monitoring purposes);

* indicate which local organisations have been involved in drawing up the plan, what their contributions will be and how they will be held to account for delivering it;

* ensure that the plan is easy to understand and accessible to the public;

* be a vehicle for setting strategies for the shaping of local health services." (Page 40, paragraph 3.43).

Last update: 11/10/2000
Author: Nick Goulder, Policy Manager

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