What the Health is going on?

Hands up – it has been a while since any reports on attendance at health meetings, so this blog is designed to rectify that and to draw together some general thoughts on health related issues and the voluntary sector.

So what is going on – the big news is that the new provider for adult services has been announced. UnitingCare Partnership, which is a consortium of Cambridgeshire and Peterborough NHS Foundation Trust with Cambridge University Hospitals NHS Foundation Trust, are the lucky winners. They will have a duty to work with voluntary sector providers and we will need to keep a close eye on how the sector can get involved and especially how smaller local providers can be supported.

Another big announcement saw the publication of the Public Health Annual Report This can be viewed here. This report sets out the different health issues facing the county broken down by district. The report will inform much of the future work across the council and CCG and should be regarded as a source of information for VCS organisations.

Other big health news includes

  • The Better Care Fund which is a government plan for allowing local areas to reform health care. It looks to move funding from acute to community health provision. The County Council are responsible for this and have put in their initial plans to government. This has been a long and difficult process and the sector have been involved to some part, but expressions of interest for projects have not been taken forward despite the time and effort put into preparing them. More information can be found in the papers from the latest Health and Wellbeing Board here.
  • The Cambridgeshire and Peterborough Clinical Commissioning Group CCG have been developing a Five Year Plan. More information can be found on the CCG website. There is ongoing discussion as to the role of the VCS in this and it is important that we keep an eye on how providers can get involved. The fact that this area is one of the countries ‘financially challenged health authorities’ probably precludes lots of money for grants to support projects, this does not mean that some funding should not flow into the sector.

These notes follow attendance at the following meetings (if papers are available follow the links)

So what does all this tell us about health and what the voluntary sector can do?

There seem to a whole raft of positives for the sector in all these new initiatives. Firstly everyone is expressing their love for the work that we do to ensure healthier communities; secondly there is a real narrative that services have to move to a more preventative nature, this is great for the sector because as a rule it is where the bulk of our work is situated. Thirdly there is a move to a more person centred, local style of service, again right up the sectors street. There are undoubtedly going to be opportunities for sector providers to play a role in the new ways of working but things are not all rosy – given that there are severe financial constraints, given that commissioning does not generally favour the small, localised and specialist services that a lot of CCVS members provide, and given that acute services can not be stopped and will continue to demand greater funding despite the desire to work more preventively.

Finally we must recognise that change brings about a certain amount of introspection and this has been evident in those organisations responsible for funding health and wellbeing; hopefully, although there are still changes happening, both the CCG and the County Council are looking out more and more. I believe that it is important that as they start looking out they see a confident and professional VCS waiting to take up the opportunities that arise. There needs to be more joined up thinking about how the sector delivers and this is starting to happen, and there needs to be projects that clearly align with the priorities that have been articulated.

South Cambs still a safe place to live

The South Cambridgeshire Crime and Disorder Reduction Partnership (papers available here) met recently for its bi-annual stakeholder event, and it is official South Cambs is still a safe place. Not as safe as previously reported where South Cambs was reported to be the least crime ridden (?) of all its comparable districts, but still generally safe. It appears that things were never quite as safe as had been indicated as there were anomalies in how crimes were reported, but things are back to being recorded correctly, and whilst this does show crime rates will have climbed, it is not crime that is going up, just the crime reports.

I hope that is clear, because to be honest I am not sure what real difference it makes, the real test of how safe a place is to live is how safe people feel it is and this can often have no bearing on the reality of the number of offenses that are committed, reported and solved. For those of you who have a morbid curiosity about the number of offences committed where you live check out county information on the Crime and Community Safety Atlas, or national information on www.police.co.uk.

What I can not say is if either of these are based on the old recording method or the new one, but my understanding is that for more serious offences there will be little or no difference. As soon as the figures that were used in the meeting are verified and published I will post a link.

The meeting also heard an update on the community trigger which is a new power relating to reporting Anti-Social Behavior (See a previous blog What’s wrong with a good old fashioned clip round the ear?) The South Cambs trigger will replicate that of other districts across the county and will need three reports in a six month period to be eligible for activation (Find out more about the national pilots here). I am a bit disappointed that districts have not followed Brighton and Hove’s example of having a much lower trigger point (check out the website), but as things move forward then there is no reason that changes can not be made. Whatever happens then we need to make sure that reporting is easy and not time consuming; again there are lessons to be learnt from the pilots.

Who knew food could be so unequal?

Food is not really something I think about much, my wife is an excellent cook and does the food stuff at home, this includes much of the shopping and the planning. My job is to eat, make my share of breakfast and packed lunches, and occasionally visit the local shops. (In my defence I do most of the cleaning and ironing).

But food is a real issue and not just in the difference between what we eat and what those in the developing world eat (see the Hunger Notes 2013 World Hunger and Poverty Facts and Statistics), but in what goes on in a relatively wealthy City like Cambridge. That was the theme of the latest Cambridge City Diversity Forum.

Food, Glorious Food was held on 23rd June at the Meadows Community Centre and saw a number of food related presentations followed by a collective exercise to produce an interactive food map of Cambridge. In no particular order we heard from a number of different projects that help to alleviate food poverty and ensure that food is used in a sustainable way.

Foodcycle in Cambridge

They are the local branch of a national movement that

 “serve a delicious lunch at The Centre at St Paul’s Church every Saturday to a range of people from the community. The Centre is at the heart of the community and helps us to reach out to people in the local area. We also work in partnership with local organisations such as the Cambridge Love Food Hate Waste campaign. Each week we collect surplus produce locally from Sainsbury’s, the City Food Bank and Lensfield Road Farmer’s Market and then we turn these ingredients into exciting and nutritious meals for our service users to enjoy”

 

Cambridge Edible Garden

Their face book page says they are

“A new edible garden project at Murray Edwards College in Cambridge for students, University staff & the local community. All are welcome!” and that they “In short, we grow food on-site and then we eat it. Simples”

Cambridge Foodbank

Web http://cambridgecity.foodbank.org.uk/

Part of the national programme of Foodbanks Cambridge City Foodbank  works from 5 distribution centres across the City. In short

“Food is donated

Food is sorted and stored

Frontline professional agencies identify people in crisis

Clients receive short-term emergency food”

Cambridge Sustainable Food

They are

“a broad new alliance of organisations promoting healthy and environmentally sustainable food for all.”

 

So all in all it seems that there is a fair bit going on in the City when it comes to food sustainability and equality. The second half of the meeting reinforced this as all those present wandered round the room adding projects that they were aware of to giant maps of the City. These will eventually be digitised and we will share the results with you once we see them.

Once again the voluntary and community sector are coming up with innovative and practical ways to solve a problem not of their making. These solutions do not cure the disease that sees some people with not enough to eat but they go some way to alleviating some of the symptoms. As a sector (and as individuals) we need to look at how we can eliminate this imbalance.  Cambridge is a wealthy City but this does not mean everyone is wealthy, but surely it is not too much to expect that no one goes hungry!

What’s wrong with a good old fashioned clip round the ear?

Well everything really – but back in the good old days when there was a Dixon of Dock Green on every street corner (check out Wikipedia if you are too young to get the reference), and everyone knew their local bobby this is how minor nuisance and what would now be called anti social behaviour (ASB) was dealt with – apparently.

This remedy is getting a 21st century update as part of changes to the law brought about by the Anti-Social Behaviour Crime and Policing Act 2014 which introduces two new ideas (amongst other things) the Community Trigger and Community Remedies.

This was one of the items discussed at the Cambridge Community Safety Partnership (CSP) the papers of which can be found here. More information can be found about these new powers in this presentation.

So there are three things here, first there is a simplification of the numerous notices, orders and ASBOs that currently exist. This will undoubtedly make things easier for the Police and other agencies but will have little effect on the public. The next issue is the Community Trigger, this will have an effect on everyone and will possibly be the best thing to come out of this government for some residents groups and community associations who spend their time dealing with ASB issues and finally there is the idea of community remedies, this will allow the Police (and in some instances others) to meet out punishments without going through a court procedure.  This could be seen as a triumph of common sense over bureaucracy or as the long slippery slope to the Judge Dredd ‘I am the Law’ scenario (again check out Wikipedia if this reference means nothing to you).

Whatever you views it is probably worth making them known to the Police and Crime Commissioner as he will be making the final decisions on how this will work. There is a survey on the PCC website here.

The meeting also heard a report on the County wide Domestic Violence needs assessment and the executive summary is included in the papers and is available here, with the full report available here. This area of work always strikes me as being well co-ordinated and being a partnership that brings out the best of both statutory and voluntary sectors. Whilst there are undoubtedly areas that could be improved my feeling is that we are getting many things right, and that this issue remains a focus of not just justice partnerships but also health and wellbeing partnerships. If this is an issue that affects you there is more information on how to get help on the County Council website.

Is the whole really greater than the sum of its parts?

As someone involved in too many partnerships to list I really hope so!! Because if not we are all wasting our time.

LHP Priorities Plan 2014_15_Page_1

South Cambs LHP Priorities

It was this question that the South Cambs Local Health Partnership was trying to answer when it looked at what solutions and actions we could take to make a real difference to the revised priorities they have developed.

A long and animated discussion led to a number of completed pages of flipchart followed by the rest of the agenda.

If all that happens is that the flipchart gets either

  • A) rolled up and put away or
  • B) written up, rolled up and put away

Then I say let’s make this the last meeting of this group and we can all use our extra time to do something useful on our own.

HOWEVER if we can start to make links and join projects together; if we can share vital knowledge across networks that improves services; if we can complement the work of one partner with the work of others and provide a more joined up service – then let’s get on with it!

What this can not be is simply a South Cambs District Council responsibility, and as such for once I have come away from this meeting with an action, rather than simply attending, reminding people how great the voluntary and community sector is and how unrecognised the work they do is, and then coming back to the office.

My argument was that we do not know how much the sector does to address the priorities that have been set. As the recognition that prevention is cheaper than cure (see my blog prevention, prevention, prevention) gains traction I believe that the sector has to be recognised and funded for the work it does – even if this takes away from the shiny acute health sector and all their big hospitals and bigger budgets.

My problem is that I do not know what impact the sector has on the priorities, or any other priorities to be fair. I know what great work many groups do, but I know that only a fraction have links with CCVS. I know that many groups provide a service but that this may not be linked directly to a priority even if it addresses it. I know that I have to start putting more flesh to the bones of my belief in the work of the sector. CCVS does this through its annual survey as well as picking up on informal feedback but now I have a small project. I am going to look at one South Cambs village; I am going to look at listing the work of the sector in that village and then mapping that against the LHP priorities. I hope it will show me a healthy and vibrant community as I have picked the village I know the best, I also hope it will help me demonstrate the impact that small community organisations have and why they should be at the forefront of preventative services.

I will post an update once I have done some work :)

Mental health is more than just a health issue

anxiety

As Mental Health Awareness Week draws to a close it seems fitting to highlight how this topic is rising up the agenda of a number of the community safety and crime partnerships CCVS attend.

Having recently attended the Community Safety Partnerships for both Cambridge and Fenland, and the Police and Crime Partnership meeting I am struck by the increasing issues raised around mental health and how it affects victims and perpetrators of crime. More and more the Police and other partners have recognised that the mental health of those that they are coming into contact with is a contributory factor to the committing of crimes and something that affects many victims.

There is a real desire to examine this issue and work out what can be done to prevent crime and to support victims and perpetrators to address any mental health issues. The new Cambridge City Community Safety Plan has a strategic objective to

“To understand the impact of mental health, alcohol and drug misuse on violent crime and antisocial behaviour”

The growing recognition that mental health is an issue and that reducing offending means looking at, and addressing, the underlying issues that people have has been recognised and the partnership recognises that it needs to find out more about this to develop effective strategies can only be welcomed.

In Fenland whilst there is no mention of mental health directly there is a strong focus on Anti-Social Behaviour and problems caused by alcohol. It is recognised that mental health problems have an impact on both these areas and that they need to be addressed.

Significantly the Police and Crime Commissioner has identified Mental Health as a priority area and will be bringing his influence to bear to look at how the system of dealing with mental health across the county can be improved with a view to reducing offending. The county has effective partnership structures in place around domestic violence that involve many agencies working together, this is overseen by a Domestic Violence Board who can ensure parity of service across the county and ensure that organisations are working together. The need for a similar board for mental health, along with the funding and partnerships to make a real difference seems to be paramount. So over to Sir Graham to make it happen!

As far as the voluntary sector goes there are numerous organisations working with and supporting those with mental health issues, reductions in funding to the NHS and increasing thresholds to get people into the clinical mental health system are putting pressure on many services. It is vitally important that everyone gets the support, treatment and information they need in an appropriate way. It is only a truly person centred and joined up system that will bring about real change for the individuals affected directly and indirectly by mental health issues; by doing this we will be able to reduce offending and create safer communities.

If you work in the mental health field please let us know your thoughts, we are looking at what we as a sector need to do in order to start influencing the agenda and providing services that work towards a common goal.

The search for someone to provide Older Peoples services continues

The consultation on the Older People’s Programme dominated the latest meeting of the Fenland Health and Wellbeing Partnership. And so it should it my opinion.

This is the biggest change in the way that health services are delivered in the county for a long time, and Cambridgeshire and Peterborough CCG are leading the way nationally in commissioning such a big piece of work. So the first thing to say is – have your say – check out the consultation website and encourage all those you work with to do the same. Spoiler alert – this page is quite long as is the consultation so it is not particularly user-friendly.

I guess for me there are three questions about this.

The first is what will the impact of the consultation be, especially the first question that asks

“On page 11 of the consultation document, Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) explains the reasons behind these changes. Please can you rate on the scale below how supportive you are of these reasons for changes?”

If everyone strongly disagrees will they not go ahead with the process? There was a hint at the meeting that this project could still be stopped if the prospective suppliers did not meet standards etc. So could people power really make a difference?

The second question I have is how this all adds up for services, for those using them and for those proving them. In effect the contractors are being asked to provide comparable services for less money. I am sure that there are efficiencies to be made in the current system that contractors could exploit to drive costs down, but introducing an extra layer of monitoring and a whole new infrastructure will surely cost so will services remain the same, will standards really improve and can we be assured that those delivering services on the ground continue to have the same salaries and benefits as they currently have. As those that know me will attest I am not a financial genius but I cannot see how these companies can deliver the same services for less money, and that overall that this way of working will save the NHS and us significant amounts of money.

My third question is where do the Voluntary and Community sector sit in this process? The consultation document talks a lot about community services and even has a section on the voluntary sector that states

“We believe that the use of the voluntary sector is very important in supporting independence and healthy living. One of the questions the CCG is asking bidders is how they will work with the voluntary sector. For bidders to answer this, we would expect them to make contact with voluntary organisations and to develop an understanding of what benefits the voluntary organisations can deliver to our patients.

As part of the procurement process a number of events have been held to provide an opportunity for voluntary sector organisations to meet with bidders to showcase the services they provide.

Bidders will be asked to explain how they will work with and fund services offered by the voluntary sector.”

So there you have it we should be expecting to receive funding – grants as well as commissions I hope. That said I don’t think that any of the shortlisted providers have been knocking on the door of CCVS to find out what the sector is doing and what they might like to do. If you have met with the shortlisted providers do let me know I would be interested to hear your experiences. CCVS will continue to push for a greater dialogue with all parties on the sectors role. We feel that it is essential that some guarantees are built into the contracts.

Getting back to the wider Fenland Health and Wellbeing Partnership I am pleased to say that future minutes and agendas will be published on the FDC website. I will post a link once they become available.

There continues to be a real feel of joined up working across some of the key priorities that the partnership have identified. Despite not getting funding to become a Local Alcohol Action Area the council are looking at how to reduce issues caused by alcohol both around health and crime and will be looking at the impact of a super strength campaign similar to the one underway in Ipswich. Similarly there is some great work underway about reducing Coronary Heart Disease and encouraging people to get a health test. More info on the FDC website.

Update the latest newsletter about the Older People’s Service is available here