Clinical Commissioning Group (CCG) Board

Transcription

1 Clinical Commissioning Group (CCG) Board Date of Meeting: 15 th March 2013 Agenda Item: Item 9 Subject: Public Health Operating Framework 2013/142 Reporting Officer: Jane Rossini, Director of Public Health Purpose of the Paper: This document proposes how Rochdale MBC will deliver its new responsibilities as leader for the health citizens as outlines in the NHS Reforms when the duty passes to RMBC on 1 st April Governance: Link to PCT Strategic Objectives All with focus on SO1 Resolution: To approve To support Recommendation Approve the new Public Health leadership role and proposed changes to the organisation outlined in this paper Acknowledge the TUPE transfer of staff to RMBC to support the new function Approve the establishment of the Rochdale Borough Health and Wellbeing Board from 1 st April 2013 Approve the Memorandum Of Understanding (MOU) with the Heywood, Middleton and Rochdale Clinical Commissioning Group ( HMR CCG) for 2013/14 to provide the mandated Public Health specialist support in order meet the mandated duty and delegate authority to the Director of Public Health to sign the final version of the Memorandum. Agree to delegate the final signing of the MOU to the Accountable Officer, NHS HMR Clinical Commissioning Group. To delegate authority to the Director of Public Health in consultation with the Portfolio Holder for health to oversee and agrees the Public Health budget and ensure that investment meets the conditions of the government grant and improves local Page 1 of 39

2 Public Health outcomes for citizens. To agree to work with the HMR CCG to further develop joint commissioning arrangements for Public Health in line with the Health and Wellbeing Board strategy for joint commissioning Key implications for the following: Financial Key Financial Implications: Has this paper been approved by the Finance Department? If YES: Name and Job Title of member of the Finance Department Commissioning and staffing budget as identified in the Public Health ring fenced budget. Yes Sam Evans and Adrian Clarkson Value for Money Risk Legal Workforce If NO what process has been agreed for financial sign off? A risk log is maintained by the Public Health Transition Board. A smooth transition is required to ensure continuity of service. Legal aspects being dealt with Department of Health and RMBC Legal Leads. This effects Public Health staff moving to RMBC under TUPE agreement. Equality Impact Assessment: N/A Included in Paper Comments yes no n/a Patient and Public Involvement Clinical Engagement Parties/ Committees consulted Subject to National consultation. This paper has been to the CCC. Executive Leadership Team (RMBC), Joint Improving Health Committee, Clinical Commissioning Committee, Rochdale MBC Cabinet (18 th March 2013) Page 2 of 39

3 1. PURPOSE OF REPORT 1.1 This document proposes how Rochdale Metropolitan Borough Council will deliver its new responsibilities as leader for the health of citizens as outlined in the NHS reforms, when the duty passes to RMBC on the 1 st April It describes the way RMBC will operate, drawing on current Department of Health guidance, work that has taken place during the transition year and takes account of the Council s Blueprint. This document therefore outlines the details of: The reform of the Public Health system in England and new duties for RMBC A proposed Rochdale Borough Public Health operating model for 2013/14 to support the Council in its new role. Full statutory duties will commence for RMBC on the 1 st April 2013 supported by a new Public Health ring fenced budget and the transfer of specialist Public Health staff and contracts for future RMBC commissioning responsibilities. 2. RECOMMENDATIONS 2.1 Approve the new Public Health leadership role and proposed changes to the organisation outlined in this paper 2.2 Acknowledge the TUPE transfer of staff to RMBC to support the new function 2.3 Approve the establishment of the Rochdale Borough Health and Wellbeing Board from 1 st April Approve the Memorandum Of Understanding (MOU) with the Heywood, Middleton and Rochdale Clinical Commissioning Group ( HMR CCG) for 2013/14 to provide the mandated Public Health specialist support in order meet the mandated duty and delegate authority to the Director of Public Health to sign the final version of the Memorandum. 2.5 To delegate authority to the Director of Public Health in consultation with the Portfolio Holder for health to oversee and agrees the Public Health budget and ensure that investment meets the conditions of the government grant and improves local Public Health outcomes for citizens. 2.6 To agree to work with the HMR CCG to further develop joint commissioning arrangements for Public Health in line with the Health and Wellbeing Board strategy for joint commissioning MAIN TEXT INCLUDING ALTERNATIVES CONSIDERED/ CONSULTATION CARRIED OUT 3.1 The Health and Social Care Bill was passed on 27/03/2012. The Department of Health described these changes as moving the NHS from an organisation to a system. 3.2 Under the NHS and Social Care Act 2012 most of the local Specialist Public Health staff and a proportion of the NHS Prevention Spend and contracts will transfer to Local Government which will have full statutory control from the 1 st April The transition of some services to local government control such as children s 0-5 years services will be delayed until 01/04/2015. Page 3 of 39

4 3.3 Over the past year the local Borough Transition Board, led by the Director of Public Health, has implemented a range of work plans as agreed by Cabinet in March This work has been supported by Officers in Legal, Finance, Human Resources, Policy and Performance. 3.4 The local transition Board has linked closely with work at a Greater Manchester level. NHS Greater Manchester led the NHS response to the Public Health transition. From the 1 st April RMBC will continue to develop the GM Public Health Network where it is more efficient and effective to do so. 3.5 As part of the statutory requirements the Council is required to ensure that Public Health specialist support is offered back to the HMR CCG. A trial Memorandum of Understanding (MOU) was put in place for 2012/13. Work has been undertaken with the HMR CCG to develop a new MOU. The local Public Health Transition Board recommends that the mandated Public Health offer to the local Clinical Commissioning Group be agreed as a MOU. A draft MOU is also being submitted through HMR CCG s governance processes and Cabinet is requested to delegate authority to the Director of Public Health to sign the final version of the Memorandum. (The Memorandum of Understanding is appended to this report as Appendices 3) 3.6 The Operating Framework for Public Health appended to this report Appendix 1 provides members with a detailed explanation of the statutory functions which will be transferring to the Council from 1 st April The Terms of Reference for the Integrated Commissioning Group is appended to this report as Appendix 2. Alternatives considered The alternative to have no change to the current operating model for Public Health was considered and discounted as this would not fit with the Council s Blueprint and the future duties of the Council and the requirements of national policy and guidance. Work on developing shared service models with other Councils will be explored where this is more efficient and effective Consultation proposed/undertaken This operating framework and the transition plans have been taken throughout the year to the Transition Board, RMBC Executive Leadership Team, HMR Clinical Commissioning Group, Shadow Health and Wellbeing Board, Human Resources, Legal, Finance and Contracting Officers. The project team has delivered continuous updates throughout the course of 2012/13 to the Transition Board (Local and GM), RMBC Executive Leadership Team, HMR Clinical Commissioning Group Governing Body, HMR Clinical Commissioning Group, Health Overview and Scrutiny Committee, Shadow Health and Wellbeing Board, Human Resources, Finance and Contracting Officers at RMBC. 4. FINANCIAL IMPLICATIONS 4.1 Local Authorities will receive a ring fenced grant which will come to RMBC from April 1 st The grant was received in January 2013 and the headlines are detailed below; Page 4 of 39

5 2013/14 settlement is 14,256m and is a 4.5% uplift (inclusive of growth and inflation) 2014/15 settlement is 14,777m and is a 3.7% uplift on 13/14 (inclusive of growth and inflation) Current Public Health spend per head was assessed in Rochdale to be 64 and the grant takes this to 69 in 13/14 and this stays the same for 14/15 The target spend per head for Rochdale is 69 This ring fenced budget needs to deliver impact on Public Health outcomes. The performance of the outcomes will in turn affect our funding via a Health Premium proposed to be introduced from 2015/16 This budget is primarily a budget to commission services for citizens but also includes the budget for the specialist Public Health staff that are transferring under TUPE to the Council on April The Public Health budget allocations for 2013/14 and 2014/15 were issued in January 2013 and this enables us to have a clear understanding of the financial landscape in both commissioning commitments, staffing and support structure needed to ensure that there is a safe transfer and transition of Public Health form and function to Rochdale Council. 4.3 The Public Health budget allocations for 2013/14 and 2014/15 were issued in January 2013 and this enables us to have a clear understanding of the financial landscape in both commissioning commitments, staffing and support structure needed to ensure that there is a safe transfer and transition of Public Health form and function to Rochdale Council. 4.4 It is stated and acknowledged in the consultation report that there is a distance to travel in many areas to reach the proposed formula. The financial allocations were received for both 2013/14 and 2014/15 and we take this as an indicator that the health premium will be introduced in 2015/ The financial allocation was released in early January (as outlined above) and it is felt that this represents a good allocation for Rochdale over the next two years but it is clear that there is some distance for the Borough to travel in many of the indicators that we are likely to be judged on for the health premium payments. We also feel that this allocation needs to pump prime the work that is needed to be undertaken to make the necessary impacts on the Borough s health and wellbeing. 4.6 The allocations were accompanied by an annexe of conditions for all Local Authorities that set out detailed arrangements for administering and claiming the grant. Some of the key areas of guidance are captured below a) The Public Health grant is being provided to give local authorities the funding needed to discharge their new public heath responsibilities. It is vital that these funds are used to: improve significantly the health and wellbeing of local populations carry out health protection functions delegated from the Secretary of State reduce health inequalities across the life course, including within hard to reach groups ensure the provision of population healthcare advice. Provide and commission mandated services Page 5 of 39

6 Meet the contractual obligations transferring to RMBC b) The grant has been made under Section 31 of the Local Government Act 2003 and there are conditions attached to the grant to govern its use. The primary purpose of the conditions is to ensure that it is spent on the new Public Health responsibilities being transferred from the NHS to local authorities, that it is spent appropriately and accounted for properly. c) In drawing up their priorities, local authorities, as members of health and wellbeing boards will have a duty to work with HMR CCGs and other partners such as the police and community safety partnerships to undertake Joint Strategic Needs Assessments (JSNAs) an assessment of the current and future health and social care needs and assets of the local community. Based on these they will have to develop Joint Health and Wellbeing Strategies (JHWSs) a strategy for meeting the identified needs in the local area based on evidence in JSNAs. Under the Health and Social Care Act 2012, JSNAs and JHWSs must inform local authority commissioning plans, and so is likely to have an impact on how the grant is spent. d) Performance information supporting the Public Health Outcomes Framework alongside the Adult Social Care Outcomes Framework, NHS Outcomes Framework and eventually the NHS Commissioning Outcomes Framework could also inform JSNAs; however, national measures should not overshadow local priorities based on evidence of local needs. e) In giving funding for Public Health to local authorities, it remains important that funds are only spent on activities whose main or primary purpose is to improve the health and wellbeing of local populations (including restoring or protecting their health where appropriate) and reducing health inequalities. f) Local authorities will need to submit quarterly returns of spend on Public Health as part of the existing Quarterly Revenue Outturn reports. At the end of the financial year they will need to return a more detailed RO return. g) The returns must be certified by the authority s Chief Executive that, to the best of his or her knowledge, the amounts shown on the Statement are all eligible expenditure and that the grant has been used for the purposes intended, as set out in this Determination. 5. LEGAL IMPLICATIONS 5.1 From 1 st April 2013 the legal responsibility for the public health functions, together with the public health staff and commissioning contracts will transfer to the Council from the Heywood, Middleton and Rochdale Primary Care Trust. 5.2 The Public Health transition process has been fully supported locally by officers from Legal and Democratic Services and Human Resources. It will involve a TUPE transfer of members staff from the Primary Care Trust to the Council. Page 6 of 39

7 5.3 Most of the legal implications relating to the transfer involve the commissioning contracts between the Heywood Middleton and Rochdale Primary Care Trust and its service providers. A due diligence exercise is underway and will be completed prior to the Cabinet Meeting and verbal feedback will be given at the meeting. 5.4 There are implications for the Council stemming from its increased statutory responsibilities and a due diligence exercise is being undertaken with regard to liability and risk to make sure that insurance cover is in place and indemnities are given in respect of liabilities arising prior to the transfer. 6. PERSONNEL IMPLICATIONS 6.1 The transition involves the transfer of staff from the NHS to the Local Authority under the Transfer of Undertaking Regulations. A TUPE process is underway with the staff identified for transfer. Local measures were issued for staff consultation in February 2013 and the process is due to be completed by March 31 st It has been confirmed that staff will be able to transfer their NHS pensions to the Local Authority pension scheme. The joint RMBC and NHS Human resources local task group of the local transition group has worked with NHS GM to implement all HR and consultation processes appropriately. It has also been confirmed that infection control staff will be transferring to RMBC. For this latter function, a shared service across the whole of Greater Manchester is under development for implementation in 2013/14. A total of 6.2 In total 25 staff member/23.82 WTE / and 2 vacancies are transferring to the Council. 6.3 The Greater Manchester Public Health Network and staff will be transferring to Tameside MBC. 6.4 A new staffing structure will be issued in March 2013 and will incorporate other RMBC staff or services aligned by RMBC under the leadership of the DPH. 7. CORPORATE PRIORITIES 7.1 Public Health and Improving Health and Well being is a cross cutting theme that contributes to the outcomes across the Corporate Priorities of Prosperity, People and Place. The Public Health functions and outcomes integrate well with promoting success and independence, quality of place, critical services and corporate and support services development. 7.2 Work is well underway with Directors and service heads to integrate Public Health as a golden thread. The Public Health team is being aligned and integrated with the Council s Blueprint priority areas. 8. RISK ASSESSMENT IMPLICATIONS 8.1 All the issues raised and the recommendation(s) in this report involve risk considerations as set out below: The transferring organisation does not exist after March 31 st 2013 which presents a potential risk in legacy information and Systems The Public Health and Commissioning functions may not work as a cohesive system from April 2013 Governance and IT systems do not function Page 7 of 39

8 Retention of skilled staff Ensuring sufficient support is retained locally to support the NHS 9. EQUALITIES IMPACTS 9.1 Workforce Equality Impacts Assessment The following workforce equality issues arise from the issues raised and the recommendation(s) in this report involve risk considerations as set out below: There is a risk in maintaining an effective multi disciplinary workforce in the future which raises a risk to RMBC in carrying out the required Public Health duties. 9.2 Equality/Community Impact Assessments The following equality/community issues arise from the issues raised and the recommendation(s) in this report involve risk considerations as set out below: a. The equality duties for the new services will move to RMBC for the transferred areas b. The transferred Public Health staff is an experienced group in relation to inequalities, equity audit, impact assessment, health needs assessment and evaluation and efficiency reviews 10.0 Commissioning and Contracting Implications In 2012/13 the Joint Improving Health Commissioning team was led by the NHS with membership from RMBC. It is proposed that RMBC lead the joint commissioning of health improvement from April 1 st 2013 but commission jointly with the HMR CCG and other key partners. This Joint Commissioning Team (JCT) will report back to RMBC via the lead portfolio holder and the DPH. The financial governance of the Public Health grant will be led by RMBC The continuation of the JCT will ensure continuity of transformational and commissioning programmes during 2013/14 and oversight of the Public Health budget and jointly commissioned programmes. The membership will be amended to reflect the new requirements of 2013/14. The Terms of Reference are attached as Appendix This JCT will also have oversight of the existing Drug and Alcohol Joint Commissioning Group budget and work programme. It is proposed that the Drugs and Alcohol Action Team (DAAT) will come under the leadership and management of the Director of Public Health and with it the budget that is allocated through the Public Health grant and also other areas of funding The JCT will report regularly to the Health and Wellbeing Board to ensure alignment with the Health and Wellbeing Strategic Framework which is based on the Joint Strategic Needs Assessment. The DAAT will continue to report as appropriate to the Safer Communities Partnership. Page 8 of 39

9 10.05 In relation to the commissioning of children s services the School health, infant mortality and healthy schools commissioning budgets are aligned to the improving health commissioning team. The children s joint commissioning lead (Karen Kenton) will continue to work jointly on the children s commissioning agenda and Public Health will continue to work jointly with the National Commissioning Board on the development of health visiting and child health which are proposed to remain with the NHS until As joint commissioning arrangements develop further within the Borough this arrangement would be reviewed and amended as agreed by the Health and Wellbeing Board, HMR CCG and RMBC. Commissioning evidence based services in our priority areas and designated budgets. To commission services within the agreed budget. To ensure commissioned services are efficient, effective and value for money. To ensure that existing commissioning and financial plans are auctioned. To monitor progress against agreed actions and indicators. To continue to work with commissioning leads to align existing base budgets in agreed areas To complete a review of all services commissioned by the Public Health Grant To ensure the Public Health Grant is used under the terms of the grant and reported accordingly The Health Act (1999) introduced the possibility of flexibilities to support the development of more integrated working across Health and Social Care. When the Act was repealed and replaced by the National Health Service Act 0f 2006, Section 31 of the original Act was directly replaced by section 75 of the new one. A variety of flexibilities are available, including Lead Commissioning, Pooled Budgets and Joint Provision. It is proposed that flexibilities enabling lead commissioning and pooled budgets be pursued amongst Commissioners within Rochdale Borough. At the current time a pooled budget exists for Drugs and Alcohol The following table shows the main budgets areas that are the responsibility of the Joint Health Improvement Commissioning Team in 2013/14 Public Health Commissioning Principles The NHS reforms and the transfer of PH duties to the Council are well underway. The recent announcement of the PH allocation has been analysed against the current spend on the Public Health specialist functions and Public Health commissioning functions. Arrangements are in place to ensure that the Council will continue to commission services for citizens in 13/14 through existing contracts and programmes that will be transferred from the NHS to RMBC on the 1 st April Page 9 of 39

10 10.09 The majority of the Public Health Grant is given to the Council as a commissioning budget for services to citizens in defined priority areas. A few services are mandated and the rest have local flexibility to determine funding levels and services required to meet outcomes In December 2012, NHS HMR and RMBC were concerned that the Public Health Grant when allocated could have a shortfall. An initial financial recovery plan was developed in case it was required to respond to a potential shortfall position. A sum of 430K was identified that could be released if necessary. Some of this funding is currently not committed for 2013/14 The current JCT for Health Improvement and RMBC have agreed to undertake a full contract and budget review of services commissioned from the Public Health budget. This is due to be completed by the end of September Services will then either be continued, re-aligned or decommissioned and new services commissioned with the intention of aligning the budget more closely to the PH service delivery plan, the JSNA, Health and Wellbeing Board Strategic Framework and the Public Health Outcomes Framework The commissioning strategy going forward will also take account of early year interventions for children in light of the Ofsted inspection and reviews and the Council Blueprint. As part of the review process services, contracts and PH spend will be assessed for quality, progress on meeting outcomes, VfM and effectiveness. The review process will be designed to ensure involvement from the Clinical Commissioning Group Under the conditions of the grant the Council has to demonstrate that there is a clear rationale for how the budget is spent in the defined areas. The Council will need to report quarterly by set Public Health headings in order to claim the Public Health grant The following principles for the investment/disinvestment of the grant are; That the Public Health Grant delivers against priority Public Health outcomes and contributes to the delivery of the Health and Wellbeing Strategic Framework There is direct line of sight to measurable health improvement Services and interventions are evidence based or clearly evaluated as pilot schemes Services and outcomes are performance managed by the DPH and are reported to Cabinet and the Health and Wellbeing Board Expenditure support the delivery of the Council Blueprint and vision for citizens In addition and in response to the public sector reform the following principles should also apply to the Grant; Up-scaling commissioning objectives that work to reach across the Borough rather than commissioning many different models and having patchy provision should be explored first. Open competition for service provision wherever possible. Page 10 of 39

11 Posts funded jointly by the Council s general funds and the NHS under previous partnership arrangements before April 2013 should be considered and where the activity is solely meeting the principles above the full cost should be met from the PH grant after the transition. The DPH will use the PH staffing overhead flexibly to ensure that there are key skills in the Council to deliver the PH agenda particularly the statutory and mandated duties eg the specialist PH offer to the HMR CCG, PH analytical skills, health protection/ infection control skills. Delivery plans for PH and HMR CCG funded services such as those in place with licensing regulation teams become internal specifications between Public Health and the service lead. All activities/services in receipt of the Public Health Grant should be managed by the DPH to ensure oversight of activities, performance and impact to ensure appropriate review against outcomes and to ensure that that PH grant funded activities are not inadvertently offered up as savings. Where it proves to be more efficient or effective PH expertise and capacity will be shared and services commissioned on a wider footprint e.g. with neighbouring LAs, the PH network, HMR CCGs, North East sector etc to militate against risk of staff turnover and loss of senior PH technical and clinical staff. Grant money carried over between financial years and where resource is released through the decommissioning/review of services will be reinvested into PH programs to minimize risk of claw back by PHE/Department of Health and to secure achievement of the health premium in future years It is recommended that the whole of the Public Health Grant should be managed by the DPH including the leadership and delivery of council services where LA service receive part of the PH allocation The Joint commissioning of health improvement services with the HMR CCG will be overseen by the Deputy DPH in conjunction with the HMR CCG commissioning lead Priority areas for investment of the PH grant in 2013/14; Integrating and developing local Healthy Lifestyle Services driving a more uniformed and accessible delivery model Health checks (mandatory) Comprehensive and integrated sexual health services ( mandatory) Action to reduce smoking prevalence and tackle obesity Community health development and capacity building at a community and Township level Page 11 of 39

12 Appendix 1 Public Health Operating Framework April 2013 (Statutory Function) 1. Introduction The Health and Social Care Bill was passed on 27 March The Department of Health describes these changes as moving the NHS from an organisation to a system. This is a system within which local government now has a new role Some of the detail still needs to be developed in secondary legislation, regulations and associated guidance. The 2012 NHS and Social Care Act outlined that most of the local Specialist Public Health staff and a proportion of NHS Prevention Spend and contracts will transfer to Local Government with full statutory control from the 1 st April 13. The transition of some services to local government control such as children s 0-5 years services will be delayed until 01/04/ Vision for Public Health and Rochdale Borough Our Vision is: To improve health and wellbeing outcomes for citizens Public Health will be a golden thread across the Council Public Health Specialist Support will be aligned across the Council, Clinical Commissioning Group and partners 2.1 RMBC as the local leader for health in the Borough will take on new responsibilities for health and for the existing NHS Specialist Public Health Function. RMBC will be commissioning NHS prevention services and will offer a Public Health specialist response across the Borough. Local Authorities are receiving these duties so they can:- - provide a local population focus for Public Health and prevention services - shape place to improve health and wellbeing - influence the social determinants of health - reduce local inequalities - manage future health risks to local populations 2.2 The operating model proposed for Public Health locally is part of an approach to Public Health delivery within Rochdale MBC which focuses on moving Public Health from being an NHS specialty controlled top down health care system intervention to one that sees Public Health as a shared aspiration to be delivered by the whole of local government, the NHS, partners and the communities we serve. Page 12 of 39

13 2.3 Public Health in the UK is divided into the three domains below and RMBC will be expected to provide leadership for aspects in all three domains supported by the Public Health team. Domain Health Protection Health Improvement Health Services Exemplified by: Monitoring of uptake of screening and immunisation programmes, infection prevention and control, Emergency Planning, Communicable Disease Control, health surveillance, epidemiology, incident management Prevention, behaviour change, evaluation and evidence of effectiveness, Public Health partnerships, early intervention and detection, public engagement, social marketing. Evaluating the effectiveness and efficiency of health care system expenditure, service redesign, needs assessment, evidence based practice and application of NICE guidance, health care system policy and strategy, ethics, secondary prevention (chronic diseases management etc), patient safety, improved treatment outcomes 3. Outcomes for Citizens 3.1 The co-ordination of Borough wide efforts to deliver the outcomes defined within the Public Health Outcomes Framework will be form a key role for the Council and the Public Health team. Success will depend on clear delivery plans, effective partnerships and clear performance management across a range of agencies and organisations. 3.2 Performance reporting on Public Health outcomes framework targets will be part of an integrated performance management system across the Borough. The Public Health Outcomes Framework has been built into the RMBC Performance System. Work has been undertaken to link the indicators from PHOF, to the NHS Operating Framework and Adult Social Care, giving us a clear understanding of how all of our activity can be interlinked. One page performance snapshots will be submitted to all relevant agendas (Cabinet, HOSC, HWBB etc) on a quarterly basis to ensure that the Public Health and wellbeing of the borough is in full view to a wide range of stakeholders. 3.3 The Director of Public Health has a responsibility to advise political portfolio holders and Officers on how their policy, decisions and resource use might be refocused to provide additional health improvement outcomes. To do this the Public Health Specialist team will work across all services to agree shared health and wellbeing goals. Action will be based on the Council Blueprint and the local Health and Wellbeing Framework. The Portfolio Holder will review these priorities as part of their performance management of elected members in their new role as leaders for Health. Page 13 of 39

14 3.4 In implementing the Public Health outcomes framework Improving Outcomes and Supporting Transparency, the Public Health function will work with Council Executives and Heads of Service to seek an approach to their ownership and delivery across the organisation and partnerships. 3.5 The DPH and specialist team will advise and support RMBC on the best approach to securing the Health Premium once this is better understood. Detail on the Health Premium and what is expected in terms of performance to attract the additional funding is proposed to come into place in two to three years time 4. The role of elected members 4.1 Members will have a new role to champion improved Public Health outcomes as part of the new system. This role will include: - Understanding the new Health system (of which Local Government is now a part). - Maximising the opportunities arising from the new role in commissioning effective Public Health and prevention services. - Developing new partnerships and alliances with the Clinical Commissioning Group and other key health commissioners and providers. - Developing how all LA services can deliver improved health (housing, education, regeneration, planning etc). - Acting as champions for improved Public Health through existing Local Government powers (e.g. using licensing in controlling cheap alcohol). - Understanding health needs and how policy and practice can be improved to improve health (with support from the Director of Public Health) - Providing political leadership for population behaviour change programmes (e.g. improved physical activity, advocating use of prevention programmes, tackling inequalities in access or uptake of prevention services - Being accountable for shared and agreed health and social care outcomes for citizens 5. Commissioning Public Health services 5.1 Part of the new Council duty and the bulk of the ring fenced budget are provided for RMBC to commission Public Health services. Alongside the budget the associated existing contracts and specifications will move to the Council. Commissioning responsibilities include those for drugs and alcohol, lifestyles, sexual health, school health, mental wellbeing and health checks 5.2 A small number of areas are mandated to ensure national consistency and there is a set requirement to commission them. There are also areas that are not prescribed yet clearly feed the indicators that the health premium will be judged against and feed into the wider performance and health and wellbeing of the Borough. Page 14 of 39

15 Outlined below are the mandatory and non mandatory elements of commissioning; Mandated functions: a) Sexual health services - STI testing and treatment b) Sexual health services Contraception c) NHS Health Check programme d) Local authority role in health protection e) Public Health specialist advice and support to the HMR CCG f) National Child Measurement Programme Non-mandated functions: g) Sexual health services - Advice, prevention and promotion h) Obesity adults i) Obesity - children j) Physical activity adults k) Physical activity - children l) Drug misuse - adults m) Alcohol misuse - adults n) Substance misuse (drugs and alcohol) - youth services o) Stop smoking services and interventions p) Wider tobacco control q) Children 5-19 Public Health programmes r) Miscellaneous, which includes: Non-mandatory elements of the NHS Health Check programme Nutrition initiatives Health at work Programmes to prevent accidents Public mental health General prevention activities Page 15 of 39

16 5.3 DoH guidance stresses that the list of Public Health prevention and commissioning responsibilities transferring to Local Government are not exclusive. Local authorities may choose to commission a wide variety of services under their health improvement duty, and indeed the Department of Health argue they: hope to see much innovation as local authorities embrace their new duties. This freedom is deliberately wide, to encourage the kind of locallydriven solutions that lie at the core of localism, underpinned by a robust analysis of the needs and assets of the local population 5.4 It is proposed that RMBC lead the joint commissioning of health improvement from April 1 st 2013 but commission jointly with the HMR CCG and other key partners. This JCT will report back to RMBC via the lead portfolio holder and the DPH. The Financial governance of the Public Health grant will be led by RMBC. The continuation of a JCT will ensure continuity of transformational and commissioning programmes during 2013/14 and oversight of the Public Health budget and jointly commissioned programmes. The membership will be amended to reflect the new requirements of 2013/14. The Terms of Reference are attached as Appendix 2. This team will also have oversight of the existing Drug and Alcohol Joint Commissioning Group budget and work programme. It is proposed that the Drugs and Alcohol Action Team (DAAT) will come under the leadership and management of the Director of Public Health and with it the budget that is allocated through the Public Health grant and also other areas of funding. 5.5 It is worth noting that many of the NHS prevention services transferring to Local Government are all already embedded within existing contracts. Some are part of larger contract specifications that have been un-weaved but will remain part of the Standard NHS contract for 2013/14. This will be a holding position as Public Health and wider Council teams review the services and development procurements for the main services within the contracts. 5.6 It is felt that for the first year of this transfer the safest management process for all the contracts was to engage the services of the Commissioning Support Unit (CSU) which has been created to assist the HMR CCGs in management of their standard NHS Contracts. This will enable a standardized approach to contract management, performance management and serviced redesign whilst giving us the time locally to discuss and agree the best contracting route for Rochdale Borough for 2014/15 onwards. Commissioning intentions and decisions will continue to be done via the JCT. 6. The Director of Public Health (DPH) 6.1 The Health and Social Care Act (2012) specifies that the (statutory) Director of Public Health is responsible for exercising the Local Authorities new Public Health functions. This post is to be appointed jointly by Public Health England and the Local Authority. The new Directors of Public Health in local government must have the necessary technical, professional and strategic leadership skills to support Councils to fulfil their duties. 6.2 Directors of Public Health will be a statutory chief officer in the Local Authority (as defined by the Local Government and Housing Act 1989) and will have Page 16 of 39

17 independent powers to provide advice on the health or the population within the public domain. 6.3 The DPH will be a statutory member of the Health and Wellbeing Board and will use this membership to drive improvement in health and integration of service delivery across health and local government. The DPH will produce an independent Annual Report and will be the key advisor on health matters to elected members. 6.4 Locally these responsibilities and functions will be carried out by the DPH by: Being a member of ELT Being a Board member of HMR HMR CCG. Being a prime source of Public Health advice to elected members. Ensuring that the Health and Wellbeing Board lead on Public Health issues and health strategy Be responsible for the production of the Joint/Integrated Strategic Needs and Assets Assessment, and the Health and Wellbeing Strategy. Leading and ensuring that there is a local response to protect local health Be the Executive lead for the Public Health ring fenced grant and associated budgets 7 The Public Health Specialist Team 7.1 Staff in the PH service lead in range of areas that will support the Council to fulfil their duties. The Directorate s primary aim is to provide leadership and focus to reduce inequalities in health, increase healthy life expectancy and improve community wellbeing. The team will; Commission a range of the services that are transferring to the Council Lead and coordinate programmes of work produce the best outcomes. Monitor performance on PH indicators and targets and take action to deliver improvements Work with and through teams, directorates and partnerships to embed health improvement so that we all meet the needs of people, communities and populations Work to influence and raise awareness of the potential impact of policies and decisions on improving the publics' health. Develop and use JSNA and health information to review evidence based approached to delivering health improvement and health strategy. Work with and support the HMR CCGs and NHS commissioners to ensure the NHS is making its contribution to health improvement and health inequalities. Write /assess evidence based policy for return on investment for the local population. Assess the equity of impact on service on the priority groups and by relevant population segmentations or footprint Plan with and supports the health care and wider system to respond to pandemics, outbreaks including contract tracing, serious incidents on population programmes, multi agency responses to major incidents, and including infection control measures for Clostridium Difficle and MRSA, MSSA and Ecoli (shared with NHSCB). Page 17 of 39

18 Work with communities and the voluntary sector to improve uptake of services Support and commission communication and campaigns for public information and education. 7.2 The staff team was restructured in 2011 and portfolios are revised each year to align staff with team objectives, RMBC services, Council Blueprint in addition to supporting the HMR CCG and partners. This has included ensuring that most staff job descriptions are generic to allow staff to be aligned to any Public Health priority area. This gives RMBC the maximum flexibility to deploy staff to agreed priority outcomes whilst maintaining the professional accreditation that specialist staff require. 7.3 The competency areas and standards of Public Health Specialists are defined centrally by the Faculty of Public Health of the Royal College of Physicians or UK Public Health Voluntary Register. All specialists will be competent and have Public Health leadership and relationship management skills to supplement technical knowledge. They will act as Public Health leaders with the services they are aligned to. They will be supported by a range of staff from the Public Health team. Activities will be performance managed though the PH business plan. They will also deliver the mandated offer that RMBC has to offer to NHS HMR HMR CCG. 7.4 Senior staff have Public Health roles that enables their portfolios to be flexible to meet the needs of the service and our customers. 7.5 Senior consultant/specialist Public Health staff will work across the Borough Council, HMR CCG and partner agencies. The Deputy Director of Public Health will be a member of the Borough Council Directorates Leadership Team and consultant input will be provided to the HMR CCG Clinical Commissioning Committee. The Public Health Directorate will assign a Specialist to the key work areas as set out in the RMBC Blue Print. We will provide the mandated offer to the Clinical Commissioning Group. Named links will be offered to each Township and to key partnerships. 7.6 The HMR CCG will have a Public Health specialist resource assigned to work directly with their organisation. This will include senior staff allocated to the Clinical Commissioning Committee and HMR CCG Board. A refreshed Memorandum of Understanding is attached for agreement (Appendix 3) 7.7 The specialist team will all be expected to work on the delivery of agreed priorities. This will include Public Health commissioning activities. They will work with colleagues on health protection issues and serious incidents that threaten the publics health. They will have direct and mandated input into NHS commissioning strategies and in shaping Clinical Quality Initiatives for public funded services at local level. It expected that there will be shared GM level work where this is more effective and efficient. This will build on the work of the GM Public Health network, although this has yet to be determined and agreed. 7.8 The Directorate workforce is flexible and have a broad range of skills. They work to an integrated Public Health Business plan to deliver work that will improve health and well being and support borough performance against the PH Outcomes Framework. It is proposed that after three years the financial Page 18 of 39

19 allocation will be made, in part linked to performance on outcomes. The Public Health team currently lead on many of these outcome areas and would continue to do so. 7.9 Public Health staff will work directly with key agencies and named staff will be assigned to key partners and partnerships including Link4Life, CVS, NHS Trusts, Children s Trust, Community Safety Partnership and Rochdale Boroughwide Housing. The flexible outward facing workforce that support and build PH capacity and understanding other teams 7.10 Staff will be given training and development opportunities according to the annual work plan and are being supported to shift into new roles and develop new skills to meet the needs of RMBC. Relevant skills and knowledge will be deployed flexibly to meet the objectives and deliverables in the business plan. Staff are expected to cross cover for each other At the moment NHS HMR is not accredited as a PH Specialist training site. However, it is our ambition locally to become one. SPR Trainers in Public Health are represented at regional level, their contracts are not held locally. Localities must be approved as training sites. The Council would gain one or more Specialty Registrars as members of workplace teams for periods up to two years at a time. Specialty Registrars can contribute to organisational objectives and department capacity. The current objectives of the team are being revised for 2013/14 under the following headings: To engage with the LSPB, partners and communities to identify and tackle the wider determinants of health and well-being To support local people to take responsibility for, choose and maintain a healthy lifestyle, makes healthy choices and reduce health inequalities To protect the Borough s health To prevent ill health, reduce the number of people of living with preventable ill health and reduce numbers of people dying prematurely To build an effective local Public Health system Support and develop an effective statutory Health and Wellbeing Board To deliver a Public Health Annual Report and programme of Health Needs Assessment, Health Impact Assessment and Equity Audit 8 The proposed Public Health Team structure 8.1 The current Public Health team structure and functions will be integrated over time with discussions within RMBC on future Council functions and structures and the Director of Public Health is fully involved in this process. 8.2 Public Health infection control staff will be coming to the Local Authority on 1 st April A shared service is being developed for this function to work across GM which is planned to be implemented during 2013/ The current Public Health structure was taken to RMBC employment committee and ELT for consideration and consultation and was approved. 8.4 A Human resources sub group of the local transition board has overseen the HR process for transferring staff. This will be a TUPE transfer. It has been confirmed that staff can take their NHS pension to the Local Authority. Page 19 of 39

20 8.5 It is proposed that line management remains with the Director of Public Health. There are options being explored that other RMBC staff and services could be aligned with Public Health as the current review progresses. 8.6 The Directorate will operate as a single managed team accountable to the Director of Public Health who will in turn be accountable locally to the Borough Council Chief Executive. Page 20 of 39

21 1. Purpose/Outcomes Appendix 2 Joint Improving Health Commissioning Team Draft Terms of Reference Version The Joint Improving Health Commissioning Group will on behalf of the Director of Public Health and RMBC oversee the delivery of Public Health/Health Improvement Commissioning and budgets as agreed by Cabinet. This includes oversight of the ring fenced public health grant to RMBC in 2013/14. The team will also oversee any commissioning and budgets delegated by HMR CCG to this team for joint commissioning. The team will oversee the work of the Drug and Alcohol joint commissioning group. 1.2 This group will take responsibility to lead commissioning in the following outcome areas:- Reduce the prevalence of tobacco Reduce the levels of childhood and adult obesity Increase the levels of physical activity Improve levels of nutrition Improve sexual health Reduce the prevalence of sexually transmitted infections Assurance that National screening and immunisation rates are achieved Reduce premature mortality rates. Improve oral health Support the improvement of the health of children and young people Reduce and prevent the harm caused by drugs and alcohol. Commissioning responsibilities and budgets will commence with the Public Health Ring fenced budget and any agreed jointly commissioned areas agreed with the CCG, including the Drugs and alcohol joint commissioning. Any additional RMBC commissioning responsibilities would only be undertaken with agreed delegated authority. The CCG will also agree any additional areas that it wishes to jointly commission through this group as the joint commissioning work evolves through the Health and Wellbeing Board. 2. Membership Title Wendy Meston, Public Health RMBC Pauline Kane/Julie Murphy, Finance RMBC Karen Kenton, Joint Commissioning lead Children & Young People, RMBC and CCG Tracy Ginnever, Manager, Rochdale Drug & Alcohol Action Team, RMBC Tim Buckley, Acting Finance Manager) RMBC Page 21 of 39

22 Ian Mello, Director of Commissioning, HMR CCG and possible clinical representation Andrea Dutton, Programme Manager, Public Health (sexual health) Michelle Loughlin, Chair of Drugs and Alcohol JCG, RMBC Richard Pinkney, Data Analyst, Public Health Elizabeth Wilson, Programme Manager, Public Health (lifestyles and obesity) Tbc, Corporate Procurement Manager, RMBC Peter Jones, Performance 3. Objectives 4. Standing items Commissioning evidence based services in our priority areas and within designated budgets. To commission services within the agreed budget. To ensure commissioned services are efficient, effective and value for money. To ensure that all services have been reviewed by October 2013 To ensure that existing commissioning and financial plans are actioned. To monitor progress against agreed actions and outcomes. Ensure the Public health grant is spent and reported according to the set conditions To continue to work to develop joint commissioning arrangements between RMBC and the CCG To report to RMBC and the Health and Wellbeing Board 4.1 Finance 4.2 Performance and outcomes 4.3 Contracts, Service specifications and procurement 5. Agenda and Papers 5.1 Agenda and Papers will be circulated 5 days before each meeting. 6. Frequency of Meetings 6.1 Monthly initially and review in July Accountability 7.1 The team will be led by and accountable through the Director of Public Health and Portfolio holder and governed by RMBC policies and procedures. Decisions that impact on the CCG that require additional CCG governance will be the responsibility of the CCG Head of Commissioning to ensure that this occurs as appropriate 8. Reporting 8.1 The team will report through the Director of Public Health to RMBC. The CCG representative will be responsible for reporting to the Clinical Commissioning Committee and CCG Board as appropriate. The team will report back to the Health and Wellbeing Page 22 of 39

23 Board twice a year. Reporting will continue as required to the Safer Communities Partnership. 9. Secretarial Support 9.1 Secretarial support will be provided by Ann Hill, PA to the Director and Deputy Director of Public Health. Page 23 of 39

24 Appendix 3 The Borough of Rochdale Public Health Offer to NHS Heywood, Middleton and Rochdale Clinical Commissioning Group 1. Introduction Memorandum of Understanding for 2013/ The purpose of this memorandum of understanding is to establish a protocol for the working relationship between the specialist Public Health function within RMBC and NHS HMR CCG from 1 st April 2013 to 31 st March This memorandum is set within the context of the transfer of PH functions and responsibilities to the Local Authority and the establishment of HMR Clinical Commissioning Group and the National Commissioning Board from the 1 st April This protocol describes the Public Health Offer from Rochdale Metropolitan Borough Council to NHS HMR Clinical Commissioning Group for 2013/14 2. Context 2.1 The Health and Social Care Bill (2010) has progressed through Parliament. The protocol is for Public Health to transfer at a national level to a new organisation, Public Health England and locally to the Local Authority, Rochdale Metropolitan Borough Council (RMBC). NHS Commissioning and Public Health responsibilities will lie with NHS HMR Clinical Commissioning Group and the NHS Commissioning Board (NCB). 2.2 The specialist public health support from RMBC to NHS HMR CCG is a mandated service for the Local Authority. 2.3 Most aspects of the public health specialist offer are best provided to NHS commissioners at a local level. However at times and where several areas are working collaboratively pooled PH expertise may offer advice to the CCGs both locally and collectively eg through the GM PH network. 2.4 The plan for Public Health locally requires a robust working relationship to deliver the right outcomes for local people and patients. 2.5 NHS HMR CCG and RMBC have a coterminous population. 2.6 At a local level the CCG will be full members of the Health and Wellbeing Board (Rochdale) and will work alongside the Board and the Director of Public Health to reflect these strategies within their local commissioning plans. 3. Public Health 3.1 The three domains of public health can only be delivered by collaboration across all partners. The three domains of public health are: Health Improvement Health protection Health and social care service commissioning 3.2 During 2013/14 the local Public Health team will prioritise agreed organisational objectives and programmes led by RMBC to ensure that they are delivered and maintain our ability to tackle health inequalities in order to Page 24 of 39

25 improve health outcomes for local people across the CCG commissioning strategy, the Health and Wellbeing Strategic framework and the council blueprint. These will be set internally, against the outcomes outlined above. However, where Public Health outcomes and objectives align or contribute to CCG and Adult Social Care (ASC) priorities there will be discussion in the integrated commissioning team meetings as to how we can set these priorities with commissioning partners contribution and intelligence to best make use of resources and priorities in the Borough. Public health objectives that are supporting core CCG business will be agreed with the CCG. 3.3 The local public health function will continue to provide specialist public health input to; Work with CCG and other partners to protect the Borough s health from major emergencies, incidents, communicable diseases, threats and ensure an appropriate response. Engage with partners including communities to identify and tackle the wider determinants of health and well-being. Support local people to take responsibility to choose and maintain a healthy lifestyle. Reduce the number of people living with preventable ill health through prevention, early identification and promoting improved uptake of screening programmes commissioned for the Borough by the NHSCB. Prevent more people from dying prematurely and increase healthy life expectancy by working with the CCG to develop commissioning strategies that span adult and children s social care and clinical services. 3.4 The Public Health Outcomes Framework has been issued (see Appendix 1) and complements the NHS and Adult Social Care Outcomes frameworks 1. Within the Public health outcomes framework NHS HMR CCG is a partner for all domains identified in the outcomes framework but a key area for specific collaboration is to deliver the outcomes relating to Domain 4: Healthcare Public Health and preventing premature mortality. 3.5 The NCB will have a key role in commissioning services and good outcomes in relation to a range of services including screening 2, immunisation, and child health 0-5 years. NHS HMR CCG will be a key partner to monitoring and advocating for equitable uptake and access to these services at a local level alongside the Local Authority via the HWBB. 3.6 The local Public Health Team is located within RMBC. The team is multi disciplinary including Public Health consultants trained and accredited to a very high level and other staff with a wide range of skills, experience and backgrounds. The team has both clinical and non clinical staff and covers health protection, health improvement and health and social care service improvement. 3.7 The ten AGMA Authorities and the ten Directors of Public Health have established a Greater Manchester Public Health Network and several work programmes are undertaken at this level funded from the local Public Heath budget. The CCG may wish to consider the public health support required at a GM level for future MOUs. 1 PH OF 2 Screening pathways will be commissioned by the NHSCB and co-ordinated by the screening and immunisations coordination function from PHE Page 25 of 39

26 3.8 RMBC and NHS HMR CCG will contract the support services of the Commissioning Support Unit (CSU) and both parties will work together to ensure best value for this contracted support. 4. The MOU between RMBC and NHS HMR CCG The Public Health Offer to NHS HMR CCG 4.1 The offer to NHS HMR CCG is to ensure that the CCG receives appropriate access and benefits of Public Health leadership, specialist and technical skills. These include areas such as public health intelligence, epidemiology, surveillance, needs assessment, skills to tackle health inequalities, clinical effectiveness, health protection, patient and public engagement and commissioning health improvement across clinical and other pathways. 4.2 The local and GM public health teams possess staff with generic skills across the ten core public health competencies as determined by the Faculty of Public Health and specialist skills within areas such as infection control, health protection, health improvement, and health care public health. The Public Health England Greater Manchester team will ensure that PHE and NHSCB plans for screening and immunisations are delivering outcomes locally and should report directly to NHS HMR CCG Governing body and HWBB. The local public health team will assist the CCG to monitor outcomes and performance at a local level Public Health is already aligned to specific priority areas which include: Provision of health protection response and joint work with the Health Protection Agency as part of Public Health England including o Technical expertise to support the CCG on the reduction of MRSA and C Difficile o supporting CCG assurance on the reduction of Cdiff and MRSA locally o input into the local Health Economy Resilience Group o support to EPPR plans and scrutiny/assurance of the screening and immunisation function. o Leadership for Infection prevention and control working jointly with PHE Leadership for Healthy Lifestyle programmes such as alcohol, tobacco, obesity, sexual health, healthy weight and physical activity. Leading the Five Ways to wellbeing programme for the Borough Leading the commissioning of health improvement services including sexual health, health checks and lifestyle service including drugs and alcohol services. Support to develop joint commissioning arrangements Leadership for reducing Teenage Pregnancy. Local public health advice and oversight to local early year s programmes and child health promotion. Support to the joint commissioning of children s services Leadership for the NHS Health checks programme and CVD primary prevention. Joint work with the CCG Clinical leads. Leading Oral health promotion. Page 26 of 39

27 Leading the Health and Wellbeing Board and delivery plans for the HWBB Development. Leading on Joint Strategic Needs Assessment and development of the Health and Wellbeing framework. Provision of Public Health Intelligence with the support of CCG data packs and CCG supplying relevant PH data when they receive this via any source. Provision of Public Health support to addressing the determinants of poor health in Rochdale Borough through joint work with RMBC and other partners. Leading on the Health Chats Programme (Making Every Contact Count). Specialist skills in and delivery of Health Needs Assessment, Health Impact Assessment and Health Equity Audit. Public health support to the CCG/NHS including support to acute and primary care commissioning. Provision of support to a number of Greater Manchester work programmes Suicide prevention report to mental health commissioning meeting Stigma/ prevention - Support to the It s a Goal project 4.3 The Public Health Team will also offer NHS HMR CCG: Attendance at and contribution to NHS HMR CCG Governing Body (DPH) and Clinical Commissioning Committee (consultant). Named staff aligned to provide links to key CCG work streams including joint commissioning to be developed with the CCG on agreed work streams for 2013/14. Public health intelligence to assist the CCG to set commissioning priorities. Production of an agreed number of health needs assessments to inform commissioning decisions. Support for the CCG commissioning strategy and joint commissioning plans for adults and children with the council to support integration. Evidence reviews of effectiveness to inform commissioning decisions in agreed areas Evaluation of an agreed number of services and participate in the CCG service review panel process Refreshing and sharing of the public health team objectives for 2013/14 including support for CCG work within agreed RMBC Public Health delivery plan. Continued support for NHS commissioning and objectives within the capacity available which will be agreed with the CCG Chair and leads to support the CCG in developing evidence based pathways. Leadership on the above public health priority areas (4.4) and will involve the CCG as required for the delivery of priority outcomes. Leadership on the development of the Health and Wellbeing Board and support for the CCG in developing their role. Leadership for the development of the JSNA and Strategy for the HWBB. Support for the CCG in aligning CCG plans to the JSNA and Strategy. Public health support to developing, implementing and monitoring relevant business cases. Public health specialist support to the CCG All Age All Cause Mortality programme for 2013/14. /life expectancy programme for 2013/14 Page 27 of 39

28 Leadership for the Joint Commissioning of health improvement and support to the development of joint commissioning between RMBC and the CCG. Work with the CCG to agree a performance framework for joint targets for 2013/14. Determine outcomes that are linked into performance frameworks for both CCG and Public Health that can be delivered through joint commissioning. Leadership for public health responses and support for the CCG in managing any public health related emergency or incident. Support and facilitation of joint working with the Local Authority and partners. Support for NHS HMR CCG in agreeing commissioning intentions. Support for the development of public health skills within the CCG and constituent practices. Support for the CCG in developing an asset based approach to improving health. Maintenance and development of a skilled multi disciplinary work force that meets agreed standards. Public Health and CCG to develop joint monitoring of shared contracts (Community and Acute) for services that contribute to outcomes frameworks that commissioners can directly influence. Provision of 1 WTE Consultant and 3-4 WTE of other staff to work alongside NHS HMR CCG staff on agreed work streams. This time will be split across the team as appropriate to the work programme. Reactive time has been built into the offer to reflect in year demands and support for indicator recovery. Sharing of performance data with the CCG to ensure that performance data giving an indication of borough performance for both parties is available to both. See Appendix NHS HMR CCG will: Secure the required NHS data for public health to support their commissioning activities and mandatory services as per the guidance and without charge. Provide clinical governance and oversight to public health programmes in 2013/14 through a jointly funded arrangement that will be reviewed annually and supported by a joint risk sharing agreement. Provide clinical and commissioning support to RMBC priority public health programmes as required by the Joint Commissioning arrangements. Ensure that NHS HMR CCG and PH joint funded programmes are delivered as agreed by both parties. Contribute to delivering shared public health outcomes for improving health and reducing health inequalities. Ensure that CCG strategies complement partner plans to improve health and reduce health inequalities. Will be a full and active member of the Rochdale Borough Health and Wellbeing Board as a statutory member in line with HWBB constitution. Collaborate with RMBC on the management and performance of CSU functions particularly where both organisations commission complementary products e.g. TPM, access to NHS data and BI Support. Ensure that early intervention, primary and secondary prevention is within care pathway redesign and development. Page 28 of 39

29 Support the inclusion and monitoring of health and wellbeing priorities within NHS contracts and plans. Embed public health priorities and action within primary and community strategies. Work jointly on public health programmes that require relevant action from NHS HMR CCG. Ensure that NHS HMR CCG is aware and ready to respond to any emergency or health protection incident and will participate in exercises to test systems. Determine how to include public health expertise within decision making processes. Utilise the specialist public health skills appropriately to improve outcomes and reduce inequalities. Agree work programmes that require support for 70% of the time available by the 1 st April Through the CCG Executive Nurse provide clinical supervision for nursing staff in the LA PH team. Provide honorary contracts to Public Health staff to enable staff to keep nhs.net addresses and access to health related websites or data. Staff details in below; 1. Dr Jane Rossini 2. Wendy Meston 3. Dr Helen Lewis-Parmar 4. Bernadine O Sullivan 5. Dr Michelle Loughlin 6. Richard Pinkney 7. John Mannion 8. Christine Khiroya This list will be owned and kept up to date by the DPH. 4.6 RMBC and NHS HMR CCG by working together as described in this MOU will ensure commissioned services are effective and value for money, that external support is efficient and meets our local requirements, that scare skills and knowledge in both organisations are shared and that each recognises the opportunities to improve outcomes for citizens though close collaboration and joint working. (See Appendices 2 and 3.) Signed... Jim Taylor Chief Executive Rochdale Metropolitan Council Signed... Lesley Mort Accountable Officer NHS HMR Clinical Commissioning Group Page 29 of 39

30 Appendix 1 to MOU Public Health Outcomes The overall goals of the Public Health Outcome Framework are; Increasing healthy life expectancy Reducing health inequalities These are supported by a framework of indicators to ensure the Health and Wellbeing Strategy is on track and to help prioritise where action will have the biggest impact quickest. The framework is summarised in figure 1. Appendix 2 to MOU Data Sharing Principles Rochdale Metropolitan Borough Council and NHS HMR Clinical Commissioning Group Principles for a the sharing of Performance Data for outcome framework indicators Performance Manager Both Rochdale Metropolitan Borough Council (RMBC) and NHS HMR Clinical Commissioning Group (CCG) will continue to use Performance Manager to monitor their organisational performance against national and internal indicators in 2013/14 Page 30 of 39