A Proposed Strategy for Healthcare in West Essex

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					Providers and commissioners:
the West Essex arrangement

           Adrian Coggins
 Senior Health Improvement Specialist
          West Essex PCT
       Providers and commissioners:
       the West Essex arrangement

• More questions than answers
• Finding our way
• Here to steal your ideas
             Providers and commissioners:
             the West Essex arrangement
• Health improvement is integrated into provider arm
  service specs, not a standalone service

• Approx 6 health improvement staff working on
  specific project areas within provider arm
  – Sexual health
  – Smoking cessation
  – Health trainers

• Combination of pragmatism combined with attempt
  at integration
  – Staff directly delivering are clearly a provider function so
    transferred to provider
       West Essex PCT Provider Arm

• Integrated into children’s services and
  adult services
  – Work programme
  – Line management
          What’s left at PCT HQ?

• Commissioning function in PH directorate
  – 2 x Senior Health Improvement Specialists
    with a LOCALITY focus
  – 3 x Health Improvement Specialists organised
    around TOPIC areas
  – 2 x Health Improvement Advisors organised
    around PROJECT areas
• Both provider & commissioning
  arrangement support overall philosophy of
  integration of health improvement into
  other PCT services; MAINSTREAMING
  health improvement & PH into other areas
  of PCT business
  – Eg. 2 senior health improvement specialists
    sit physically in locality teams to influence
    PBC, and locality commissioning
          2008/9 a transition year

• An overall Service Level Agreement with
  provider arm outlining general principles

• Individual service specs within overall SLA

• PH/health improvement topic leads have
  had most involvement at individual service
  spec development level
What has been our (PH) level of influence In
     2008/9 transition year SLA? 1)
• compromise – provider arm is in many ways a new &
  separate organisation – internal organisational
  development is a priority, BUT

• 2008/9 is a year of doing PH differently in WEPCT:
   – More robust methodology on health inequalities through a
     strategic health inequalities commissioning framework
   – Social marketing as a key methodology to better engage target

• Have we got the right balance of general v. specific
  requirements in SLA?
What has been our (PH) level of influence In
     2008/9 transition year SLA? 2)
• General SLA
  – Requirement for health equity audit with demographic
    parameters specified
  – Requirement to use NICE guidance on behaviour
    change, including explicit statement of assessing
    readiness to change

• Individual service specs
  – Much more specific in terms of outcomes, evaluation
    & methodology relevant to specific service
     • Eg. General requirement to use NICE behaviour change
       guidance, is more explicit with suggestion of use of specific
       tools (training implication)
     • More of a focus on reporting quantified OUTCOMES not
             Questions arising…
– How much variation is there in Essex health
  improvement configuration and can we compare
  implementation of the same initiatives through
  different configurations? (useful)

– does a standalone provider service risk loss of a seat
  at the table when work programmes being
   • ( = potential loss of
       – health improvement as a core function of other PCT staff eg.
         Community services
       – funding
       – health improvement work programmes
               Questions arising…

• What is our definition of a “world class” health
  improvement service?

• Can we expect provider arm to provide it? This
  year? Next year? Year after?

• How do we best support provider arm towards
  delivering a world class service?
   – What level of specificity in service specs?
   – Training?
           Questions arising…

• What determines how much autonomy
  commissioners are prepared to give
  provider arm?
  – leap of faith handing over pet projects?
  – Some way to go towards DH ALTO (Arms
    Length Trading Organisations) policy

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