Hammersmith and Fulham CCG Governing Body Meeting Agenda Item: 10 10 th September 2013 Paper Title: Memorandum of Understanding between the Triborough Public Health Service (3BPH) and Hammersmith and Fulham Clinical Commissioning Group Summary: This Memorandum of Understanding (MOU) establishes a framework for governing the relationship between the Triborough Public Health Service (PH) and Central London (CCG) for 2013 / 2014. It has been developed jointly through a working group involving all CCGs, 3BPH and other leads as appropriate including our Clinical Chief Information Officer. Although this MOU was agreed in April, it was not formally signed off by the Governing Body. Formal sign off is necessary to enable the Public Health intelligence team to have access to relevant data to support the JSNA and the CCG commissioning intentions. Strategic Fit: The Health and Social Care Act 2012 creates a set of new arrangements for the oversight, commissioning and delivery of clinical and public health services. Among the changes are the establishment of: a) CCGs with a duty to commission about 60% of the required local health services; and b) a new public health service within local authorities with specific public health duties and commissioning responsibilities. There is also a requirement for the new public health departments to provide certain core services to CCGs. Patient Engagement (What patient engagement has taken place and what impact has it had on this proposal): N/A Health Inequalities (evidence of how these are addressed in the paper): The MoU sets out principles for the CCG working with Public Health to address health inequalities Equality (evidence of how this is addressed in the paper): The MoU sets out principles for the CCG working with Public Health to address health inequalities Action required by the Governing Body: Approve the policy. Responsible Director/lead: Eva Hrobonova - Consultant in Public Health (Children and Families Services) Deputy Director, Tri-Borough Public Health Author: Dr Ike Anya - Consultant in Public Health (Children and Families Services)
Service Date: August 2013
Memorandum of Understanding between the Triborough Public Health Service (3BPH) and Hammersmith and Fulham Clinical Commissioning Group 1 April 2013 31 March 2014 Introduction This Memorandum of Understanding (MOU) establishes a framework for governing the relationship between the Triborough Public Health Service (PH) and [insert name] (CCG) for 2013 / 2014. Background The Health and Social Care Act 2012 creates a set of new arrangements for the oversight, commissioning and delivery of clinical and public health services. Among the changes are the establishment of: a) CCGs with a duty to commission about 60% of the required local health services; and b) a new public health service within local authorities with specific public health duties and commissioning responsibilities. There is also a requirement for the new public health departments to provide certain core services to CCGs. These changes require Public Health and CCGs to cooperate and collaborate effectively and efficiently. This MoU sets out the principles, processes and practicalities for ensuring optimal cooperation and collaboration. It covers five areas as follows: 1. Provision of a core offer by public health to CCGs 2. Coordination and collaboration over JSNA and HWS 3. Effective management of commissioning inter-dependencies 4. Health Protection 5. Information Systems and Governance Core Offer The Triborough Public Health Service core offer to CCGs will come in the form of: 1) public health consultant expertise; and 2) support from the Public Health Intelligence team.
As a Triborough function, the public health department intend to provide a fair shares service to each of the three CCGs we work with (Central London CCG, West London CCG and Hammersmith and Fulham CCG). For 13/14 fair share will mean equal support. Public Health Consultant Each CCG will be allocated the services of a PH consultant for roughly 1.5 days per week. It is expected that the PH consultant will: Participate at CCG Governing Body and key management meetings Provide public health advice to CCGs Support the CCG in priority setting and commissioning of equitable, evidence based services Support the CCG in reviewing existing and developing new evidence based care pathways, service specifications and quality indicators Design monitoring and evaluation frameworks, and interpret results for specific projects and/or services as per mutual agreement. Help CCGs develop effective joint working arrangements with local authority and other partners (including clinical networks and regional policy groups) Support the CCG to develop new/refreshed strategies around critical areas such as mental health, smoking, alcohol consumption and obesity, and the reduction of health inequalities; and advise on appropriate metrics for progress and outcomes of CCG action to be monitored Provide intelligent customer services to CCGs to commission specialist programme support as required Provide a wide range of information on the www.jsna.info website Public Health Intelligence team The PHI team currently comprises 6.4 WTE posts consisting of: Senior Public Health Analysts 2 WTE Knowledge Manager 1 WTE Public Health Analysts 3 WTE
Epidemiologist 0.4 WTE About 40% of this non consultant capacity will be devoted to providing support to the three CCGs of INWL. This works out to be approximately 0.8 WTE per CCG. PH and CCGs agree to consult with each other over the development of commissioning intentions and business planning. This will inform the development of the PHI team work plan and timetable to support the CCGs within the defined resource allocation. The appended document (Tri- Borough Public Health Intelligence Resource and Business Plan) provides a detailed description of how the PHI team is structured and staffed; and how it intends to operationalise its support to CCGs as well as other stakeholders in the system. There will also be elements of programme work that would not be in the core offer where CCGs may wish to commission PH or agree a reduction in the quantum of the core offer in order to offset the diversion of PH capacity. Examples of non core activity are likely to be where one CCG has a desire / need for PH input which is unique to that CCG (as this would not be consistent with the fair shares approach), where the input could not be met from the dedicated CPH or PHI resource, or where the CCG required expertise which was not available within the Triborough public health team but where the public health team would be best placed to procure such expertise on the CCG s account, for example health economics expertise any such procurement would be on cost recovery basis. CCGs CCGs are expected to treat the public health core offer as a means for instituting a population health perspective into their activities and duties. According to national guidance, the purpose of the core offer is to ensure that PH skills and expertise in health care (e.g. economic evaluation; health services research and evaluation; and evidence-based appraisals of clinical effectiveness) are retained for use by CCGs. It is expected that CCGs will: Incorporate their allocated Consultant onto their governing body Incorporate specialist public health advice into decision making and commissioning processes. Coordinate with each other when making demands upon the PHI team
so as to maximise synergy and economies of scale Ensure that any work expected from the PHI team is reasonable and consistent with the available resources Enable the PHI team to have access to relevant data and information CCGs will establish principles within their management teams, governing bodies and with their constituent practices to manage requests for responsive (ad hoc) support from the PHI team ensuring that: a) these fit with the overall strategic direction, business plans, QIPP reviews etc for the CCG; and b) they can be met through the available resources. Coordination and collaboration over JSNA and HWS The Health and Social Care Act requires local government, CCGs and other actors (Health Watch and NCB) to produce a Joint Strategic Needs Assessment (JSNA) and Health and Wellbeing Strategy (HWS), under the oversight of a Health and Wellbeing Board. These two outputs will provide the overarching frameworks for improving overall health and reducing health inequalities through the commissioning of both health and social care services, and the commissioning and delivery of public health programmes. Coordination and collaboration between CCGs, Public Health, Adult Social Care and Family and Children s Services will be critical. The Triborough Public Health Service will Promote health improvement partnership working between CCGs, local government partners and residents to integrate and optimise local efforts for health improvement and disease prevention. Support the CCG to embed public health interventions into the frontline clinical services of their constituent practices especially in relation to prevention programmes; primary and secondary prevention; behaviour change; and patient and community empowerment CCGs will Commit to improve health and reduce health inequalities and to support the delivery of public health priorities. Place appropriate priority on the monitoring of CCG action to secure population health improvement and reductions in health inequalities. Support and encourage all practices to maximise their contribution to health improvement through prevention programmes; primary and
secondary prevention; behaviour change; patient and community empowerment; and influencing the upstream social determinants of health. Contribute data, information and capacity to the production of the JSNA and HWS Management of commissioning inter-dependencies The Health and Social Care Act divides commissioning responsibilities between CCGs, NCB, PHE and local authorities. However, these divisions are not clean or necessarily clear-cut and in a number of areas commissioning decisions by the CCGs or by the local authority will impact upon services commissioned by the other party. The Triborough Public Health Department and the CCG therefore agree that in respect of the commissioning of the following services each party will consult with the other before making any changes to commissioning: Central London Community Health services Sexual health services Health Checks, secondary and tertiary prevention services for CVD and DM Drug and alcohol services Obesity prevention and treatment Health Protection The Health and Social Care Act (2012) makes changes to the arrangements for health protection and for health emergency preparedness, resilience and response. The Triborough public health team will: work with the CCG to provide information and advice to promote the preparation of appropriate local health protection arrangements. draw upon the resource and expertise of PHE to advise the CCG of local health hazards and risks The CCG will
Participate in the Borough Resilience Forum Appoint an Accountable Emergency Officer at Board level Plan, prevent and prepare for health emergencies including training and testing Information Systems and Governance To enable optimum cooperation and collaboration between 3BPH and CCGs, there is a need to establish a population-based health information system that is capable of: Joining up routine health care activity data sets from different parts of the health care system Joining up health care activity data with population-based data Joining up health care data with social care and other local government data In addition, there is a requirement to establish appropriate IG policies and procedures that will allow safe, appropriate and optimal sharing of data across organisational boundaries. 3BPH and CCGs will work together to define the dataset that is required from the CCGs and their constituent GP practices and services. Data will be included by default, recognising the principle that failing to share data can be as harmful as sharing it inappropriately. The information governance structures within 3BPH and CCGs will be an enabling force within this process and will ensure that the dataset is as inclusive as possible whilst respecting data protection law and regulations. 3BPH will ensure that undue stress is not placed on CCGs in extracting and transferring data to the 3BPH. Data extraction and transfer will be automated and will occur as a background process within CCG services and surgeries, without the need for ongoing involvement of CCG, practice or service staff. This will occur as part of the same data extraction process that feeds the CSU data warehouse. The reporting of public health data will be via the same platform that provides an overview of CCG finance, activity and outcomes data. This will allow CCGs to maintain a comprehensive overview of their performance in commissioning services for their patient population. It will also allow the demand for new or enhanced services to be assessed
in the context of existing need and performance. It is recognised that the means to do this is not immediately available, however as it becomes available it is expected that the reporting of public health data will be transitioned over to a combined reporting platform. 3BPH and CCGs will work together to define the analysis and reports that will be provided to CCGs and their constituent parts. This will occur on at least an annual basis and will include clinician representatives from both 3BPH and the CCGs. 3BPH will advise CCGs of issues with data quality relevant to public health and will make recommendations for improvement in specific areas. CCGs will ensure that this information is disseminated to their constituent practices and services and will provide sufficient educational support to effect an improvement in data quality in these areas. Review Both parties commit to a review of the MOU after 6 months when it is planned to add a further level of detail where required; describe governance in more detail and agree the process to resolve disputes.