Community empowerment in practice: lessons from Communities First looks at community empowerment in local governance and service delivery which has become a key component of government policy in the UK. However, there are critical challenges to achieving this in practice. This research sees the Joseph Rowntree Foundation use 9 case studies to consider:

It considers:

• how far partnerships have developed and evolved to empower communities;

• the relationships communities have with other representative channels;

• the extent to which communities have influenced other agendas;

• the overall impact of regeneration partnerships.

It finds that:

• Community members responded positively to the opportunities for participation provided by Communities First and, as they began to recognise their own role in promoting positive change in their community, their confidence in their abilities increased.

• Community members brought varied skills and knowledge to the partnership process but required support to develop the skills required for effective partnership working.

• Levels of community engagement were improved by providing multiple routes to participation. Highly localised forums that fed into the partnership widened community empowerment and helped to support community members of the partnerships.

• Little evidence of community influence over statutory members of Communities First partnerships and no evidence of significant mainstream ‘programme bending’ where statutory agencies prioritised actions and expenditure in the Communities First partnership area.

• Clearer links are needed between strategic partnerships at ward level and those at the local authority level. Local Strategic Partnerships or Local Service Boards are not sufficiently local or connected to the community to facilitate effective community empowerment.

• Concludes that government will need to provide incentives and sanctions to promote a greater statutory sector response to processes of community empowerment. Consideration should be given to allocating specific functions and resources to local partnerships which they can deploy. The continued commitment of community members will be conditional on ‘purposeful’ community involvement.

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

Following the the Ministerial Industry Strategy Group’s Longterm leadership strategy  for medicines to encourage joint working between the NHS and pharmaceutical industry it was recommended an interactive toolkit was developed to support this.  The strategy had three main themes

• Improving the relationship between the NHS and industry to support the better use of cost effective medicines
• Supporting the European Commission’s plans to improve the competitiveness of Europe through the High Level Pharmaceutical Forum
• The need to improve the effectiveness of medicines regulation.

The toolkit aims to:

• encourage NHS organisations and staff to consider joint working as a realistic option for the delivery of high-quality healthcare
• provide the necessary information and have easy access to the tools which will help to enter into joint working.

A selection of templates are also available.

How to set and monitor goals for prevalence of child obesity follows on from the Government’s obesity strategy  Healthy Weight, Healthy Lives: a Cross-Government Strategy for England.  It provides advice to PCTs and local authorities on how to set child obesity goals as part of the Vital Signs and the National Indicator Set.

‘Better Care: Better Lives: Improving outcomes and experiences for children, young people and their families living with life-limiting and life-threatening conditions’ aims to improve the care and support given to children in England with life-limiting or life-threatening condition and their families. The strategy calls on commissioners, service providers, voluntary sector partners – to improve the experiences of young people and their families by:

• improving data sources

• building stronger joint working arrangements

• developing better needs assessments and support regimes

• tackling inequalities

• encouraging the delivery of care in the most appropriate setting.

Looking at social exclusion in the elderly Age Concern have produced  Out of sight, out of mind: Social exclusion behind closed doors sets a number of challenges across both local and central government and for voluntary groups to ensure that older people are socially included.  These are:

• Develpment of a cross-departmental government commitment to help the most disadvantaged older people.

• Central and local government strategies for tackling social exclusion and neighbourhood renewal must include older people.

• Local authorities should revisit A Sure Start to Later Life and re-model their services to ensure they are joined-up, user-friendly, rooted in the community and flexible enough to reach out to vulnerable older people.

The report recommends:

For people who are over 80 and living alone

• Consultation and involvement that is genuinely inclusive.

• Local policies and programmes to enhance social contact.

• Low-intensity home services.

• Thoughtful planning of local services and transport options to help promote independence.

For people who are recently bereaved

• Improved support for counselling and support services.

• Multi-agency initiatives to identify and follow-up on bereaved people at risk of exclusion.

For people who are living in unfit housing

• ‘Handyperson’ schemes available nationwide.

• Multi-agency promotion of home repair schemes and free home audits.

• Improvements to the Warm Front scheme.

• Improve access to suitable housing, by reforming planning rules, funding home adaptations, and matching’ people to accessible homes.

For people who have limited capacity to make their own decisions

• Improved support for independent advocacy.

• Services that sustain social contact and independence for as long as possible.

Thanks to Sue over at Lancashire Care for pointing out this one.

Research  from the  National Institute of Health Research presenting the organisational characteristics shared by emergency departments by identifying three factors that are strongly associated with shorter waiting times, Organisational factors that influence waiting times in emergency departments (summary) identifies the following key findings:

• Waiting times are a key performance target for emergency departments, with all hospitals aiming to treat and either admit, discharge or transfer people within four hours of arrival.

• Two significant factors that influence waiting times are the size of the department and the seriousness of cases entering the department.

• Three other important factors which are associated with shorter waiting times are:
  • lower levels of sickness absence among nursing staff
  • lower expenditure on non-pay items (such as medical equipment, clinical investigations and processes)
  • a more participative leadership style by the lead consultant.

• Together these five factors account for more than a third of the variation in average waiting times between emergency departments. However, more research is needed to establish ‘cause and effect’ – i.e. whether these factors are responsible for lower waiting times or vice versa.

• Practitioners cite a range of working practices which they believe improve waiting times, such as more co-operative working within the emergency department and better co-ordination with primary and secondary care services. A participative leadership style may help promote such working practices.

• While waiting times have an impact on patient satisfaction, it is important also to understand and address the other factors that influence quality of patient care.

Realising Britain’s Potential: Future Strategic Challenges for Britain (Executive Summary) from the Cabinet Office identifies four major challenges to be faced by Britian:

• The importance of early years learning and childcare in helping those from poorer homes and in improving later performance.

• Continued investment in physical infrastructure (roads and rail).

• Demands on public services and housing, especially in the South East, from a rising population, including continuing net migration into Britain.

• Increasing life expectancy, with a rise of a half within a decade of those aged over 85, and a two-fifths increase by 2022 in the demand for informal care from family, friends and community members.

The report suggests a mix of the public and private sector providers will be required to meet demand. Taxpayers cannot finance all of the expanded early learning and childcare, increased transport facilities and care for the elderly To reduce the tax burden, individuals will have to accept that individuals will have to save much more and pay more in user charges (via road pricing and elderly care).

Turning Point and Dr Foster Intelligence have produced ‘A Personal Approach to Public Services’, a new report which states world class public services can be provided without structural reform or significant additional resources or costs, the holy grail of the public sector! Key to achieving this are:

• Intelligent customer insight - improving effective and consistent use of data to know understand and profile the diversity of the communities served
• Service design - must involve stakeholder participation including local people, particularly those in most need, to design services around need
• Personalisation - create individual budgets and provide multiple needs through one integrated service
• Prevention - make prevention a mainstream activity at the heart of the commissioning process
• Partnerships - make partnership work for users rather than creating talking shops and further bureaucracy.

The NHS in England: operating framework for 2008-09 (includes Annexes A, B and C) gives an overview of the priorities for the NHS next year. The annexes provide more detail on the priorities, how they are measured and how the new arrangements for managing the system will work. The framework also details PCT allocations for 2008/09.

Principles and rules for Cooperation and Competition are the subject of Annex D and recognise that competition and choice are powerful levers to drive up service quality, deliver better value and reduce inequalities but require enforceable rules guiding and governing behaviour within the healthcare system.  These rules ensure fair and transparent competition where this is needed to make the best use of resources and enable innovation, and provide essential safeguards for the interests of patients, taxpayers, and the reputation of the NHS.

There is also a new Standard NHS contract for acute services in Annex E.

In summary the 2008-09 Operating Framework sets out:

1. NHS priorities for the year ahead: freeing up the front line by moving towards local stretch targets, whilst delivering on national priorities. 2008/09 is the start of the next three-year planning round. In this context, the Operating framework sets out the priorities and planning framework for the NHS for the 2008/09 financial year, within the context of the 3 year CSR period 2008/09 – 2010/11;
2. Reform levers and enabling strategies: reform with a purpose – to improve services. The focus will be on developing world class commissioning as the key agent for change on behalf of patients and the public, using the full range of levers and incentives to transform services and improve outcomes;
3. Financial regime: setting out a framework that fully supports reform goals and incentivises transformational improvements in services within available resources. Key to this will be the need to sustain the surpluses the NHS is on track to deliver;
4. The business processes: ensuring a business-like and transparent approach to planning that supports locally led decisions whilst providing accountability. There is a strong emphasis on genuine partnership working at a local level with local government and other partners to ensure that local health and wellbeing needs are better understood and addressed in partnership.

The vital role of interagency working in childrens services is recognised and developed in a new document setting out the Government’s goals for 2020. it identifies a new leadership role for Children’s Trusts in every area, a new role for schools as the centre of their communities, and more effective links between schools, the NHS and other children’s services so that together they can engage parents and tackle all the barriers to the learning, health and happiness of every child are detailed in The Children’s Plan: building brighter futures (Executive Summary).

The plan will

• strengthen support for all families during the formative early years of their children’s lives
• take the next steps in achieving world class schools and an excellent education for every child
• involve parents fully in their children’s learning
• help to make sure that young people have interesting and exciting things to do outside of school
• and provide more places for children to play safely.

The Single Equality Scheme Delivery Plan that underpins the plan emphasises equality of opportunity regadless of disabilty, race and gender.

Crisis Resolution Home Treatment teams are having a positive impact on local acute mental health services, providing an alternative to hospital admission for people experiencing a short-term mental health crisis.

But Helping people through mental health crisis: The role of Crisis Resolution and Home Treatment services (Executive Summary, Crisis Resolution Home Treatment Services: Report from a Survey of Referring Clinicians) from the National Audit Office found that services are being limited by a lack of input from specialist health and social care professionals, variations in staffing levels across the country and too few admissions to hospital being assessed by CRHT teams. These teams have been implemented across most areas of the country, there are wide variations between areas in the extent to which teams are staffed and resourced but where they are working they are making a significant impact. CRHT teams have reduced pressure on beds and the teams have been successful in reaching many service users who would otherwise have needed admission to hospital. CRHT teams are also supporting people in early discharge from hospital.

Only three regions achieved the Department’s estimate for a full functioning service of 14 or more whole-time-equivalent CRHT staff per 150,000 population. Staffing in the least well resourced region (North West) is 25 per cent lower than that in the best (South Central) and the national headcount for staff is only 90 per cent of the number estimated by the Department as required.

The report concludes that there is still more to do. To maximize the impact of CRHT and improve value for money the Department and the NHS need to ensure that CRHT teams are properly resourced, fully functional and integrated within local mental health services. National data on services must improve, and better use of feedback and data made at the local level. Local NHS organizations need to improve links between CRHT teams and other mental health services, and Mental Health Trusts should enforce written policies and procedures requiring every inpatient admission to be preceded by a CRHT assessment.

Draft guidance has been issued by the Department of Health to support planning for any incidence of pandemic influenza.

Pandemic flu: A national framework for responding to an influenza pandemic describes the Government’s strategic approach for responding to an influenza pandemic published jointly by the Department of Health and the Cabinet Office. It provides background information and guidance to public and private organisations developing response plans. It updates and expands upon health advice and information contained in previous plans issued by UK health departments and is intended to replace those documents.

Planning

Responding to pandemic influenza – The ethical framework for policy is designed to assist planners and strategic policy makers with ethical aspects of decisions they face before, during and after an influenza pandemic. It may also help clinicians and other health and social care professionals with decisions they need to make in the same context.

Pandemic influenza: surge capacity and prioritisation in health services - provisional UK guidance gives guidance on managing the surge capacity needed to respond to an increased volume of patients during an influenza pandemic.

Pandemic influenza: human resources guidance for the NHS is designed to give an overall framework for local organisations to build on/work within and deals in more detail with the workforce and human resource issues that may arise in the pandemic.

Pandemic influenza: Guidance on the management of death certification and cremation certification proposes changes to the procedures for death and cremation certification that could be used in a severe influenza pandemic in order to enable doctors to spend as much time as possible on the care of the living and to ensure that processes for death and cremation certification can be managed as effectively as possible during a pandemic

Service Based Guidance

Primary care guidance will assist primary care trusts (PCTs) in developing their plans for responding to an influenza pandemic. It is also intended to be a useful document for primary care professionals such as those working in general practice, community pharmacy and nursing, and for partner agencies providing services in the community setting. Also relating to the Primary Care setting is An operational and strategic framework: planning for pandemic influenza in adult social care which is supplementary to the revised national framework for responding to an influenza pandemic. It is intended to help local authorities, providers of social care services and PCT’s plan ahead for how they will manage and respond to the situation.

Pandemic influenza: Guidance for ambulance services and their staff in England provides ambulance trusts with a clear and pragmatic guidance to assist with their planning and reparations for an influenza pandemic. Specifically, it advises on national strategy, clinical management (including infection control) and business continuity planning.

Pandemic influenza: Guidance on preparing acute hospitals in England is designed to assist acute hospitals and foundation trusts in England in developing their plans for responding to an influenza pandemic.

Pandemic influenza: guidance on preparing mental health services in England is designed to assist mental health trusts and other specialist mental health service providers in developing their plans for responding to an influenza pandemic. This document details a national approach, setting out the key planning assumptions and principles, roles and responsibilities that should inform the development of local plans.

POPP is an initiative being led by the Department of Health, providing £60m funding to council-based partneships to set up innovative pilot projects to:

• Provide person-centred and integrated care for older people.
• Encourage investment in preventative approaches which promote health, well being and independence for older people.

The strategic aim of ‘Partnerships for Older People Projects’ is to test and evaluate innovative approaches that enable a sustained focus on prevention. It is expected that partnerships will demonstrate improved outcomes in:-

• Providing more low level care and support in the community with a view to preventing or delaying the need for higher intensity and more costly care
• Reducing avoidable emergency admissions to hospital
• Supporting more older people to live at home or in supported housing such as sheltered or Extra-care housing rather than in long-term residential care

Just published are interim reports on the projects progress.

• National Evaluation of Partnerships for Older People Projects: Interim report of progress
• National Evaluation of Partnerships for Older People Projects: Interim report of progress, Briefing paper: Cost-effectiveness, Measuring Effects: Emergency Bed-Day use

You can also check out the Mass Media Coverage 21/11/07 over on Fade the Blog.

Services for people with learning disabilities and challenging behaviour or mental health needs is best practice guidance to councils with social services responsibilities and health bodies. It is not mandatory and no extra resources will be provided for its implementation. Councils and health bodies should take it into account in setting their own priorities and policies. It will also be useful to people using services, their families and representatives, staff and those responsible for commissioning of local services as a statement of best practice. It is an updated version of the guidance originally produced by Professor Mansell and his project team in 1993.