Health & Wellbeing - bringing together the pieces

1. going beyond: project management business consulting construction and property services
Health & Wellbeing
...bringing together the
pieces

2. Context
• Different systems / terminology
• Shrinking budgets and drive for efficiency
• Changes to public health and the NHS
• Future introduction of Health and Wellbeing boards
• Service offerings have tended to grow organically over time

3. Bringing together the pieces....
Determinants
of
health
Disease
Adult Social Care
Independent Living
NHS
Third Sector

4. A shared understanding....
Condition Specific Support & Treatment (Assessed Services)
Assessment of Need
Individual’s Life Course
Point of crisis / intervention
PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION
Non Assessed Services
Condition management
Characterised by absence of an issue or
condition, but there may be a risk associated
with genetics, lifestyle or environment
Characterised by an issue or condition but this is managed to
prevent deterioration (movement into the next stage)
Universal
Prevention
Targeted
Prevention
Specialist
Prevention /
Short-term
Intervention
Specialist Care
Health & Social CareWider PartnersCommunity Assets
Spectrum of provision
Audit of Health & Wellbeing
ProvisionAsset Based Working
Joint Strategic Needs Assessment

5. Finding a more unified approach....

6. Scope (1)
Health & Social Care
Single Organisation
Wider Partners
Local Strategic Partnership
Community Assets

7. Scope (2) – The inverted triangle of action
Level of need
General population need
Low to moderate
needs
Substantial
needs
Complex needs
Strategic focus Types of activity
Citizenship
Neighbourhood & community
Info & service access
Volunteering opportunities
Age proofing services
Community development
Enabling community self help
Community safety initiatives
Decent homes
Active ageing initiatives
Befriending
Shopping, gardening, repairs
Intermediate care
Enablement services
Carer support
Integrated care teams
End of life care
Post-discharge support
Pathways out of hospital or residential
care
Lifestyle
Practical support
Enablement & early
intervention
Long term care in the
community
Institutional avoidance
Timely discharge

8. Recognising community assets….
Source: ‘A Glass Half Full: how an asset approach can improve community health &
wellbeing’
http://www.idea.gov.uk/idk/core/page.do?
pageId=18364393

9. Methodology

10. Sample outputs
Amount %
Primary Prevention
Amount (%)
Targeted Prevention
Amount (%)
Adult Services £12,000,000 40% 0% 100%
NHS £900,000 5% 86% 14%
Housing £10,000,000 35% 59% 41%
Corporate Services £1,900,500 10% 67% 33%
CVS £1,900,500 10% 0% 0%
Total amount of funding
Value Schemes
Amount % Count %
Supporting People £8,367,601 32% 122 62%
Adults (Mainstream) £939,202 4% 33 9%
Drugs £995,404 4% 9 4%
Carers Grant £243,682 1% 7 3%
NHS £1,353,220 5% 12 6%
AIDS Grant £34,767 0% 6 2%
Self Funders £154,340 1% 2 1%
Area Based Grant £23,351 0% 1 0%
Learning Disabilities Development
Fund £47,700 0% 6 2%
Funding source

11. Sample outputs
Type of services provided through funding (Primary vs. Targeted)
Primary Targeted
Emergency Alarm £0 £1,195,000
Home Improvement / Handyperson £4,940,000 £2,500,000
Information & Advice £2,245,000 £750,000
Support Network £14,000 £415,000
Luncheon Club £0 £55,000
Drop In £0 £258,000
Befriending £0 £144,000
Volunteering Opportunities £366,000 £0
Age Group Spend
Focus of targeted
spend (%)
2009 estimates
non-specific £22,000,000
18-25 £1,500,000 41% 12%
25-39 £450,000 12% 26%
80+ £2,100,000 59% 5%
Age

12. Benefits....
• Detailed understanding of:
• What this funding is spent upon
• The target recipients of this investment
• Purpose of the provision
• Ensure that provision is in the correct places
• Identify duplication in provision and opportunities for better co-
ordination, thus identifying efficiencies
• Alignment to policies such as ‘Total Place’ and the ‘Big Society’
• Promotes partnership working
• First steps towards the integration of Public Health into Local
Authorities

13. Need Cost Resource shift
Complexity
Thickening the preventative waist.....

14. Our experience....
Bolton Council and NHS Bolton required an independent review of current health and wellbeing
provision to assist with strategic planning. CPC conducted this baseline audit of prevention based
services across social care, health, housing, corporate services and the CVS. This audit provided an
outcome framework against which services can be mapped so that spending can be aligned to local
issues and contribution to strategic objectives can be traced. CPC also identified opportunities for
better co-ordination and will ultimately inform the future targeted wellbeing and prevention strategies.
In order to maximise the impact of prevention based services it was important to understand who
currently benefits from them. CPC developed a framework within which the preventative services of
both health and social care could be jointly examined. As a result of this work we identified overlaps
and gaps of service provision so that future redesign of services can be undertaken and the process
could be continually updated in a sustainable fashion.
CPC were commissioned by NHS North West and the Department of Health to develop a ‘whole-
system’ framework for the adoption / integration of a community asset approach within health, social
care and related systems, enabling organisations to effectively plan and commission services in order
to achieve the best possible outcomes for the people in their area. This work will also support
commissioners and providers to redesign services, with other stakeholders including communities, in
order that local assets (community and organisational) are pooled to enable the futures desired by all
stakeholders to develop.
Portsmouth City Council appointed CPC to undertake an in-depth independent review of the City
Council’s Health Improvement and Development Service (HIDS), in order to inform future service
development and investment decisions. The review provided the Council with a clear view of HIDS
central co-ordination and leadership role for prevention, early intervention and health promotion
across health and social care. CPC also provided a robust validation of the performance and
contribution to wider agendas relating to determinants of health. The operational efficiencies of
having health promotion and social care teams working together provide vital learning for other areas
and place HIDS in a leading role.

15. Brett Nelson
Associate Director
CPC
0161 830 2139 / 07827 804156
brett.nelson@cpcltd.com