Cllr Amanda Martin and Theo Leijser. 27 January Dear Amanda and Theo, Health and Wellbeing Peer Challenge

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1 Cllr Amanda Martin and Theo Leijser 27 January 2014 Dear Amanda and Theo, Health and Wellbeing Peer Challenge On behalf of the Councillor Ford, David Hagg and myself, I would like to say what a pleasure and privilege it was to be invited to the Isles of Scilly to deliver the health and wellbeing peer challenge day on 27 th November. Also thank you for the opportunities that were made available to us and the wider team to access core Isles of Scilly stakeholders, as part of the 4 day long challenge in Cornwall the same week. We were grateful to all of you but Aisling Hick in particular for the time and trouble she went to in order to make the day a success. As you will be aware this work was delivered within the context of the LGA s health and wellbeing system improvement programme. This programme is based on the principles of sector led improvement, i.e. that health and wellbeing boards will be confident in their system wide strategic leadership role, have the capability to deliver transformational change, through the development of effective strategies to drive the successful commissioning and provision of services, to create improvements in the health and wellbeing of the local community. Scope and focus of the peer challenge The purpose of the health peer challenge is to support Councils in implementing their new statutory responsibilities in health from 1 st April 2013, by way of a systematic challenge through sector peers in order to improve local practice. The framework we use has four headline questions: 1. Is there a clear and appropriate approach to improving the health and wellbeing of local residents? 2. Is the HWB at the heart of an effective governance system? Does leadership work well across the local system? 3. How effective are the key relationships? Is good use being made of the available energies, commitment and skills across the local health and wellbeing system? 4. Are there effective arrangements for evaluating impacts and for underpinning accountability of the public? 1

2 Within this you asked us to specifically take into account the following during as part of our challenge: The operation and effectiveness of the Health and wellbeing board in the context of the size and capacity of the Isles Using the peer challenge to raise awareness and understanding of the council s new responsibilities in health among councillors, managers and staff Exploring whether/how the Council is maximising the allocation for public health and the effectiveness of the shared arrangements with Cornwall Council It is important to stress that this was not an inspection. Peer Challenges are improvement focused. The peers used their experience and knowledge to reflect on the information presented to them by people they met, things they saw and material that they read. It is also important to stress that we only spent one full day on site in the isles. This letter provides a summary of the peer team s findings. It builds on the feedback presentation delivered by the team at the end of our day with you, which was then also incorporated into the Cornwall feedback. This is reflected here in slightly more detail and is reported back to you under 3 headings: 1. What we found -your strengths 2. Food for thought -some ideas from our team that we believe might help you as a council and the board in particular 3. The isles of Scilly Asks -key messages we picked up from your stakeholders focussing upon how they believe the health system might improve for the future In presenting this feedback, the Peer Challenge Team acted as fellow local government and health officers and members, not professional consultants or inspectors. We hope this will help provide recognition of the progress Isles of Scilly and its Health and Wellbeing Board have made during the last year, whilst stimulating debate and thinking about future challenges. 1. What we found A key external stakeholder told us that the Isles of Scilly s (IoS) HWB board...absolutely get health, they absolutely get wellbeing and they absolutely get the relationship between the two. We can only endorse that. We found board members who have a clear focus, own the agenda and have a sense of pragmatism and purpose. They have specific priorities for the islands residents e.g. supported to live independent lives and access to mental health services. 2

3 As such the Board and its members are providing a clear leadership role. We found a range of people and resources with passion and purpose to support them in this. The Board is ably supported by an innovative and purposeful senior officer. It is served well by a very effective Healthwatch delivering targeted reviews, promoting islanders needs whilst challenging the board effectively. There is a very active voluntary sector e.g. Buzzer Bus, Age UK and more besides all working on sensible joint programmes with you. We visited your Town Hall, a valued resource and well used Wellbeing Centre and a very proactive and purposeful GP Surgery; all of which are focussed upon delivering the outcomes the Board seeks. We found flexibility and resilience across several of your arrangements. There are several examples of the workforce taking on two roles e.g. School Nurse It struck the team that the opportunities were considerable. We have made reference to the passion and pragmatism already but there is more than that: It is about the fact that you are seeking local solutions that work e.g. dementia support training and roll-out to islanders, Mental Health Crisis Management and Warm Homes initiative. The Council is undergoing significant change; financial pressures, modernising services and senior management changes that are being modelled by the current political and officer leadership. We commend them for this and would recommend that they use the opportunities of both new people and new structures to mainstream HWB into the council s DNA. The council along with Cornwall Council has been successful in its Pioneer Bid and this along with the Better Care Funding should now create additional impetus for all stakeholders to act as one to push on further and turn some of the plans to reality It is self-evident that there is potential for utilising effective technological solutions to trial and test new ways of working and delivering services. Many of the islands stakeholders are committed to this. 2. Food for thought There are areas that we believe the board could focus on further to realise some of the great opportunities and existing solid foundation referred to above. The following are our observations taken from a day with you and whilst they represent purely a snapshot we feel they merit you reflection. There is a general recognition that the Shadow HWB board hit the ground running last year. A range of factors have inevitably influenced momentum e.g. 3

4 the council changes and indeed the appalling winter which caused disruption. However, it is now time to reignite the initial impetus and translate some of the objectives from the strategy s action plan into action e.g. stimulate alternative social opportunities or improve links to support and advice beyond the in development and mapping stages. We wondered if there was sometimes an over-reliance upon anecdotal and qualitative data; as one stakeholder said this should be backed up by clear and convincing quantitative data. You have the evidence of the person through Healthwatch; however the HWB partners and other stakeholders should be providing empirical evidence, supporting your ambitions in commissioning, delivery and outcomes. One of our observations was that good relationships don t mean effective relationships. It was obvious that some of the islands stakeholders were frustrated, by either the lack of progress or apparent bureaucracy. Related to this it was not always apparent to us how the HWB strategy aligned with the action plan and indeed specific project/programme plans e.g. integration plan. It seemed to us that this whole area of performance management accountability and challenge would benefit from a refresh and a move to something aligned to a Red, Amber, Green, as already used within your Children and Learning Plan. This approach will help you hone in on issues needing progression and assist in effectively challenging providers. Our advice would be to challenge provider s accountability via outcomes based models and robust data We were struck by the range of committees you operate and how you ensure effective overview and scrutiny of the boards work. We are clear that you do this within your current circumstances as well as you can. We do believe though that as part of your future plans you do intend to review your political governance arrangements and this would strike us as an ideal opportunity to review both the purpose and membership of your structure. It was not apparent to us within one day how integrated the HWB and the work of the Children s Trust were. Aligned to this we were unclear as to how embedded the concept of HWB was across the range of council services e.g. planning and housing. That is not to say we found evidence to the contrary but we do wonder if this is an area that might both help you strengthen the delivery of your priorities, avoid potential duplication and ensure that HWB is core to the council. 3. The isles of Scilly asks From a day working with you we were inevitably both enthused by your ambitions but also acutely aware of the place specific challenges that you as a council deal with daily. You are inevitably unique as a place and a council. 4

5 Your asks were reported back to the Cornwall challenges feedback in Truro. The words of your chairman provide a useful reminder of your intent for all your stakeholders Work with us more. We really want to make a difference. In terms of our observations (in 2 above) we believe it would be useful to task yourselves and your partners on how you can collectively describe in tangible ways, how these can be delivered. Essentially, who will do what, when and how? You had several fantastic asks in our view. You are unique and therefore a great environment to trial new ideas and innovations. The resounding view we heard is that we are up for change. Again it would be useful to use this to challenge both yourself and others. List the 5 things you are or could be trialling. You understandably highlighted the issues of compliance, bureaucracy, pace and focus. It is not our place to specifically comment on any detail here but we did hear about a range of issues: handling of missed appointments at the mainland hospital, the management of ophthalmic services, the use of the x-ray machine, the slow rate of progress with utilising technology. Our view is that it is important to have mature and focussed discussions about proportionality including scale and pace with your stakeholders. A good example might be how you invest and align with partners on the untapped potential of video-conferencing & broadband to improve service delivery and save costs. Summary of Recommendations use the opportunities of both new people and new structures to mainstream HWB into the council s DNA. translate some of the objectives from the strategy s action plan into action HWB partners and other stakeholders should be providing empirical evidence, supporting your ambitions in commissioning, delivery and outcomes review your political governance arrangements strengthen the delivery of your priorities, avoid potential duplication and ensure that HWB is core to the council. task yourselves and your partners on how you can collectively describe in tangible ways, how you can make a difference? Essentially, who will do what, when and how List the 5 things you are or could be trialling have mature and focussed discussions about proportionality including scale and pace with your stakeholders Next steps No doubt you will wish to reflect on these findings and suggestions we have made before determining how the Council wishes to take things forward. If we 5

6 can support you with this then we will and I look forward to receiving your comments about this letter and that offer when you are ready. In the meantime we are keen to continue the relationship we have formed with you and colleagues through the peer challenge to date. Andy Bates, Principal Adviser, South West is the main contact between your authority and the Local Government Association. Andy can be contacted Andy.Bates@local.gov.uk (or tel ) and can provide access to our resources and any further support. In the meantime, all of us connected with the peer challenge would like to wish the Council every success going forward. Once again, many thanks for inviting the peer challenge and to everyone involved for their participation. Yours sincerely Paul Clarke Programme Manager Local Government Support Local Government Association Tel: paul.clarke@local.gov.uk. 6