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East Midlands Improvement & Transformation Board 2pm, 2 nd March 2015 Pera Business Park, Melton Mowbray, LE13 0PB Agenda 1. Apologies 2. Declarations of Interest 3. Minutes of meeting held 25 th November 2014 4. LGA Consultation - the Future of Sector-led Improvement and Proposed Approach 5. Regional Chair Networks – Health and Wellbeing Boards 6. East Midlands Member Development Programme 2015/16 7. Regional Health Review – Next Steps 8. EMC Business Plan a) Local Government Funding Settlement b) Housing Pressures in the East Midlands

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East Midlands Improvement & Transformation Board

2pm, 2nd March 2015 Pera Business Park, Melton Mowbray, LE13 0PB

Agenda

1. Apologies

2. Declarations of Interest

3. Minutes of meeting held 25th November 2014

4. LGA Consultation - the Future of Sector-led Improvement and ProposedApproach

5. Regional Chair Networks – Health and Wellbeing Boards

6. East Midlands Member Development Programme 2015/16

7. Regional Health Review – Next Steps

8. EMC Business Plana) Local Government Funding Settlementb) Housing Pressures in the East Midlands

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Item 3

East Midlands Improvement and Transformation Board meeting 25th November 2014

Minutes

In attendance Councillor Roger Begy OBE (Chair) Rutland County Council Councillor Fiona Martin MBE (Vice Chair) East Lindsey District Council Councillor Marion Brighton OBE North Kesteven District Council Councillor Annette Simpson Bassetlaw District Council Councillor David Sprason Leicestershire County Council Councillor Robin Brown Northamptonshire County Council Councillor Tony Howard East Lindsey District Council Officers Stuart Young (SY) East Midlands Councils Lisa Butterfill East Midlands Councils Becca Singh LGA 1. Apologies

Councillor Blake Pain Harborough District Council Councillor Alan Rhodes Nottinghamshire County Council Councillor John Clarke Gedling Borough Council Councillor Chris Baron Ashfield District Council Councillor Alan Chambers Bassetlaw District Council Councillor Anne Western Derbyshire County Council Mark Edgell LGA Alison Neal East Midlands Councils

2. Declarations of Interest

None 3. Minutes of meeting held 10th September 2014

The minutes were approved as an accurate record of the meeting. At the outset of the meeting, the Chair expressed his concern that there are a number

of members who have not attended IT Board meetings. There is a real issue as to why they are not present and it was considered those members are taking up a place of another member who may wish to attend IT Board meetings. SY confirmed that Management Group agreed at their last meeting to take a firm line with regard to attendance at future Board/Group meetings. Failure to attend two Board meetings without a valid reason will result in the Board looking to appoint another member.

4. Proposed Role and Focus of the Improvement and Transformation Board

SY presented the report to the Board. Members considered the report in order to agree a way forward in identifying and agreeing a potential programme of work.

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Over the coming years there are a lot of issues and consideration should be given as to how councils are tackling these and consider what support will be required in order to bring new members up to speed. Members considered there is a real benefit in the networks across the region and felt these should be organised with links to the LGA; ensuring services provided and the relevance is shared with new councils. It is important that these discussions take place with a prospectus being provided for new councillors.

Peer challenge – joint offer between the LGA and EMC. Benefit of bringing in councils from outside the patch. Better engagement with councils in the region.

Action: Chair suggested that:

• One member from other meetings be invited to attend future IT Board meetings;

• Chairs of other groups be brought together in order to progress some of the issues identified more effectively.

The Board considered that very little feedback is received from the Executive Board as to what is required from the IT Board. Elements of the Board’s focus are of interest to the Executive Board and it was therefore considered that all pilot work should also be transmitted to the Executive Board.

Sharing good practice and learning across the region from the grants previously received is key. There is a role for this Board to ensure this learning is shared with colleagues.

Going forward – consideration to be given as to how we identify the issues, incorporating the experiences/examples of past knowledge; and involvement of the LGA to highlight good practice etc.

In terms of networks and events – districts and boroughs need to promote what they do. Members are keen to work together but there is an issue with officers. More services are being devolved down to communities. Better engagement is a key factor.

• Health, Adults and Children’s Network meetings to operate and meet on the same day.

• Develop a stream of district and boroughs which may then be fed into the Boards.

• Planning and Housing should be devolved down from the Executive Board. • Look at the profile of some of the work currently undertaken.

Cllr Simpson considered there is a need to consider what councils require and how they view devolution. Consideration to be given to formulate a devolution plan and what is required in the East Midlands around devolution. The Board requested that further consideration be given to the better use of networks and the need to ensure Councillors recognise this. Devolution – CCN have already undertaken work on this. Part of the role of EMC, supported by IT Board – members from around the region to discuss devolution, roles and responsibilities and how we work together with the proposals. Action: Strategic discussions around health, housing and children’s services to be undertaken by the IT Board.

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Item 3

Regional corporate support – peer discussion. This is an additional offer from the LGA and EMC to councils in the region. Is this something members would wish to support – post May elections? The Chair felt that the IT Board should have at least two projects for consideration. SY advised that there are two projects currently being work on – Welfare Reform and the Health Project. There is also a need to ensure that attendance at events is cost effective, especially when numbers are low. The report was noted.

5. Health Review EMC has commenced a review on regional health matters, focusing on where a collective approach adds value and will support the consideration of issues of joint interest to councils, MPs and wider partners. A summit on health priorities for the region was held in the Houses of Parliament on 30th October highlighted recruitment and retention. Members asked whether EMC would be able to assist councils to “sell” their areas and how to make the region more attractive in order to retain medical candidates. NHS England are looking at scholarships in order to try and keep medical students within the East Midlands. Options to be identified and promoted. SY briefed the Board on the funding issues around health care. Councillor Begy advised of the recent LGA meeting - £1.5bn NHS funding. Action: SY agreed to prepare a paper for discussion at 5th December Executive Board meeting. SY advised that the APPG meetings were useful but advised MPs need to take leadership. Reference to the BCF to be included as part of the Health Review. Members noted the report.

6. Member Development Programme Lisa Butterfill (EMC) attended the meeting in order to provide an update on progress in delivering the 2014/15 Member Development Programme and seeking Member direction of the future 2015/16 programme. Going forward - A copy of the draft induction programme was tabled at the meeting. Benefit of members being involved in networks – could this be considered as part of the July AGM in order to attract members to attend and limit this to EMC members? Charter – Members felt as there are so many competing needs on time and resources and felt there needs to be a better case made and slightly less resource intensive. Members supported the promotion of the remaining two events on the current Regional Programme of Policy Briefing Events in January and February 2015.

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Action: Bring together Leaders/Members and officers who have already undertaken the Charter. Item for July AGM. Board members agreed to encourage member engagement with the remaining sessions of the 2014/15 policy briefing programme on 22nd January and 24th February 2015. Action: All

Councillor Begy congratulated EMC on their hard work. The report was noted.

7. Regional Summit on ‘The Future of Local Government and Public Service Delivery in the Next Parliament’ Members were invited to reflect on this summit meeting and discuss any learning that can be taken to inform the development of any similar events in the future. 150 delegates from 63 authorities/organisations attended the summit. Positive feedback received from those who attended. Board reflected on this summit meeting highlighting the following: Cllr Martin felt the Housing afternoon session held at LCFC on 21st November,

would have been of more benefit to Members than the morning session. Devolution booklet issued too early Timescales too tight to enable discussions prior to the event Future events – questions to the Panel to be agreed prior to the meeting taking

place. The report was noted.

8. Welfare Reform – Where are we now?

The report provided an update on the impact of the welfare reforms and on the recent

work by East Midlands Councils and the Welfare Reform Steering Group. The paper also reviews evidence and data from local authorities on the impact of the introduction of local council tax support and housing reforms in particular.

SY advised Board members that there is a lot of work currently taking place on welfare reform. Action: Item for discussion at February 2015 Executive Board meeting.

The report was noted.

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Item 4

Improvement and Transformation Board 2nd March 2014

Sector-Led Improvement

Taking Stock: Where next with sector-led improvement?

LGA Consultation

Summary

The following report provides a summary of the current consultation on the LGA sector-led improvement offer, with specific reference to some key challenges as outlined in Section 2 of this report.

Recommendation

Members of the Regional Improvement and Transformation Board are invited to consider and comment on sector-led improvement to inform a response to this consultation.

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1. Introduction 1.1 Three years ago the LGA published 'Taking the lead' setting out an approach to

improvement in local government which had been developed and agreed with councils. 1.2 The LGA highlight the sector-led improvement programme as a success, and residents

remain satisfied with and continue to trust their local council. However, the LGA have confirmed the need to further consider issues for the future and a consultation paper, ‘Taking Stock: Where next with sector-led improvement’ was released on 20th January 2015, asking whether the approach is still the right one. These are important issues for the sector and therefore useful for councils to respond to this consultation.

1.3 The consultation document was sent directly to Leaders and Chief Executives by

covering email from Cllr Fleming and Carolyn Downs respectively. Responses are requested by Friday 13th March.

2. Key Points 2.1 Sector-led improvement is the approach to improvement put in place by local

authorities (including Fire and Rescue Authorities), in part with the Local Government Association (LGA), following the abolition of the previous national performance framework. It is based on the fundamental principles that councils are responsible for their own performance and are accountable for it locally (not nationally), and that the role of the LGA is to support the sector.

2.2 The success of the approach is demonstrated by the results of the independent

evaluation of sector-led improvement which has been used to track the impact of the approach and the LGA’s contribution to it – since 2011. Despite having to deliver savings amounting to almost 40%, councils have continued to deliver high quality services which are accountable to local people and trust in councils from the public remains high. The support provided by the LGA has had an impact and has been very well received by councils.

2.3 However, external stakeholders and the public still remain to be convinced about the

robustness of the sector-led approach when there is no national system or obligation to be involved.

2.4 While inspection in many areas has ended, many in the sector are now starting to

question the credibility and objectivity of the Ofsted-led inspection regime for children’s services. Additionally, in the run-up to the General Election, political parties will be considering their wider approach to local government and sector-led improvement.

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2.5 All these factors provide an opportunity for the sector to review the suitability of the current approach to sector-led improvement. This consultation invites your views.

2.6 There are a number of key challengers that the consultation poses, although three are

specifically highlighted:

a) A key ‘ask’ of local government is a place-based approach to the integration of local public services and associated spending decisions. Alongside this, are the agreement of combined authorities and greater of programmes and funding. How should sector-led improvement respond to the move towards this more place-based approach?

b) While local councils are at the forefront of the accountability and transparency

agenda, is there more that councils should be doing to strengthen local accountability and for councillors to exercise effective scrutiny?

c) Information about council performance is now more available – but is there more

that councils or the LGA should do to provide opportunities for the public and others to have comparative data about councils? For example, should all councils be expected to carry out and make public a self-assessment each year?

2.7 The consultation paper, ‘Taking Stock: Where next with sector-led improvement’ is

attached as Appendix 4(a) to this report. 3. Recommendations 3.1 Members of the Regional Improvement and Transformation Board are invited to

consider and comment on sector-led improvement to inform a response to this consultation.

Mark Edgell Principal Advisor - East Midlands Local Government Association

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Consultation

Taking stock Where next with sector-led improvement?

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3 Taking stock – where next with sector-led improvement?

Contents

Foreword 4

Introduction 5

Key principles and future challenges 6

Consultation questions 1-6 8

Improvement, assurance and intervention 9

Consultation questions 7-11 11

Improvement support 12

Consultation question 12 12

Children’s services, adult social services and health 12

Consultation questions 13-19 13

Consultation question 20 14

Conclusion 15

Consultation question 21 15

How to Respond 15

Appendix A 16

Appendix B 17

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4 Taking stock – where next with sector-led improvement?

Foreword

Three years ago the Local Government Association (LGA) published ‘Taking the lead’ setting out an approach to improvement in local government developed and agreed with councils.

It has been a success. As the wide-ranging evaluation demonstrated:

• residents remain satisfied with and continue to trust their local council, despite the increasing financial constraints being faced by the sector

• councils’ performance across a wide range of metrics continues to improve

• the approach and offer of support from the LGA is welcomed and valued by councils.

But as public expectations continue to rise, resourcing pressures increase and political parties begin to think about potential policy changes impacting on local government we need to ask whether it is the right approach for the future or whether any changes are needed.

This consultation paper is your opportunity to tell us – please take it.

Cllr Peter Fleming Chairman, LGA Improvement and Innovation Board

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5 Taking stock – where next with sector-led improvement?

Taking stock

IntroductionSector-led improvement is the approach to improvement put in place by local authorities (including Fire and Rescue Authorities) and the Local Government Association (LGA) following the abolition of the previous national performance framework. It is based on the fundamental principles that councils are responsible for their own performance and are accountable for it locally (not nationally), and that the role of the LGA is to support the sector.

The success of the approach is demonstrated by the results of the independent evaluation of sector-led improvement which has been used to track the impact of the approach and the LGA’s contribution to it – since 2011. Despite having to deliver savings amounting to almost 40 per cent, councils have continued to deliver high quality services which are accountable to local people and trust in councils from the public remains high. The support provided by the LGA has had an impact and has been very well received by councils. A summary of the key facts and some of the research findings are set out in Appendix A. However, external stakeholders and the public still remain to be convinced about the robustness of the sector-led approach when there is no national system or obligation to be involved.

While inspection in many areas has ended, children’s services are still subject to an inspection regime. Increasingly, many in the sector are now starting to question the credibility and objectivity of Ofsted given the increasing number of councils being rated in the lowest two categories and the consultation provides an opportunity to comment on the future of inspection in children’s services.

The publication of the evaluation findings, coinciding with the run up to the next General Election, provides a good opportunity to ‘take stock’ and consider, with local authorities (including Fire and Rescue Authorities) and our key stakeholders, whether any changes to the approach are necessary. While it is unlikely that political parties will be highlighting issues around improvement in their forthcoming manifestos, it is the case that they are starting to develop their thinking and Appendix B summaries the position as we understand it at the moment.

All these factors provide an opportunity for the sector to review the suitability of the current approach to sector-led improvement. This consultation invites your views. Please take the time to respond.

Details on how to respond can be found at the end of this document.

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6 Taking stock – where next with sector-led improvement?

Key principles and future challengesThe context within which local authorities (including Fire and Rescue Authorities) operate continues to change. A key starting point must be to ask whether any of these changes challenge the fundamental basis and principles on which sector-led improvement rests.

Government funding to local authorities for local services will have been cut by 40 per cent by May 2015. Councils have responded well, rising to the challenge. But there is more to come. At the same time public expectations remain high and demographic trends signal further pressures on already stretched services.

Sector-led improvement: key principles

At the heart of the approach to sector-led improvement is a set of core principles that have been developed with and re-affirmed by the sector. They are that:

a) Councils are responsible for their own performance and improvement and for leading the delivery of improved outcomes for local people in their area.

b) Councils are primarily accountability to local communities (not government or the inspectorates) and stronger accountability, through increased transparency, helps local people drive further improvement.

c) Councils have a collective responsibility for the performance of the sector as a whole (evidenced by sharing best practice, offering member and officer peers, etc).

d) The role of the LGA is to maintain an overview of the performance of the sector in order to identify potential performance challenges and opportunities – and to provide the tools and support to help councils take advantage of this approach.

Place-based approach: The momentum towards a stronger place-based approach to local public service delivery continues unabated – from the early days of community strategies and local strategic partnerships through local area agreements, total place pilots to community budget pilots – getting stronger at each stage.

A place–based approach to the integration of local public services and associated spending decisions is a key ‘ask’ we and councils are making of central government. In recent months, there has also been a focus on the work of combined authorities and agreement by Government to devolve some more Government programmes to them. How should sector-led improvement respond to the move towards a more place-based approach?

Local Accountability: One of the earliest actions of the incoming coalition Government was to dismantle much of the old top-down performance management framework to which local authorities had been subject. It had lost any ability it might have had to drive improvement and the cost of maintaining the complex architecture (estimated at £2 billion) was simply unsustainable.

Councils have always been at the forefront of the accountability and transparency agenda. Almost all decisions are made in public. Decisions are subject to scrutiny by the public, media and scrutiny committees. Councils consult and engage with the communities they serve far more than other parts of the public sector. But is there more that councils should be doing to strengthen local accountability or for councillors to exercise effective scrutiny?

All councils make information about their performance available on their websites and through other means. In the field of adult social care, the LGA and the Association of Directors of Adult Social Services (ADASS) have encouraged all councils to produce a “local account” on an annual basis setting out for the public an account of what has been achieved with the resources available.

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7 Taking stock – where next with sector-led improvement?

More broadly, LG Inform, the LGA’s online data comparison service, has now been made available to the public. LG Inform stores around 2,000 different measures, allowing officers, councillors and the public to assess the performance of councils and Fire and Rescue Authorities against a wide range of metrics and also compare performance with other areas. But is there more that councils or the LGA should do to provide opportunities for the public and others to have comparative data about councils? For example should all councils be expected to carry out and make public a self-assessment each year?

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8 Taking stock – where next with sector-led improvement?

Consultation questions1. Given the current and future challenges facing the sector, are the principles on which sector-led improvement is based still the right ones?Answer options: Yes, they are still all relevant exactly as they are Yes they are generally relevant, but I suggest some changes No, none of them are relevant now Don’t know

2. If you answered no, or suggested changes, what would you suggest as alternatives/additions?

3. How should the increasing role that councils play in working with other parts of the public sector on a place-based approach be reflected in sector-led improvement?

4. Is there more that all councils should do to strengthen local accountability in their areas? If so what?

5. Do councils or the LGA need to do any more to ensure that local people and others have the comparative performance data they need to hold councils to account? If so what?

6. Is there anything more that needs to be done to help councillors exercise effective scrutiny?

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9 Taking stock – where next with sector-led improvement?

Improvement, assurance and interventionOne of the key underlying principles of sector-led improvement is that local authorities are accountable to local people and communities, not to central government or the inspectorates and, as part of our offer to the sector, we made available a range of support to help local authorities strengthen local accountability. The LGA has always been clear that while our role is primarily to provide support to authorities we will also maintain an overview of the performance of the sector so that we can ensure that we continue to develop the right forms of support, but also to ensure we can respond quickly to challenges with individual councils or groups of councils and offer appropriate support.

Yet Government continues to collect huge amounts of data from the sector (estimated at around 40,000 data items per council per year) and in some instances this data is being used to make judgements about performance. For example, the Department for Communities and Local Government (DCLG) uses data returns to monitor the speed with which councils process planning applications. Planning authorities who process 40 per cent or less of major applications within 13 weeks may be designated as, ‘poorly performing’ and as a result applicants may choose for their application to be handled by either the local planning authority or the Planning Inspectorate.

Some stakeholders believe that the lack of a national framework or system allows some authorities to effectively opt out of sector-led improvement and therefore there is a danger that councils that are “coasting” or where performance is declining, are not being sufficiently challenged by the sector to improve. The fact that corporate peer challenge is voluntary is held up by many as an example of why sector-led improvement may lack sufficient rigour and coverage.

The Public Accounts Committee has raised concerns about what is perceived to be a lack of knowledge by Government about the performance of councils, on the basis that it still funds local government to a significant extent and are relying on councils to deliver many of their policy objectives. The current Government has so far resisted re-entering this space but there are concerns that a future government could be minded to introduce at least some form of a national performance management system.

Some commentators within local government and central government have suggested that the LGA should take a tougher line and that sector-led improvement should have more bite. This includes an expectation that all authorities should have a corporate peer challenge and that without everyone participating it undermines sector-led improvement. While it is the case that the overwhelming majority of authorities have published their peer challenge report and many have published a response or action plan, the fact that this is not always the case can also undermine our approach to sector-led improvement.

Moreover, in the past few months, there have been two high profile cases where central Government has used its inspection powers to go into a council to gather evidence which allows the Secretary of State to decide whether to formally intervene or not. This is the first time that Government has used such powers since 2008 and could signal a growing appetite to intervene.

The Government has adopted a different approach to inspection in these two cases. In the case of Tower Hamlets, it commissioned PwC but in the case of Rotherham it appointed Louise Casey, a DCLG official, as the ’inspector’. The way these inspections have been carried out and the formal engagement with the council has therefore varied and there appears to be no clear or standard process in place.

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10 Taking stock – where next with sector-led improvement?

This is in contrast to the way “Corporate Governance Inspections” were carried out previously which included a clear methodology and process for clearing a report with the council and often member or officer peers participating as part of the inspection team.

In addition, Sir Bob Kerslake has recently completed a review of the governance and organisational capabilities of Birmingham City Council. The methodology he adopted for the review was based on the principles of the LGA’s peer challenge model and included an advisory panel of member and officer peers.

In the light of all this activity, do we need to re-position sector-led improvement slightly and, in particular, the peer challenge element?

All corporate peer challenges look at the things we know are critical to local authority performance and improvement, as well as providing lots of flexibility about the rest of the scope of the challenge. The five core areas are:

1. Understanding of local context and priority setting

2. Financial planning and viability

3. Political and managerial leadership

4. Governance and decision-making

5. Organisational capacity.

Do we need to make any changes to the way we deliver corporate peer challenge, including the core components?

The stakeholder (particularly Government’s) concerns about sector-led improvement could largely be dealt with if every authority committed to a peer challenge every four or so years with the reports all made public and a commitment to an action plan and follow up. This would re-position peer challenge as more than just an improvement tool but it is likely to be seen as attractive to whichever party is in control after the general election and would mean that pressure for Government to fill this space would be significantly reduced.

A possible alternative is that government decides that if peer challenge remains voluntary that it will create some form of diagnostic or inspection to provide them with the reassurance it needs to be carried out in authorities which do not participate in peer challenge.

In addition, it is likely that there may continue to be occasional instances in the future where government may want to use its powers of intervention. Even in these cases, there could be value in offering to work with government on the methodology it adopts when carrying out such inspections and potentially play a role.

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11 Taking stock – where next with sector-led improvement?

Consultation questions7. Do you have any views on the core components of a corporate peer challenge?

8. Should all authorities be expected to have a corporate peer challenge on a regular basis, say every four years?Answer options:

Yes No Don’t know

9. Should all corporate peer challenge reports be published?Answer options:

Yes – all should be published Yes – unless there are exceptional circumstances No – this should be a matter of local choice Don’t know

10. Should all authorities be expected to produce an action plan following a peer challenge?Answer options:

Yes No Don’t know

11. Are there other things we should do to limit government’s potential appetite for inspection?

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12 Taking stock – where next with sector-led improvement?

Children’s services, adult social services and healthOver the last three years, the LGA, working with Solace, the Association of Directors of Children’s Services (ADCS) and ADASS has developed a comprehensive programme of support across children’s social care, adults and health improvement building on the elements of the ‘core’ offer. (‘Sector-led improvement in local government’. LGA June 2012).

Children’s services: The LGA offers a range of support to councils for children’s services including safeguarding children peer reviews, safeguarding practice diagnostics, care practice diagnostics, leadership essentials for lead members for children’s services and a new diagnostic for Local Safeguarding Children Boards.

The recent events in Rotherham have brought renewed focus on child sexual exploitation and there is an element of tackling this within the LGA’s existing offer but councils may want more support in this area.

Similarly, events surrounding the Trojan Horse letter in Birmingham have demonstrated

the unclear and overlapping accountability arrangements for schools and a number of councils have suggested that the LGA should now develop a specific improvement offer to help councils adapt.

The current inspection regime for children’s social care, through Ofsted’s Single Inspection Framework, is onerous and to date no council has received the highest rating of outstanding. Inspections can impact on staff morale and councils’ ability to attract and retain staff.

A new integrated inspection programme is being piloted to assess the effectiveness of all agencies in an area in keeping children safe. Rather than a single inspection across all agencies, as the LGA and others have called for, it is proposed that separate inspections will continue through individual inspectorates within a similar timeframe and with the addition of a joint assessment of the Local Safeguarding Children Board.

Questions have been raised about public confidence in Ofsted following a number of cases where judgements have been downgraded after a high profile incident, both in schools and councils. The LGA has called for an independent review of the inspectorate.

Improvement supportIn summary the LGA’s core support offer has included:

Support to assist local politicians to lead both their places and their authorities through a range of leadership programmes.

At no cost, a regular corporate peer challenge to every authority.

LG Inform – the sector’s own online data sharing and benchmarking service.

Helping the sector to capture and share good practice through the web, including the creation of Knowledge Hub.

Helping councils to drive down costs through our productivity programme.

Working with the regional and other infrastructure to ensure that the most is made of the resources available.

Authorities have valued the support that has been provided but looking ahead are there some key changes you would like to see? For example, should we do more to support councils to make savings? Is there more that can be done to share good practice or foster innovation?

Consultation question12. What changes would you like to see from the LGA’s improvement offer?

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13 Taking stock – where next with sector-led improvement?

Consultation questions13. Is there a continued need for the inspection of services that protect and care for children and young people? Answer options:

Yes No Don’t know

14. If you answered yes, should that inspection be carried out by Ofsted? Answer options:

Yes No Don’t know

15. Is there a continued need for the inspection of councils’ school improvement services?Answer options:

Yes No Don’t know

16. If you answered yes, should that inspection be carried out by Ofsted? Answer options:

Yes No Don’t know

17.Should separate inspections of agencies contributing to the protection and care of children, such as councils, health and the police, be replaced by a single inspection of services across all agencies in an area? Answer options:

Yes No Don’t know

18. If a new multi-agency inspection for the protection and care of children is developed, should this be delivered through Ofsted, another existing inspectorate or a new inspectorate?Answer options:

Ofsted Another existing inspectorate (e.g. Care Quality Commission, Her Majesty’s Inspectorate of Constabulary, Her Majesty’s Inspectorate of Probation) A new inspectorate Don’t know

19. Do councils need further support, such as bespoke models of peer review for child sexual exploitation or schools improvement, to meet the challenges faced in children’s services? If so, what?

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14 Taking stock – where next with sector-led improvement?

Adult social care and health: Continuous sector-led improvement in adult social care is led and coordinated by TEASC (Towards Excellence in Adult Social Care). A Board chaired by ADASS with membership from the LGA, Department of Health (DH), Care Quality Commission and Think Local Act Personal oversee a programme of regionally based improvement which is robust, transparent and has the increasing respect and confidence of sponsors and stakeholders.

At a national level LGA and ADASS work with experts in the sector to develop self-assessment and reporting tools – Managing Risk, Use of Resources, Commissioning for Better Outcomes, Safeguarding Adults, Adult Social Care Framework (ASCOF) performance – which Directors of Adult Social Services (DASSs) use in peer challenge at a regional level. In some regions, there is an improvement board chaired by a Chief Executive who oversees the improvement work and in some it is chaired by regional DASSs – often the Chair of the ADASS region.

The ASCOF data shows that nationally, performance in adult social care is increasing, despite having to make significant budget savings (over 20%) over recent years. Whether this would have been achieved without a continual focus on improvement, supporting leaders to lead, ensuring authorities who are struggling are picked up and supported by peers and the LGA, making the tools for improvement available to the sector is a major part of the debate.

The strong links between the national team and the regional programme support teams and with the DASSs through ADASS contributes to the increasing transparency

which makes this approach more robust. Capacity in this system is currently stretched and we have recently introduced the Adult Improvement Advisers (AIA’s) to support the LGA Principal Advisers and the regional DASS lead to embed the programme of improvement in each region and to support local authorities on particular areas of challenge.

Continuous sector-led improvement is therefore a major part of how adult social care has managed to maintain their performance and has become the way change is embedded in adult social care.

More recently the LGA, ADASS and the regions have been commissioned by DH to help councils deliver a number of specific changes in adult social care and health. This has led to a number of joint programmes dealing with the Better Care Fund, Care Act and Winterbourne View.

Some of these programmes might more strictly be thought of as providing implementation support as opposed to ‘improvement’. The LGA working jointly with DH and other partners, has developed stocktakes to support local planning and inform national support and resource discussions, providing reassurance at all levels.

This has sometimes felt uncomfortable for some in the sector but by being part of the process we have played a key role providing confidence back to Government about the sector’s ability to deal with these challenges.

Consultation question20. Do you have any comments about the arrangements and support put in place to help councils and their partners implement changes across adults and health programmes?

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15 Taking stock – where next with sector-led improvement?

How to respondThis consultation invites the sector’s views about the future of sector-led improvement and the shape of the LGA’s support offer to the sector. We are keen to receive a wide range of views, from leading members and officers in local authorities (including those involved in scrutiny), from national stakeholders in Government departments and the Inspectorates and from partners with which councils work locally.

The closing date for the consultation is Friday 13th March 2015. An online form has been set up to provide a quick and convenient method for responding.

All leaders and chief executives have been sent their own unique link to the online form. If you are a chief executive or leader and you have not received your unique link, please contact [email protected], who will forward this to you.

Anyone else wishing to submit a response can generate their own unique link by clicking here: http://survey.euro.confirmit.com/wix9/p1841157349.aspx

Please note that unique links should not be shared with colleagues unless you would like them to fill them in on your behalf, as their response will overwrite your own.

We have set up the online form to provide a quick and convenient method for responding to the consultation. However if you would rather respond by email or another method, please feel free to do so. Responses can be sent directly to [email protected].

All responses will be treated confidentially by the LGA. Information will be aggregated, and no individual or authority will be identified in any publications without consent.

If you have any queries about this consultation, please contact [email protected].

ConclusionIt is now over three years since we launched ‘Taking the lead’ setting out the approach to sector-led improvement and the LGA’s support offer. A lot has happened since then.

We have the experience of providing a wide range of support; we have the lessons from the independent evaluation and the

policy and financial context within which local authorities (including Fire and Rescue Authorities) work is becoming clearer, if no less challenging.

It is therefore opportune to ‘take stock’. We are keen to do this with local authorities and for their views to inform how the approach and offer develops.

Consultation question21. Do you have any other comments about the current approach to sector-led improvement?

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16 Taking stock – where next with sector-led improvement?

Sector-led improvement: Key facts and evaluation findings

• Nationally, nearly three quarters of almost 100 indicators have improved since 2010.

• Residents trust in councils is high: when asked in July 2014 whether they most trusted their local council or the Government to make decisions about how services are provided in their local area, 80 per cent said their local council (significantly higher than the 70 per cent a year previously), while just 14 per cent most trusted the Government.

• The percentage of leaders and other senior councilors agreeing that the LGA understands what councils need to help improve their service and organisational capacity has increased from 70 per cent in 2012 to 79 per cent in 2013.

• Over 350 peer challenges have been delivered, making use of thousands of peer days donated by councils and the research found that the challenges were helping councils drive forward improvements.

• Ninety three per cent of leaders and chief executives said the support from the LGA had had a positive impact on their authority.

• Support from the LGA’s productivity programme had helped councils achieve savings in excess of £400 million, equivalent to a saving of £8 for every £1 of investment.

• Over the three years over 2,000 councillors had been trained and developed through the LGA’s leadership programmes and a further 300 graduates had been recruited through the National Graduate Development Programme.

• LG Inform has received over 66,000 visits from 36,000 unique visitors since it was launched and is now available to the public.

Appendix A

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17 Taking stock – where next with sector-led improvement?

Appendix B

Policy ContextIn the run up to the next General Election the political parties will be reviewing their thinking about local accountability and performance. The impact of the Scottish Referendum and the subsequent debate around devolution continues, but in the meantime:

For the Conservatives the commitment to localism and local accountability is likely to remain a key feature of the approach to local government, maintaining the reduced burden of data reporting and inspection. There has been a noticeable focus on transparency and this may remain, with ministers also continuing to make their views known about specific issues as they arise (of which the joint letter from Eric Pickles MP and Nicky Morgan MP about safeguarding vulnerable children is an example). Separately, the Government has recently announced that it intends to explore how the budget given for improvement services can be opened up to competition.

The Liberal Democrats pre-manifesto document re-affirms the Party’s commitment to decentralisation and commits to a reduction in DCLG’s powers to interfere in democratically elected local government in England and to the establishment of a commission “….. to explore the scope for greater devolution of financial responsibility to English local authorities…..” At the same time there is a commitment to spread democracy in everyday life, including by “……..increasing the opportunities for people to take democratic control over the services on which they rely”. (A Stronger Economy and a Fairer Society: Enabling every person to get on in life. August 2014).

The Labour Party in the final report from their Innovation Task Force (People-powered public services. Local Government Innovation Task Group. July 2014) has suggested that the next government should review existing data reporting requirements to ensure they are fit for purpose in a more devolved system. This should focus on fewer strategic outcomes rather than a larger number of narrowly defined targets. Local authorities would need to publish data on outcomes being delivered in their communities in a clear, comparable and accessible way so that they can be held to account by local people for their performance.

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18 Taking stock – where next with sector-led improvement?

In addition to accountability by people, a ‘light touch’ approach to performance management is suggested and would need to be agreed with central government. This would seek to detect and respond appropriately to underperformance:

• For authorities improving outcomes: no need for any action.

• For authorities not improving outcomes: a toolkit of options would be available which range from self-improvement measures to peer challenges, which have been shown to effectively drive improvement by identifying unique issues with a council’s performance and taking bespoke measures to overcome them.

• For authorities persistently failing to make progress: the centre retains reserve powers to intervene as a last resort. Options would be available to initiate appropriate special measures such as the direct appointment of time-limited commissioners, a boundary review or a governance review.

The Taskforce recommends a separate and more intensive approach to challenging safeguarding to ensure standards are monitored and constantly driven up. Safeguarding peer challenges (both child and adult) should be conducted every three years, and the challenges should cover all services with safeguarding responsibilities in the area including the council, health bodies and the police.

The Public Accounts Committee has been pressing Government about how it ensures it is better informed about the situation on the ground among local authorities across England, in a much more active way, in order to head off serious problems before they happen. To date Government has stopped short of re-creating a performance management or inspection regime which provides them with such reassurance but the debate about this has not gone away.

Finally, the DCLG select committee have said in the next Parliament they will launch a review of councils’ scrutiny functions.

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Local Government Association Local Government House Smith Square London SW1P 3HZ

Telephone 020 7664 3000 Fax 020 7664 3030 Email [email protected] www.local.gov.uk

For a copy in Braille, larger print or audio, please contact us on 020 7664 3000. We consider requests on an individual basis. L14 - 551

© Local Government Association, January 2015

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Item 5

Improvement and Transformation Board

2nd March 2015

Regional Chair Networks

Health and Wellbeing Boards Chairs’ Network

Summary The LGA and EMC provide support for a number of lead member/chair networks on matters of key responsibility for the sector, specifically Health and Wellbeing, Children’s Services and Adult Social Care. The role of the Health and Wellbeing Board Chairs’ Network is to represent the collective view on health and wellbeing matters at national and regional events; share best practice, develop strong long relationships, to meet with senior national policy and health leadership figures, and to influence the development of emerging policy In the co-ordination of activity of common interest and to support learning and the sharing of best practice, it was agreed that the Board should bring together the Chairs of these networks on a regular basis. This would also link in to the wider activity of the sector that relates to improvement and transformation across both tiers of local government across the region. Sue Woolley, Chair of the Health and Wellbeing Board Chairs Network will attend the Board meeting to support discussion with Members on the work and focus of the network, the opportunities offered by the better co-ordination of activities of different networks, e.g. adults, children and scrutiny – and also to offer reflections on how progress should be made against the recommendations of the recent health review. Recommendation Members of the Regional Improvement and Transformation Board are invited to discuss the work of the Health and Wellbeing Board Chairs’ Network and opportunities for better co-ordination of activities of respective lead member networks specifically; health and wellbeing boards, children’s, adults and scrutiny.

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Item 6

Improvement and Transformation Board

2nd March 2015

East Midlands Member Development Programme 2015/16 Summary The following report updates the Regional Improvement and Transformation Board on the proposed Member Development Programme for 2015/16, and provides initial evaluation analysis of the 2014/15 programme. Recommendations Members of the Improvement and Transformation Board are invited to: Consider and endorse the proposed Member Development Programme

2015/16. Consider the issues highlighted in the initial analysis of the 2014/15

programme to inform the successful implementation of the programme in 2015/16.

Consider board members role in increasing engagement with councils. Review the 2014/15 KPIs and consider potential indicators for the coming

year 2015/16.

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Item 6

1. Introduction 1.1 The following report presents the Regional Improvement and Transformation

Board with the proposed Member Development Programme for 2015/16. 2. Reflections on the Member Development Programme 2014/15 2.1 The Member Development Programme is an important element of the

2014/15 Business Plan, and members have previously highlighted its importance for the future work of EMC.

2.2 To reflect this, key performance indicators were set by the Executive Board in

relation to the delivery of the programme, specifically:

Provide direct membership benefits to councils through increasing by 10% the number of councillors participating in: a) Regional programme of briefing events. The baseline for 2013/14

being 197. To date, 243 councillors have participated in the current programme with a further event scheduled for 24th February on Employment and Skills. This represents a 23% increase on the 2013/14 figures.

b) Member development skills workshop. The baseline for 2013/14 being 84. To date, 189 councillors have participated in the programme. This represents a 125% increase on the 2013/14 figures.

c) Officer continuous professional development (CPD). While not member development, it remains a valued element of sector-led improvement and should be overseen by this Board. The baseline for 2013/14 being 1371 places. To date, 1085 places have been taken-up, with two events remaining – it is likely that this target will be marginally missed.

2.3 While the ‘participation’ figures are positive and will meet the KPI, and the

team should be congratulated for their efforts, there are areas of the current programme that have been less successful that include: Average attendance at the Regional Programme of Policy Briefing events

is lower than previous years. Four skills development sessions were cancelled due to low numbers. Engagement across all councils is not consistent and there are a small

number of authorities where there has been very little participation in the programme.

2.4 The full evaluation report of the 2014/15 progamme will be brought to the

next Improvement and Transformation board meeting on 3rd June 2015, once the programme has been completed. The report will further explore the reasons for some of the less successful areas of the programme and how

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Item 6

they can be mitigated against in the future and how improvements should be made.

3. Initial Evaluation of the 2014/2015 Programme 3.1 The following initial evaluation findings from the programme can be provided. 3.2 Analysis of attendance figures across all areas of EMC member development

work can be found at Appendix 6(a). This shows that engagement by Councillors with the member development programme has increased during 2014/15, although there is significant variation across the programme and from EMC member councils.

3.3 There are a number of councils highlighted in Appendix 6(a) where there are

high levels of engagement across all areas of the programme. This is an encouraging feature and represents the close working relationship with some councils. Appendix 6(a) highlights that in some cases this correlates with Member Development Charter status.

3.4 Whilst the overall numbers of Councillors attending either the Regional

Programme of Briefing events or Skills Development sessions, there remain some authorities with lower levels of engagement and participation. In some cases geographic location of the authority could be argued, but not in all.

3.5 The initial analysis also shows a higher level engagement in policy based

events rather than skills development sessions. This may reflect where many authorities are in their election cycle, as well as the impact of the General Election later this year, with Councillors keen to keep abreast of policy development across all political parties.

3.6 The analysis at Appendix 6(a) provides an insight in the broad nature of the

members development programme, with an increasing number of high level policy based events offered to members. Looking to the future, it is likely that this should remain a feature of our work, as EMC needs to be responsive to the changing political environment and recognise where policy changes impact on the sector and reflect this in our offer of support.

3.7 Members are invited to consider these issues to inform the successful

implementation of the 2015/16 programme. 3.8 Members of the Improvement and Transformation Board are also invited to

consider their role in increasing engagement with councils highlighted in Appendix 6(a), through the potential development an ambassador(s) role for board members. The development of this role would enable Councillors on the board to engage directly with Councillors within authorities.

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Item 6

4. Key Performance Indicators for Councillor Development 4.1 EMC invites the Improvement and Transformation Board members to review

the key performance indicators for councillor develop, to ensure that they remain fit for purpose and reflect the focus for member development activity in the coming year. Members are invited to consider how trends in engagement can be incorporated into the indicators for 2015/16 and the role they can play in supporting this.

4.2 There are currently two specific indicators for Councillor Development in

2014/15, these are: Provide direct membership benefit to councils through increasing by 10%

the number of councillors participating in; Regional Programme of Briefing Events; and Member Development Skills Workshops

4.3 Improvement and Transformation board members are invited to review the

2014/15 KPIs and consider what the indicators should be for the coming year 2015/16.

5. Member Development Programme 2015/16 5.1 Members have previously considered and agreed proposals for the 2015/16

Member Development Programme to support both the member induction programmes taking place within councils in the first three months after the 2015 election, alongside wider development of members’ skills and knowledge (including policy) over the remainder 6-9 months.

5.2 Opportunities to deliver this locally for groups of councils are currently being

explored. 5.3 The brochure for the proposed member development programme 2015/16 is

attached to this report as Appendix 6(b). The 2015/16 programme of member development has been designed to support the different councillor roles, and will include policy specific events as well as skills development sessions. Specific support for new Councillors and Councillors new to roles within authorities has been incorporated into the programme. The programme has been designed to complement and enhance local authorities own induction and member development programmes, and will be further added to as opportunities arise.

5.4 As part of the programme EMC are working with national partners such as

Local Government Information Unit, The MJ and Whitehall Industry Group to bring their expertise into region.

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Item 6

5.5 The General and Local Elections in May provide EMC with an opportunity to

further increase engagement, both across local authorities and with a broader spectrum of councillors.

6. Programme of Policy Briefing events 6.1 The Regional Programme of Policy Briefing events will continue to be a

substantial area of the member development support offer to councils in the East Midlands. The programme will focus on the policy implications and challenges, as informed by Government priorities post-May 2015.

6.2 The first half of the programme has been identified and will reflect the

outcomes of the General Election, with the aim of supporting the understanding of policy changes and implications. The dates and content for the first three sessions are:

24 June 2015 – What the outcomes of the General Election mean for

Local Government and Public Services This event will provide initial analysis of what the outcomes of the General Election will mean for policy affecting local government and the public sector

23 September 2015 – Key Policy Issues for Local Government

This event specifically for new Councillors will provide an overview of key policy issues for local government and will provide an opportunity to hear directly from policy experts on areas of Welfare Reform, Housing policy and Planning.

6 November 2015 – Delivering Public Services in the new Parliament

This event will explore what the changes in Government mean for delivering public services in the new Parliament.

6.3 EMC wishes to ensure that the programme remains topical and responsive

and as such the content of the second half of the programme will be confirmed after the General Election. The dates for these sessions are 2nd December 2015, 28th January 2016 and 9th March 2016

6.4 EMC invites Improvement and Transformation Board members to identify

possible content for the second half of the programme at the June meeting following the outcome of the General Election in May.

7. Recommendations

Members of the Improvement and Transformation Board are invited to:

7.1 Consider and endorse the proposed Member Development Programme 2015/16.

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Item 6

7.2 Consider the issues highlighted in the initial analysis of the 2014/15

programme to inform the successful implementation of the programme in 2015/16.

7.3 Consider board members role in increasing engagement with councils. 7.4 Review the 2014/15 KPIs and consider what the indicators should be for the

coming year 2015/16.

Stuart Young Executive Director

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Item 6, Appendix (a)

Name of Authority Cou

ncill

or D

evel

opm

ent C

hart

er S

tatu

s

11 J

une

2014

- Th

e R

ole

of th

e C

ivic

Hea

d

19 J

une

2014

- B

eing

an

Effe

ctiv

e C

ounc

illor

11 S

epte

mbe

r 201

4 - E

qual

ity a

nd D

iver

sity

18 S

epte

mbe

r 201

4 - B

uild

ing

a R

esili

ence

30 S

epte

mbe

r 201

4 - S

ucce

ssfu

l Cllr

Dev

Wor

ksho

p

16 O

ctob

er 2

014

- Cllr

/Offi

cer R

elat

ions

hip

14 O

ctob

er 2

014

- Suc

cess

ful C

llr D

ev w

orks

hop

3 D

ecem

ber 2

014

- Loc

al G

over

nmen

t Fin

ance

12 D

ecem

ber 2

014

- The

Fut

ure

of S

crut

iny

7 N

ov 2

014

- RTP

I Bre

akfa

st M

eetin

g

14 N

ov 2

014

- RTP

I Bre

akfa

st M

eetin

g

28 N

ov 2

014

- RTP

I Bre

akfa

st M

eetin

g

5 D

ec 2

014

- RTP

I Bre

akfa

st M

eetin

g

12 D

ec 2

014

- RTP

I Bre

akfa

st M

eetin

g

17 J

une

2014

- Th

e Im

pact

of M

igra

tion

24 S

epte

mbe

r 201

4 - W

et W

et W

et

8 O

ctob

er 2

014

- Pla

nnin

g, H

ousi

ng &

Wel

fare

Ref

or

22 J

anua

ry 2

015

- Com

mun

ity S

afet

y

21 N

ovem

ber 2

014

- The

Fut

ure

of L

ocal

Gov

ernm

en

4 N

ovem

ber 2

014

- Reg

iona

l Pay

Brie

fing

10 O

ctob

er -

East

Mid

land

s R

ail S

umm

it

9 Ju

ne 2

014

- Mig

ratio

n A

PPG

Mee

ting

7 A

pril

2014

- LE

P St

rate

gic

Econ

omic

Pla

ns A

PPG

30 O

ctob

er 2

014

- Hea

lth A

PPG

13 F

ebru

ary

- EU

Prio

ritie

s ev

ent

Tota

l

Amber Valley Borough Council 0Ashfield District Council Charter 1 1 1 4 2 9Bassetlaw District Council 1 2 2 5 2 1 1 1 1 1 17Blaby District Council Charter 2 4 2 3 11Bolsover District Council 1 1 1 5 8Boston Borough Council Charter 1 1 4 1 2 1 1 2 13Broxtowe Borough Council Charter 1 3 4Charnwood Borough Council Charter 1 2 1 1 1 1 3 3 2 2 17Chesterfield Borough Council 1 1 2Corby Borough Council 1 2 1 1 5 1 3 1 1 16Daventry District Council 1 2 3 1 1 8Derby City Council 1 1 2 1 1 5 2 1 14Derbyshire County Council 2 2 1 3 2 1 11Derbyshire Dales District Council 2 2East Lindsey District Council 1 4 1 1 1 1 1 2 2 2 16East Northants Council 1 1Erewash Borough Council 1 2 4 7Gedling Borough Council 1 2 2 2 1 2 10Harborough District Council 2 1 3High Peak Borough Council Charter 1 1 1 1 4Hinckley and Bosworth Borough Council

2 1 1 1 5Kettering Borough Council Charter 1 2 1 1 1 4 1 2 2 15Leicester City Council 4 1 3 1 9Leicestershire County Council 2 2 2 1 7Lincoln City Council 3 1 2 2 8Lincolnshire County Council Charter 1 1 3 2 4 1 2 2 2 3 2 23Mansfield District Council Charter 2 2 3 2 1 1 11Melton Borough Council 1 2 2 2 1 2 3 2 0 2 1 18Newark and Sherwood District Council 1 1 2 1 2 2 3 12North East Derbyshire District Council Charter 2 2 4 1 9North Kesteven District Council Charter 1 1 2 4 3 1 3 1 16North West Leicestershire District Council

1 2 1 1 5Northamptonshire County Council 1 3 3 2 1 2 12Nottingham City Council Charter 1 1 2 2 1 1 3 1 12Nottinghamshire County Council 1 5 2 1 9Oadby and Wigston Borough Council 1 1 1 1 2 1 1 8Peak District National Park Authority 1 1Rushcliffe Borough Council Charter 1 1 4 3 2 11Rutland County Council 2 1 0 1 2 1 2 9South Derbyshire District Council 1 1 2 1 5South Holland District Council Charter 2 2 2 1 3 0 10South Kesteven District Council 1 1 1 1 1 5Wellingborough Borough Council 1 1 3 2 1 1 9West Lindsey District Council 1 1 1 2 3 1 9TOTAL 14 12 11 1 1 14 6 11 14 10 2 3 2 4 6 28 24 36 22 86 9 54 9 13 20 13 411

Policy EventsPlanningSkills Development

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East Midlands Councils Councillor Development Programme | February 2015

East Midlands CouncilsCouncillor

Development Programme

2015-16

East Midlands CouncilsCouncillor Development Programme 2015-16

February 2015

Item 6, Appendix (b)

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East Midlands Councils Councillor Development Programme | February 2015East Midlands Councils Councillor Development Programme | February 2015 2

East Midlands CouncilsCouncillor Development Programme 2015-16

1

East Midlands CouncilsCouncillor Development Programme 2015-16

• A programme of regional induction eventsto complement local authorities owninduction programmes

• A tailored programme of policybriefing events for Councillors in theEast Midlands. The first event in theprogramme will provide initial analysis ofwhat the outcomes of the General Electionwill mean for policy affecting localgovernment

• A weekly briefing service with the latestdigested news for local government

Key aspects of the support include;

• Skills workshops delivered at ourheadquarters or in your authority on areassuch as Chairing, Scrutiny and Mediaawareness

• The East Midlands Regional CouncillorDevelopment Charter assessment andsupport

• Councillor Development Network

• A Scrutiny Network for practitioners

• Personal Development Planning forCouncillors

For more information or to book a place at any of the events listed in this brochure please visit :www.emcouncils.gov.uk/Councillor-Development

East Midlands Councils (EMC) provides a comprehensive, value for money Councillor Development programme for member councils in the East Midlands that includes policy events on issues such as: Welfare Reform, skills development workshops and personal development planning for Councillors.

East Midlands CouncilsCouncillor Development Programme 2015-16

East Midlands Councils Councillor Development Programme | February 2015East Midlands Councils Councillor Development Programme | February 2015

Item 6, Appendix (b)

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Chairing and Facilitation Skills16 September 2015

Facing the Media Confidently26 November 2015

Influencing Skills4 February 2016

Conflict Resolution and Mediation

11 March 2016

Local Government Finance10 December 2015

Speed Reading10 February 2016

Making Progress on Problems26 February 2016

Regional Programme of Policy Briefing Events

Various

Mentoring for Mentors and Mentees19 June 2015

East Midlands Councillor Development Network

Quarterly meetings

Civic Heads and Team27 May 2015

Being on the Frontline! Maximise your Impact in the Community8 October 2015

Strengthening and Sustaining Personal Resilience20 January 2016

New Role as a Councillor Workshops24 June 2015, 14 July 2015, 19 November 2015

East Midlands Scrutiny NetworkQuarterly meetings

Scrutiny and Effective Challenge17 September 2015

Raising the Bar in Scrutiny and Effective Challenge14 October 2015

East Midlands Scrutiny NetworkQuarterly meetings

43 East Midlands Councils Councillor Development Programme | February 2015East Midlands Councils Councillor Development Programme | February 2015

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Date27 May 2015

VenueEMC Offices, Melton Mowbray

Civic Heads and TeamA practical one day seminar for Civic Heads and members of their team, which will

explore the role of prospective Civic Heads, Mayoress, Consorts or Escorts, their

Deputies and Civic Support Officers.

Time10:00 - 16:30

Cost£175 for EMC Members

Date19 June 2015

VenueEMC Offices, Melton Mowbray

Mentoring for Mentors and MenteesTwo half day workshops for Councillors on Mentoring, this includes a session for

new Councillors looking to be mentored and experienced Councillors looking to

be a political mentor.

10:00 – 13:00 – For Councillors interested in having a Mentor

13:30 – 16:30 – For Councillors interested in being a Mentor

Time10:00 - 13:0013:30 - 16:30

Cost£95 for EMC Members (each session).

Date24 June 2015

Venue Pera, Melton Mowbray

What the outcomes of the General Election mean for Local Government and Public Services The first event in the Regional Programme of Policy Briefing events for Councillors,

it will provide initial analysis of what the outcomes of the General Election will

mean for policy affecting local government and the public sector.

Time10:00 - 13:00

CostFree for members of the Regional Programme of Policy events.

Date24 June 2015

VenuePera, Melton Mowbray

New Role as a Councillor Workshop

This workshop is aimed at new Councillors or Councillors new to roles in their authorities, the workshop will include:� An understanding of the role of the Councillor in the Community

� Making connections and understanding the context in which the Council works

� Making relationships with Council Officers work well

� A policy and finance context, outlining current bills and recent acts and a link to resources

� An overview of support available to you locally, regionally and nationally to help new Councillors to stay ahead of the game!

Time13:30 - 16:30

Cost£95 for EMC Members.Buy one get one free.

Calendar of Events

Date14 July 2015

VenueKettering Borough Council

New Role as a Councillor WorkshopThis workshop is aimed at new Councillors or Councillors new to roles in their authorities, the workshop will include:� An understanding of the role of the Councillor in the Community

� Making connections and understanding the context in which the Council works

� Making relationships with Council Officers work well

� A policy and finance context, outlining current bills and recent acts and a link to resources

� An overview of support available to you locally, regionally and nationally to help new Councillors to stay ahead of the game!

Time18:00 - 20:30

Cost£95 for EMC Members.Buy one get one free.

Date16 September 2015

VenueEMC Offices, Melton Mowbray

Chairing and Facilitation SkillsThe workshop will explore what makes a `good` meeting, the skills of a good chair

and why meetings sometimes fail to meet their objectives. The workshop will also

provide Councillors with an opportunity to learn and practice the basic tools and

techniques of facilitation.

Time10:00 - 13:00

Cost£95 for EMC Members

Date17 September 2015

VenueEMC Offices, Melton Mowbray

Scrutiny and Effective ChallengeThis workshop is aimed at all Councillors who wish to develop knowledge

and skills in the role and powers of scrutiny and the importance of effective

questioning skills and monitoring.

Time13:00 - 16:00

Cost£95 for EMC Members

Date23 September 2015

VenueMelton Borough Council

Key Policy Issues for Local GovernmentThis event for new Councillors will provide an overview of key policy issues for

local government and will provide an opportunity to hear directly from policy

experts on areas of Welfare Reform, Housing policy and Planning.

Time10:00 - 15:00

CostFree for members of the Regional Programme of Policy events.

Item 6, Appendix (b)

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East Midlands CouncilsCouncillor Development Programme 2015-16

East Midlands Councils Councillor Development Programme | February 2015

Date8 October 2015

VenueEMC Offices, Melton Mowbray

Being on the Frontline! Maximise your impact in the CommunityDeepen your knowledge and understanding of the leadership and engagement

role in your community. Explore the key trends, challenges and expectations

in the current climate together with tools and techniques to help empower and

maximise your impact. This one day workshop includes a range of mini practical

sessions to increase skills and confidence.

Time10:00 - 16:30

Cost£175 for EMC Members

Date14 October 2015

VenueEMC Offices, Melton Mowbray

Raising the Bar in Scrutiny and Effective ChallengeThis workshop is aimed at experienced scrutineers, and will help build specific

knowledge and skills to make a beneficial difference to the performance of the

council.

Time13:00 - 16:00

Cost£95 for EMC Members

Date6 November 2015

VenueDerby City Council

Delivering Public Services in the New ParliamentThis seminar will help Councillors understand what the changes in Government

mean for delivering public services in the new Parliament.Time10:00 - 15:00

CostFree for members of theRegional Programme of Policyevents.

Date19 November 2015

VenueEMC Offices, Melton Mowbray

New Role as a Councillor Workshop – six months on…This workshop for new Councillors will provide an overview of key issues and

challenges affecting Councillors and local government. The workshops will enable

Councillors to reflect on their first 6 months and key challenges/issues; supporting

their personal development needs going forward.

Time10:00 - 13:00

Cost£95 for EMC Members

Date26 November 2015

VenueEMC Offices, Melton Mowbray

Facing the Media ConfidentlyThis training is designed to help you handle a media enquiry effectively and safely

and help you avoid a crisis situation by being media savvy.Time10:00 - 13:00

Cost£95 for EMC Members

Date2 December 2015

VenueMelton Borough Council

Regional Policy Briefing EventThis seminar is part of the Regional Programme of Policy Briefing events for

Councillors.Time10:00 - 15:00

CostFree for members of theRegional Programme of Policyevents.

Date10 December 2015

VenueEMC Offices, Melton Mowbray

Local Government FinanceA seminar aimed at both new and experienced local authority Councillors,

who want to understand the basics of local government finance and financial

management – and develop a grasp of the financial implications of any

forthcoming changes being planned by the Government.

Time10:00 - 16:30

Cost£175 for EMC Members

Date20 January 2016

VenueEMC Offices, Melton Mowbray

Strengthening and Sustaining Personal ResilienceA seminar for Councillors, providing practical methods and ideas to manage the

pressures and challenges faced.Time10:00 - 13:00

Cost£95 for EMC Members

Date28 January 2016

VenueMelton Borough Council

Regional Policy Briefing EventThis seminar is part of the Regional Programme of Policy Briefing events for

Councillors.Time10:00 - 14:00

CostFree for members of the Regional Programme of Policy events.

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Date4 February 2016

VenueEMC Offices, Melton Mowbray

Being an Effective Councillor: Influencing SkillsThis workshop has been designed to development knowledge, skills and

understanding of the art and methods of influencing and persuading others, in

order to gain cooperation, support and commitment.

Time10:00-13:00

Cost£95 for EMC Members

Date10 February 2016

VenueEMC Offices, Melton Mowbray

Speed ReadingA workshop for Councillors designed to provide tips and techniques on how to

read work-related documents in a fraction of the time that it currently takes.Time10:00 - 13:00

Cost£95 for EMC Members

Date26 February 2016

VenueEMC Offices, Melton Mowbray

Making Progress on ProblemsA practical session providing Councillors with an opportunity to develop an action

plan for an issue that they intend to make progress on, using Action Learning

techniques.

Time10:00 - 13:00

Cost£95 for EMC Members

Date9 March 2016

VenueMelton Borough Council

Regional Policy Briefing EventThis seminar is part of the Regional Programme of Policy Briefing events for

Councillors.Time10:00 - 13:00

CostFree for members of the Regional Programme of Policy events.

Date11 March 2016

VenueEMC Offices, Melton Mowbray

Conflict Resolution and MediationA highly practical workshop for Councillors, designed to equip participants with

skills to cope more effectively when conflict arises, and also be able to reduce the

likelihood of it occurring in the first place.

Time10:00 - 13:00

Cost£95 for EMC Members

Councillor Practitioner Networks

Scrutiny NetworkA local authority network for Councillors and Officers involved with Scrutiny, providing an opportunity to share knowledge, work programmes and information, as well as providing an opportunity to explore national developments concerning scrutiny.For more information regarding the scrutiny network visit:www.emcouncils.gov.uk/Scrutiny-Network

Dates: 10 July 2015 25 September 2015 11 December 2015

CostFree to EMC member authorities.

Councillor Development NetworkThe Network supports local authority Councillors and Officers responsible for councillor learning and development, by sharing knowledge, information and ideas across the region through discussions and presentations.For more information regarding the Councillor Development network visit:www.emcouncils.gov.uk/Councillor-Development-Network

Dates: 8 July 2015 11 November 2015 3 February 2016

CostFree to EMC member authorities.

For further information on our events and the support we can provide, either visit:www.emcouncils.gov.uk/Councillor-Development

Or contact Lisa Butterfill Tel: 01664 502 643 Email: [email protected] Lowe Tel: 01664 502 637 Email: [email protected]

Item 6, Appendix (b)

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East Midlands Councils Councillor Development Programme | February 2015

East Midlands CouncilsCouncillor Development Programme 2015-16

East Midlands Councils

T: 01664 502 620

E: [email protected]

W: www.emcouncils.gov.uk

@EMCouncils

East Midlands Councils,

Pera Business Park,

Nottingham Road, Melton Mowbray,

Leicestershire, LE13 0PB

For more information please call 01664 502 620 ore-mail: [email protected]

This document has been printed on recycled paper.

Published February 2015.

Item 6, Appendix (b)

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Improvement and Transformation Board 2nd March 2015

Health Review:

A Healthier Future for the East Midlands? Summary In July 2014, members of East Midlands Councils directed that a review should be undertaken into the key health challenges for the region. The final report, with conclusions and recommendations, was endorsed by the full meeting of East Midlands Councils on 13th February 2015. Recommendations Members of the Regional Improvement and Transformation Board are invited to consider and agree the proposed work in support of the report’s recommendations.

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1. Introduction 1.1 The importance of health, and how health services are funded and delivered,

needs little explanation. Alongside the very real impact on the health and wellbeing of people in our local communities, with the General Election in May 2015, the NHS will be a key political battleground. All parties have promised to protect NHS funding meaning that planned public spending cuts will fall disproportionately on other government departments.

1.2 However, with the emphasis of health policy (if not yet practice) moving more

towards prevention and care in or as close to the home as possible; the leadership, commissioning and service provision roles of local government become much more important. These include social care in the home, transport (cycling and walking), recreation, increasing the capabilities of communities to look after their most vulnerable members, targeted services for high risk groups (e.g. troubled families, repeat offenders), the economy (particularly unemployment) and housing.

1.3 The NHS has been subject to a series of major structural reorganisations –

particularly affecting how services are commissioned. With the latest reforms still bedding down, no political party is seriously suggesting more of the same. The focus is instead on how to deliver better outcomes, more efficiently, e.g. through the adoption of different approaches to delivery, preventing ill health and reducing health inequalities in order to reduce demand. Collaboration between local government and CCGs in the region is progressing well but still in its early stages and a review of progress and opportunities for increased collaboration and leadership against mutual priorities is timely.

1.4 At the regional level, there is a generally a good geographical fit between local

government and NHS organisations that cover, commission or provide services across the East Midlands region, e.g. Public Health England, NHS England Area Teams, East Midlands Ambulance Service and Clinical Commissioning Groups. There is, therefore, good potential for improving health outcomes, unity of purpose and collective leadership through collaboration between these agencies, councils, MPs and wider health partners.

1.5 This review is intended to complement the work already undertaken by health

and wellbeing boards and local health scrutiny committees through ‘adding value’ and support in addressing the joint priorities of councils, MPs and key health partners.

1.6 This review has been led by members of East Midlands Councils but in the

development of the final report, a range of partners have informed its conclusions and recommendations, including from the health sector and

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academia, and through an All-Party Parliamentary Group meeting at the House of Commons on 30th October 2014.

2. Summary of Conclusions and Key Recommendations 2.1 While the full report highlights a range of issues of importance to the region,

the following four priority outcomes have been identified in undertaking this review: Reducing inequalities in health outcomes. Eliminating inequalities in funding for healthcare. Improving the recruitment and retention of the health workforce. Effective cross sector, collective leadership.

a) Inequalities of Health Outcomes in the East Midlands 2.2 In most aspects, the health of the East Midlands is close to the national

average. It is not the worst region in the country, but neither is it the best. However, within the East Midlands there are major health inequalities and these are widening across many parts of the region. As a region, we will never meet, or even get near to, national expectations of health outcomes unless these disparities are addressed.

2.3 The current health profile is unacceptably poor. The East Midlands should be

better than average in terms of health – and the wide variations in health outcomes are unjustifiable. For example: People in Derby, Leicester and Nottingham have a life expectancy

significantly less than the national average. There are huge disparities within communities, e.g. men living in the most

deprived wards of Derby have 12 years less life expectancy than men in the most prosperous wards.

There is a disproportionate number of people that are likely to experience poor health affecting their everyday life before they turn 60; meaning over 15 ‘unhealthy’ years, with associated impact on their quality of life, increasing social care and welfare costs, and costs to the wider economy caused by reduced attendance at work.

There are high levels of deaths from causes considered preventable; particularly in the 3 cities, North Nottinghamshire/Derbyshire and East Lincolnshire.

Higher than national levels of obesity, smoking and alcohol related admissions to hospital.

Smoking in pregnancy as the major concern across the East Midlands with levels significantly higher than the national average - and urgent action is needed to reverse the rising trend.

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2.4 There is also significant inequality in the treatment and prevention of mental compared to physical ill health with high proportions of people with mental ill health not receiving treatment and some parts of the region exhibiting higher levels of depression than others.

2.5 Common understanding of health inequalities and priorities is an important first

principle in ensuring health agencies and local councils are able to target resources and identify opportunities for collective intervention.

2.6 Key Recommendation: A clear statement of the most effective measures to

improve health outcomes and reduce inequalities in physical and mental health is developed involving health agencies and local councils in the East Midlands that prioritises the allocation of resources and identifies best practice.

b) Inequalities in Funding for Healthcare in the East Midlands 2.7 The East Midlands is underfunded across its health system – this is not only

unjust but it also means that the region is unable to tackle the big issues that we know the health, social care and public health systems face.

2.8 The latest national data (2012-13) shows that total spending on health in the

East Midlands is the 2nd lowest in the county, only the North East received lower levels of funding.

2.9 In terms of spending per head, the situation is only a little better; a health

spend of £1,850 per head of the population in this region compares unfavourably to the national average of £1,912 for England and £1,937 for the UK. Spending per head was higher in North East, North West, Yorkshire and the Humber, West Midlands and London - with only the East of England, South East, and South West receiving lower levels. This is despite Government policy being to move all areas to their target fair funding allocation as soon as possible.

2.10 CCG Programme Budget Baseline Allocations show that:

Allocations per head for the East Midlands in 2014/15 are lower than the England average.

In Northamptonshire, NHS Nene CCG is -6.99% below target and NHS Corby CCG, the worst hit, is -11.32% below target, with underfunding of -£186 per person. West London is the most overfunded, with +£508 per head over the target amount.

The NHS Midlands and East area is further below its target allocation than anywhere else in 2014/15, and will continue to be so in 2015/16.

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2.11 Key Recommendation: The Department of Health should require NHS England to move local commissioners to their target allocations within a maximum of 2 years.

c) Recruitment and Retention of the Health Workforce 2.12 Unless this region addresses the problems in GP and nurse recruitment, then

with the numbers of GPs set to retire in the next few years – this region will face a crisis in primary care.

2.13 Primary care is under massive pressure – and the problems of GP retirement

and lack of trainee doctor recruitment and retention means that we are facing a real crisis imminently. For example: Over 30% of GP training vacancies in this region remain unfilled, against a

99% fill rate in London and a UK average of 90%. The East Midlands has one of the lowest levels in England of full time nurses

per head of population (5.2 nurses per 1,000 population compared to an England average of 5.6).

2.14 This region has the joint lowest number of consultants per head of population

in the country. There is almost double the number of consultants per head of the population in London than in the East Midlands.

2.15 All the evidence suggests that more effective primary care will reduce demand

on acute services including accident and emergency. It is therefore particularly important that the numbers of GPs are increased to meet requirements. We welcome the new plan to expand the general practice workforce announced in January 2015 but urge NHS England and partners to maintain a particular focus on the East Midlands given the issues this report has identified.

2.16 Key Recommendation: To improve the recruitment and retention of key

healthcare staff, all parts of public sector in the region should collaborate to make this region a great place for medics to train and work – with a priority for increasing the numbers of GPs.

d) Collective Leadership 2.17 The scale of the challenges facing health are not solely ensuring adequate

levels of funding to meet future demand for health and social care – they are also about reform of decision-making and resource allocation to deliver better health outcome at reduced cost.

2.18 Failure to take action is morally and financially unsound. We need a new sense

of collective leadership and unity of purpose; bringing together leaders from the NHS, universities, LEPs, industry and local councils to develop strong and

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powerful partnerships in order to drive improvements in healthcare across our region.

2.19 A new approach to NHS reform is needed where the Government devolves

more authority and accountability to local councils and the NHS organisations responsible for delivering care – allowing leaders in local government and the health sector to improve the focus and quality of services and develop new models of care against local priorities.

2.20 Key Recommendation: Council and NHS leaders should together develop a

new model of collective leadership to improve health outcomes which requires: Greater local autonomy for policy setting and integration of funding. A collaborative approach with other parts of the public sector including

police, universities and LEPs. Working towards a fully integrated whole place/whole system approach

backed by place-based budgets for the prevention and treatment of ill health.

3. Next Steps 3.1 EMC will develop an action plan in order to make progress against the delivery

of each agreed recommendation. This will include the development of partnerships, e.g. HEEM, EM Academic Health Science Network, in addition to building upon the work already undertaken done, e.g. with LEPs and PHE.

3.2 Member advice is sought in regard to the suggested content and overall

approach for the development of this action plan. 4. Recommendations

Members of the Regional Improvement and Transformation Board are invited to consider and agree the proposed work in support of the report’s recommendations

Roger Begy Chairman EMC Health Review

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A Healthier Future for the East Midlands | February 2015

February 2015

A Healthier Futurefor the East Midlands?

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1 A Healthier Future for the East Midlands | February 2015

Foreword 2

Members of the Health Review Task Group 3

1 Introduction 5

2 Context 8

3 An Overview of Health – Roles and Responsibilities 10

4 Inequalities of Health Outcomes in the East Midlands 13

5 Funding for Healthcare in the East Midlands 20

6 Recruitment and Retention of the Health Workforce 26

7 Collaboration and Leadership 29

8 Appendix 1: Health Profile 32

9 Appendix 2: The Better Care Fund 37

10 Appendix 3: Good Practice Examples 39

11 Appendix 4: Wider Health Partners 41

Contents

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2A Healthier Future for the East Midlands | February 2015

Foreword

Cllr Jon CollinsChair, East Midlands Councils

Dr Fu-Meng KhawCentre Director, East MidlandsPublic Health England

Cllr Roger BegyChair, Health Review Panel

The importance of health, and how health services are funded and delivered, needs little explanation. Alongside the very real impact on the health and wellbeing of people in our local communities, with the General Election in May 2015, the NHS will be a key political battleground. All parties have promised to protect NHS funding meaning that planned public spending cuts will fall disproportionately on other government departments.

The NHS has been subject to a series of major structural reorganisations – particularly affecting how health services are commissioned. With the latest reforms still bedding down, no political party is seriously suggesting more of the same. The focus is instead on how to deliver better outcomes, more efficiently; through the adoption of different approaches to delivery, preventing ill health and reducing health inequalities in order to reduce demand. As a consequence, the leadership, commissioning and service delivery roles of local government become much more important.

In a review of health outcomes and practice in this region, the following report examines a number of issues of importance; but in particular, four priority areas are highlighted:

• Inequalities in health outcomes.

• Inequalities in funding for healthcare.

• Recruitment and retention of the health workforce.

• The need for collective leadership.

Too many decisions that affect the health and wellbeing of local communities are taken at the national level. To improve health outcomes of people living in this region, there needs to be a greater devolution of responsibilities to the local level - allowing local decisions makers to better focus resources on specific priorities and challenges.

We need to build upon the collective work that already exists in parts of the region – but remains lacking elsewhere, particularly between sectors. And so it is intended that the conclusions and recommendations of this review will support further joint work between councils, MPs, the NHS, Public Health England and wider health partners by highlighting those issues where collective leadership can help address the key health challenges for this region.

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3 A Healthier Future for the East Midlands | February 2015

Cllr Roger Begy OBE (Chair) Cllr Roger Begy has been Leader of Rutland CC since 2003 and is on the East Midlands Councils

Executive and Chairman of the Regional Improvement Board. He is a shadow governor of Leicestershire Partnership Trust and is a member of the Better Care Together Partnership Board in Leicestershire Leicester & Rutland. Roger is a board member of Midlands Arts Council and the LGA People & Places board.

He is Vice Chairman of the Regional Services Network that focuses upon rural issues. He received the OBE in 2008 for services to Further Education.

Cllr John Boyce Cllr John Boyce is the Leader of Oadby and Wigston Borough Council.

He is the District Council representative on the Leicestershire Health and Wellbeing Board and also the Chair of the Borough Council’s Health and Wellbeing Board.

Cllr Robin Brown Cllr Robin Brown was elected to Northamptonshire County Council in May 2003 and is currently the

council’s Cabinet Member for Public Health and Wellbeing and Chair of the Northamptonshire Health and Wellbeing Board.

Andy Gregory Andy joined the NHS in 1991 and has worked in a variety of roles in the development and management

of primary care and community services, performance, planning and commissioning. 

Andy has led the development of clinical commissioning across East Midlands, West Midlands and East of England and was part of the national authorisation team before successfully being appointed to Chief Officer, Hardwick CCG in September 2012. 

Andy completed the Kings Fund Top Leaders Programme in 2013 and recently became a member of the East Midlands Health and Well Being Board Leadership group and undertakes national LGA peer review assessments.

Members of the Health Review Task Group

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4A Healthier Future for the East Midlands | February 2015

Dr Fu-Meng Khaw Meng is Centre Director for the Public Health England (PHE) East Midlands Centre. He leads the delivery

of Public Health services, and support and advice to the local health and care system, including local authorities, the NHS, academic institutions, the voluntary and community sector and partners in industry.

Cllr Alex Norris Cllr Alex Norris is Nottingham City Council’s lead member for Adults, Commissioning and Health.

He is the Chair of Nottingham’s Health and Wellbeing Board. Their priorities include; integrating health and social care, improving Nottingham’s mental health, supporting Priority Families and reducing the impact of drugs and alcohol in the city.

Mike Sandys Mike is Director of Public Health (DPH) for Leicestershire and Rutland County Councils being appointed

to the post in February 2014.

Mike joined the NHS in the late 1980s and has worked in public health since 1992. His public health career has seen him work in a number of public health intelligence, research and development and manager roles in both the NHS and academia.

Dr David Sharp David has been a director in the NHS since 2000. He holds a Doctorate in Business Administration and is

a part time professor with specialties in change management and also in the funding of healthcare.

David has been Chief Executive and Finance Director in NHS organisations in Derbyshire and Nottinghamshire and took on his recent role as Director within NHS England in November 2012.  His experience in the NHS includes acute, mental health and primary care.  

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5 A Healthier Future for the East Midlands | February 2015

1.1 The importance of health, and how health services are funded and delivered, needs little explanation. Alongside the very real impact on the health and wellbeing of people in our local communities, with the General Election in May 2015, the NHS will be a key political battleground. All parties have promised to protect NHS funding meaning that planned public spending cuts will fall disproportionately on other government departments.

1.2 However, with the emphasis of health policy (if not yet practice) moving more towards prevention and care in or as close to the home as possible; the leadership, commissioning and service provision roles of local government become much more important. These include social care in the home, transport (cycling and walking), recreation, increasing the capabilities of communities to look after their most vulnerable members, targeted services for high risk groups (e.g. troubled families, repeat offenders), the economy (particularly unemployment) and housing.

1.3 The NHS has been subject to a series of major structural reorganisations – particularly affecting how services are commissioned. With the latest reforms still bedding down, no political party is seriously suggesting more of the same. The focus is instead on how to deliver better outcomes, more efficiently, e.g. through the adoption of different approaches to delivery, preventing ill health and reducing health inequalities in order to reduce demand. Collaboration between local government and CCGs in the region is progressing well but still in its early stages so a review of progress and opportunities for increased collaboration and leadership against mutual priorities is timely.

Conclusions and Recommendations

1.4 At the regional level, there is generally a good geographical fit between local government and NHS organisations that cover, commission or provide services across the East Midlands region, e.g. Public Health England, NHS England Area Teams, East Midlands Ambulance Service and Clinical Commissioning Groups. There is, therefore, good potential for improving health outcomes, unity of purpose and collective leadership through collaboration between these agencies, councils, MPs and wider health partners.

1 Introduction

1.5 This review is intended to complement the work already undertaken by health and wellbeing boards and local health scrutiny committees through ‘adding value’ and support in addressing the joint priorities of councils, MPs and key health partners.

1.6 While the full report highlights a range of issues of importance to the region, the following four priority outcomes have been identified in undertaking this review:

� Reducing inequalities in health outcomes.

� Eliminating inequalities in funding for healthcare.

� Improving the recruitment and retention of the health workforce.

� Effective cross sector, collective leadership.

Inequalities of Health Outcomes in the East Midlands

1.7 In most aspects, the health of the East Midlands is close to the national average. It is not the worst region in the country, but neither is it the best. However, within the East Midlands there are major health inequalities and these are widening across many parts of the region. As a region, we will never meet, or even get near to, national expectations of health outcomes unless these disparities are addressed.

1.8 The current health profile is unacceptably poor. The East Midlands should be better than average in terms of health – and the wide variations in health outcomes are unjustifiable. For example:

� People in Derby, Leicester and Nottingham have a life expectancy significantly less than the national average.

� There are huge disparities within communities, e.g. men living in the most deprived wards of Derby have 12 years less life expectancy than men in the most prosperous wards.

� There is a disproportionate number of people that are likely to experience poor health affecting their everyday life before they turn 60; meaning over 15 ‘unhealthy’ years, with associated impact on their quality of life, increasing social care and welfare costs, and costs to the wider economy caused by absence from work.

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6A Healthier Future for the East Midlands | February 2015

� There are high levels of deaths from causes considered preventable; particularly in the 3 cities, North Nottinghamshire/Derbyshire and East Lincolnshire.

� Higher than national levels of obesity, smoking and alcohol related admissions to hospital.

� Smoking in pregnancy is the major concern across the East Midlands with levels significantly higher than the national average - and urgent action is needed to reverse the rising trend.

1.9 There is also significant inequality in the treatment and prevention of mental compared to physical ill health with high proportions of people with mental ill health not receiving treatment and some parts of the region exhibiting higher levels of depression than others.

1.10 Common understanding of health inequalities and priorities is an important first principle in ensuring health agencies and local councils are able to target resources and identify opportunities for collective intervention.

1.11 Key Recommendation: A clear statement of the most effective measures to improve health outcomes and reduce inequalities in physical and mental health is developed involving health agencies and local councils in the East Midlands that prioritises the allocation of resources and identifies best practice.

Inequalities in Funding for Healthcare in the East Midlands

1.12 The East Midlands is underfunded across its health system – this is not only unjust but it also means that the region is unable to tackle the big issues that we know the health, social care and public health systems face.

1.13 The latest national data (2012/13) shows that total spending on health in the East Midlands is the 2nd lowest in the county, only the North East received lower levels of funding.

1.14 In terms of spending per head, the situation is only a little better; a health spend of £1,850 per head of the population in this region compares unfavourably to the national average of £1,912 for England and £1,937 for the UK. Spending per head was higher in North East, North West, Yorkshire and the Humber, West Midlands and London - with only the East of England, South East, and South West receiving lower levels.

1.15 CCG Programme Budget Baseline Allocations show that:

� Allocations per head for the East Midlands in 2014/15 are lower than the England average.

� In Northamptonshire, NHS Nene CCG is -6.99% below target and NHS Corby CCG, the worst hit, is -11.32% below target, with underfunding of -£186 per person. West London is the most overfunded, with +£508 per head over the target amount.

� The NHS Midlands and East area is further below its target allocation than anywhere else in 2014/15, and will continue to be so in 2015/16.

� This is despite Government policy being to move all areas to their target fair funding allocation as soon as possible.

1.16 Key Recommendation: The Department of Health should require NHS England to move local commissioners to their target allocations within a maximum of 2 years.

Recruitment and Retention of the Health Workforce

1.17 Unless this region addresses the problems in GP and nurse recruitment, then with the numbers of GPs set to retire in the next few years – this region will face a crisis in primary care.

1.18 Primary care is under massive pressure – and the problems of GP retirement and lack of trainee doctor recruitment and retention means that we are facing a real crisis imminently. For example:

� 30% of GP training vacancies in this region remain unfilled, against a 99% fill rate in London and a UK average of 90%.

� The East Midlands has one of the lowest levels in England of full time nurses per head of population (5.2 nurses per 1,000 population compared to an England average of 5.6).

1.19 This region has the joint lowest number of consultants per head of population in the country. There is almost double the number of consultants per head of the population in London than in the East Midlands.

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7 A Healthier Future for the East Midlands | February 2015

1.24 A new approach to NHS reform is needed where the Government devolves more authority and accountability to local councils and the NHS organisations responsible for delivering care – allowing leaders in local government and the health sector to improve the focus and quality of services and develop new models of care against local priorities.

1.25 Key Recommendation: Council and NHS leaders should together develop a new model of collective leadership to improve health outcomes which requires:

� Greater local autonomy for policy setting and integration of funding.

� A collaborative approach with other parts of the public sector including police, universities and LEPs.

� Working towards a fully integrated whole place/whole system approach backed by place-based budgets for the prevention and treatment of ill health.

1.20 All the evidence suggests that more effective primary care will reduce demand on acute services including accident and emergency. It is therefore particularly important that the numbers of GPs are increased to meet requirements. We welcome the plans to expand the general practice workforce announced in January 2015 but urge NHS England and partners to maintain a particular focus on the East Midlands given the issues this report has identified.

1.21 Key Recommendation: To improve the recruitment and retention of key healthcare staff, all parts of public sector in the region should collaborate to make this region a great place for medics to train and work – with a priority for increasing the numbers of GPs.

Collective Leadership

1.22 The scale of the challenges facing health are not solely ensuring adequate levels of funding to meet future demand for health and social care – they are also about reform of decision-making and resource allocation to deliver better health outcome at reduced cost.

1.23 Failure to take action is morally and financially unsound. We need a new sense of collective leadership and unity of purpose; bringing together leaders from the NHS, universities, LEPs, industry and local councils to develop strong and powerful partnerships in order to drive improvements in healthcare across our region.

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8A Healthier Future for the East Midlands | February 2015

2.1 A high level review of government policy statements, independent reviews and recent political 2015 election related statements has been undertaken. The summaries below have been selected because of the links they make between achieving better health outcomes and areas of local government responsibility.

2.2 Three white papers were issued by the Government early in the current Parliament – ‘Healthy Lives Healthy People’ (2010 and 2011 Update), ‘No Health without Mental Health’ (2011) and ‘Caring for the Future; Reforming Care and Support’ (2012). Taken together they:

a. Accept the substantial scale and nature of the health challenge – especially given demographic changes - and the (unsustainable) costs associated with a business as usual approach.

b. Recognise that Whitehall driven solutions will not work when the nature of problems and solutions vary from place to place.

c. Propose that individuals and communities play a bigger role in looking after their own needs and promote greater independence including greater support for carers and personal budgets.

d. Recognise that local authorities have been given responsibilities for public health because of their community role and the opportunity to develop solutions covering the full range of services including leisure, housing, planning, transport, employment and social care.

e. Emphasise the need for action in early years – a ‘life course’ approach - recognising that many lifestyle choices are influenced from a young age and even before birth.

f. Explicitly recognise that ill health has an impact wider than the health budget – with implications for the economy (mental health problems cost the UK economy £8.4bn a year in sickness absence), benefits take up, school attendance, educational attainment and social problems such as homelessness, crime and substance abuse.

A consensus is emerging around the need for preventative care and early intervention. More services need to be delivered using a holistic, person-centred approach. Interest in collaborative approaches involving pooled or aligned commissioning is growing.

g. Recognise that wider issues such as being in employment, having good housing and a supportive community and family life is likely to prevent health problems while the opposite is likely to create them.

h. Require a parity between mental and physical health services.

i. Want to stop people being ‘bounced around’ between services

2.3 The Kings Fund – a respected health based think tank – commented on the Government’s policies in 2012 (Transforming the Delivery of Health and Social Care – The case for fundamental change). Amongst other things it was concerned that the NHS is still too focused on treatment of illness rather than the promotion of health and that prevention remains the poor relative. It notes the need to do more in primary care to support people to improve their health, a potential increased role for the third sector and for local government to work through ‘transport, leisure, planning and education departments to improve population health’.

2.4 In its view, Health and Well Being Boards are well placed to provide leadership at a local level, and to develop strategies for health improvement that ‘move beyond traditional silos to focus on communities and populations’. It also considers that funding reductions in social care mean it is more difficult to act early to help people in their own homes and that services for children remain fragmented.

2.5 An Independent Panel was asked by Ministers in early 2014 to recommend changes which would help public services deal with demographic changes, increasing expectations and the need to reduce the cost of public services. In its report ‘Bolder, Braver and Better: why we need local deals to save public services’ (2014) the panel calls for three fundamental changes:

a. That local and central government use the person-centred approach of the Troubled Families programme to design services for groups and individuals with multiple and complex needs.

2 Context

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9 A Healthier Future for the East Midlands | February 2015

b. More easily accessible and more flexible up-front funding for the up-front costs of transformation.

c. Radical improvements in how data and technology are used to provide smarter services.

2.6 The Panel held a roundtable with national health agencies from which the following strong message emerged:

“Creating the scale and pace for transformation required a deepening of trust between agencies. This could be positively supported by central government with a narrative that was more closely aligned to what was perceived as the “real” issues for a locality. This would probably mean greater flexibility, or as much flexibility as possible, for any new funding initiatives. It was also considered more helpful if new funding was targeted specifically at people, not services.”

2.7 The Chair of the Panel said:

“It is clear that the traditional approach to public services is not working. It is no use for individual organisations – be it council, police, health, Jobcentre Plus or another – to concern themselves with just one aspect of somebody’s very complex problems. This has, tragically, not delivered better outcomes for a great many people and it has not reduced the need for costly support. We have called for the government and places to work together and create better interventions for those groups of people who contribute, for whatever reason, to the increasingly high demands on public services.”

2.8 In his Autumn Statement 2014, the Chancellor commented on the need for reforms in the next Parliament to ‘drive out waste and inefficiency and improve outcomes’. He described the benefits of some initiatives to integrate public services and cited the Troubled Families Programme and Better Care Fund as examples of measures to encourage this integration. He welcomed the contribution of the service transformation panel (above) and stated that ‘further integration of services will be delivered by developing and extending the principles underpinning the Troubled Families Programme approach to other groups of people with multiple needs’.

2.9 In a recent statement, the SoS for Health Jeremy Hunt indicated that “choice is not the main driver for service improvement”. He noted the need for somebody with whom the ‘buck’ stopped to have the support necessary to keep somebody with complex needs out of hospital. His opposite number Shadow SoS for Health Andy Burnham – commenting on the relationship between social care and

health service funding notes that ‘’in the ageing century it’s not going to be possible to keep disaggregating people’s needs into different silos.”

Conclusions

2.10 There seems to be a policy consensus that:

a. Single service approaches do not work satisfactorily because the needs of many people with high use of public services are complex.

b. The impact of these complex needs has ‘cause and effect’, e.g. unemployment can lead to a range of health problems and an ongoing health problem can lead to unemployment.

c. There is a need for a ‘buck stops here’ approach to co-ordinate preventative and early intervention and other services through a holistic person-centred approach.

d. More services should be integrated and jointly commissioned through pooled budgets.

e. More effective prevention is needed at individual and community level if costs are to be contained.

f. People need to do more for themselves and each other.

g. Collaborative approaches involving pooling or aligning commissioning and transformation budgets are helpful.

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3.1 Primary health care provides the first point of contact in the health care system. The main source of primary health care is general practice – the local GP, but primary care is also provided by NHS walk-in centres, dentists, pharmacists and optometrists. Primary health care involves providing treatment for common illnesses, the management of long term illnesses such as diabetes and heart disease and the prevention of future ill-health through advice, immunisation and screening programmes. Secondary, or ‘acute’, care is the healthcare that people receive in hospital; ranging from unplanned emergency care or surgery, to planned specialist medical care or surgery.

3.2 It is now over 18 months since the Health and Social Care Act 2012 came into force and with it some of the most wide-ranging reforms of the way the NHS commissions secondary/acute care since it was founded in 1948. Most of the changes took effect on 1st April 2013 and have had an effect on who makes decisions about NHS services, how these services are commissioned and the way money is spent. Some organisations such as Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs) were abolished, and other new organisations, such as clinical commissioning groups (CCGs), have taken their place.

National Structures

3.3 The Secretary of State for Health has ultimate responsibility for the provision of a comprehensive health service in England, and ensuring the whole system works together to respond to the priorities of communities and meet the needs of patients.

3.4 The Department of Health (DH) is now responsible for strategic leadership of both the health and social care systems, but is no longer the headquarters of the NHS, nor does it directly manage any NHS organisations.

3.5 NHS England was originally established as the NHS Commissioning Board in October 2012. It is an independent body, at arm’s length from government. Its main role is to improve health outcomes for people in England and:

� Provide national leadership for improving outcomes and drive up the quality of care.

� Oversee the operation of clinical commissioning groups.

� Allocate resources to clinical commissioning groups.

� Commission primary care and specialist services.

3.6 Public Health England (PHE) was established in April 2013, and brings together a number of services and statutory functions to deliver an integrated offer of services, advice and support to local stakeholders across the three domains of public health; health protection, health improvement and healthcare public health.

3.7 Healthwatch England is the national consumer champion in health and care. It has significant statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services.

Sub National Arrangements

3.8 Public Health England has 4 regions (North of England, South of England, Midlands and East of England, and London) and currently 15 local centres, with London being an integrated Centre and Region. From 1st July 2015 PHE will be operating from 9 Centre footprints. The current East Midlands Centre footprint is Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire and Rutland, and the new footprint will also include Northamptonshire. The East Midlands Centre provides expert services, advice and support to the local public health system. It works with local government, the NHS and other stakeholders to protect and improve health and reduce health inequalities across the East Midlands.

3.9 The East Midlands is within the Midlands and East of England NHS region. The local presence of the NHS is through its newly formed Sub-Regions; NHS North Midlands includes Derbyshire and Nottinghamshire and

3 An Overview of Health – Roles and Responsibilities

The Health and Social Care Act 2012 heralded some of the most wide-ranging reforms in the way the NHS commissions secondary/acute care since it was founded in 1948. The organisations responsible for commissioning health services in the East Midlands need the ability to innovate and use budgets in the most effective way if they are to achieve the greatest impact on health outcomes.

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11 A Healthier Future for the East Midlands | February 2015

NHS Central Midlands covers Leicestershire, Lincolnshire, Northamptonshire and Rutland. The NHS Sub Regions work with CCGs, local authorities, Public Health England, Health Education East Midlands, local Healthwatch bodies and the NHS Trust Development Authority to improve health outcomes. NHS Sub-Regions have direct commissioning responsibilities, such as primary care, primary dental care, screening and immunisation services, amongst others.

Local Structures

3.10 Primary care trusts (PCTs) used to commission most NHS services and controlled 80% of the NHS budget. On 1st April 2013, PCTs were abolished and replaced with Clinical Commissioning Groups (CCGs) – the cornerstone of the new health system. CCGs have taken on many of the functions of PCTs and in addition some functions previously undertaken by the Department of Health.

3.11 CCGs are GP-led organisations responsible for buying and planning the majority of health services, including emergency care, elective hospital care, maternity

services and community and mental health services. There are 211 CCGs altogether, responsible for a budget of approximately £65bn (around 60% of the total NHS budget), commissioning care for an average of 226,000 people each. The East Midlands region is covered by 20 CCGs with a total programme budget allocation of a little over £5.1bn, commissioning care for an average of 232,000 people each, ranging from 650,000 people in Nene CCG, to 73,000 people in Corby CCG.

3.12 The Health and Social Care Act 2012 established new responsibilities for local councils to improve the health of their populations, backed by ring-fenced grant and a specialist public health team, led by a Director of Public Health. The new public health functions include:

� Health Improvement – to improve the health of their local population.

� Health Protection – to protect the health of the local population against a range of threats and hazards.

� Healthcare Public Health – the requirement to provide public health advice to NHS commissioners.

3.13 Health and Wellbeing Boards are central to the vision of a more integrated approach to health and social care – and are one of the features of the recent health reforms that have met with widespread support in providing a sense of local purpose and a strong partnership between CCGs and the local authority. Established by every upper tier local authority, their role is to provide a forum for local commissioners from the NHS, public health, elected representatives and Local Healthwatch, to plan how best to meet the needs of their local population and tackle local inequalities in health through:

� Increasing democratic input into strategic decisions about health and wellbeing services.

� Strengthening working relationships between health and social care.

� Encouraging integrated commissioning of health and social care services.

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3.14 Ultimately, the key challenge is whether Health and Wellbeing Boards add value through offering a strong, credible and shared leadership that engages partners in making a real difference for local people.

3.15 Local Healthwatch are independent organisations for citizens and communities to influence and challenge the local provision of health and social care services. It has a seat on the statutory health and wellbeing boards, ensuring that the views and experiences of patients, carers and other service users are taken into account when local needs assessments and strategies are prepared, such as the Joint Strategic Needs Assessment (JSNA) and the authorisation of Clinical Commissioning Groups.

Conclusions

3.16 A number of organisations have responsibility for, and influence on, the commissioning of health services in the East Midlands. These agencies need a common vision, aligned aims and objectives, clear evidenced based priorities and the ability to innovate and use budgets in the most effective way if they are to achieve the greatest impact on health outcomes.

Recommendation

3.17 Health agencies and Local Authorities should ensure that the visions, aims, objectives and priorities are aligned across multiple strategies, plans and budgets.

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13 A Healthier Future for the East Midlands | February 2015

4.1 Given its socio-economic profile, the East Midlands should be better than average in terms of health – and the wide variations in health outcomes are unjustifiable. This is despite the significant efforts of a number of organisations including local government, the health sector and universities.

4.2 Many health challenges are linked to socio-economic factors. The poorest performing wards for health outcomes tend to be areas with high levels of deprivation; in large cities; on the coastal strip of Lincolnshire; and in areas of industrial decline, e.g. Nottinghamshire, Derbyshire, and Corby (see figure 1).

Figure 1 % living in income deprived households reliant on

means tested benefit. 2010 (source: DCLG)

Life Expectancy and Healthy Lives

4.3 Life expectancy at birth is similar to the national average for both men and women living in the East Midlands.

Life expectancy at birth (years) Men Women

East Midlands 79.1 82.9

England 79.2 83.0

4.4 However, across the East Midlands there is wide variation, with significantly higher life expectancy in Leicestershire and Rutland; and, significantly lower life expectancy in Derby, Leicester, Nottingham and Nottinghamshire compared to the national average. There are also large disparities in how long people live within areas; in Derby City life expectancy is 12.2 years lower for men and 9.0 years lower for women living in the most deprived areas compared to the least deprived; and in North West Leicestershire the gaps are 12.5 years for women and 8.1 years for men.

Life expectancy at birth (years) Men Women

Leicestershire 80.1 84.0

Rutland 81.0 84.7

Derby 78.6 82.8

Leicester 77.0 81.8

Nottingham 76.9 81.5

Northamptonshire 79.3 82.7

Nottinghamshire 76.9 81.5

4 Inequalities of Health Outcomes in the East Midlands

In most aspects, the health of the East Midlands is close to the national average. It is not the worst region in the country, but neither is it the best. However, within the East Midlands there are major health inequalities and these are widening across many parts of the region.

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a poor diet) has reduced, people from poorer backgrounds and the most vulnerable are still more likely to undertake three or more of these behaviours.

4.9 Excess weight in adults is significantly higher than the national average in the East Midlands with two thirds of adults being overweight or obese in 2012 (65.6% compared to 63.8% nationally). This is a particular problem for county areas (ranging from 66.4% in Nottinghamshire to 68.2% in Lincolnshire) rather than the city areas (Leicester is significantly better than the national average at 57.0%).

4.10 Levels of smoking remain a problem, particularly in Nottingham with almost a quarter of adults (24.4%) still smoking in 2012, and among the routine and manual populations living in Lincolnshire with more than a third (35.6%) still smoking in 2012.

4.11 However, health agencies and local councils highlight smoking in pregnancy as the major concern across the East Midlands; with 15.1% of pregnant women reported smoking at the time of their baby’s birth. This is well above the national average of 12.7% and urgent action is needed to reverse the rising trend.

4.12 Smoking in pregnancy impacts on the developing foetus and is known to cause miscarriages, stillbirth and low birth weight.  In the East Midlands in 2012, 7.3% (4,037) of babies born had low birth weight. This is the most significant factor in infant deaths and in developmental problems that have an adverse impact on educational attainment.

4.13 Alcohol related admissions are also significantly higher in the region as a whole at 646 per 100,000 population compared to 637 nationally. The cities again fair worse with Nottingham City a particular cause for concern.

Alcohol related admissions 2012/13 Per 100,000 population

England 637

East Midlands 646

Leicester 717

Derby 742

Nottingham 878

4.5 As well as living longer, there should be an emphasis on healthier, more productive lives. In the East Midlands generally, both men (63.2 years) and women (63.6 years) can expect to live in good health almost to retirement age with people in Northamptonshire, Leicestershire and Rutland retaining good health well into their 60s and even to their 70s. However, men and women in Derby, Leicester and Nottingham are significantly more likely to experience poor health affecting their everyday life before they turn 60. This means that many individuals face over 15 ‘unhealthy’ years, with associated quality of life concerns and increasing public costs including care needs and benefits.

The Big 5 Killers

4.6 Heart disease, stroke, cancer, respiratory and liver disease - these five big killers account for more than 150,000 deaths a year among under-75s in England alone and estimates indicate that 30,000 of these are entirely avoidable. Excess weight, lack of physical activity, smoking and increasing intake of alcohol are all major risk factors associated with these preventable causes of death.

4.7 In this region, more than 200 deaths per 100,000 population are related to preventable infections, heart disease, stroke, diabetes, cancer, respiratory and liver disease, mental health issues, substance and alcohol misuse and poor quality healthcare (preventable deaths are higher in the cities of Derby 207, Leicester 234 and Nottingham 247). The costs to the health and social care system of not tackling the preventable ‘big killers’ are significant.

Preventabledeaths CVD Respiratory

diseaseLiver

disease Cancer

Derby 63.0 - 20.7 -

Leicester 73.2 22.0 22.7 -

Nottingham 75.3 31.3 26.4 107.1

(All figures are per 100,000 person population. Only death rates which are significantly higher than average are shown).

4.8 More than twice as many people from the poorest backgrounds die of circulatory disease than those from the most affluent backgrounds, and whilst the number of people overall who engage in multiple risky health behaviours (such as excessive drinking, smoking, or having

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4.14 A more detailed health profile (Appendix 1) and Figures 2-5 illustrate that life expectancy can be improved if deaths from causes that are considered preventable are reduced.

Areas that are lighter for life expectancy in the first map (signifying lower life expectancy) are darker in the second map (signifying higher preventable mortality).

Figure 2 Male Life Expectancy – age in years, 2008-2012

Figure 4 Female Life Expectancy – age in years, 2008-2012

Figure 3 Male mortality from causes considered preventable, age-

standardised rate per 100,000 population, 2011-2013

Figure 5 Female mortality from causes considered preventable,

age-standardised rate per 100,000 population, 2011-2013

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Mental Health

4.15 Mental ill health is a significant health challenge – and the statistics surrounding mental health are salutary:

� Among people under 65, nearly half of all ill-health is mental illness.

� Mental illness is generally more debilitating than most chronic physical conditions.

� Only a quarter of all those with mental illness such as depression are in treatment.

� 75% of all chronic mental health problems start before the age of 18 – but only a quarter of children and teenagers aged up to 15 with mental health problems receive any support, and just 6% of the mental health budget is spent on children.

� Physical and mental health treatment need greater integration – all too often they remain in separate silos within health services.

� People with poor physical health are at higher risk of experiencing mental health problems, and people with poor mental health are more likely to have poor physical health.

� Currently people with poor mental health have the life expectancy of people who lived in the 1950s – some 10 to 15 years shorter than the current average.

4.16 As with physical health there are considerable variations in mental health outcomes across the region. Hardwick and Nottingham City CCGs areas both have significantly higher levels of long-term mental health problems than national levels. The majority of CCG areas report levels of depression that are above the national average with 6% of the adult population registered as suffering from this condition. Spend on prescribing shows that some areas with a higher prevalence of depression have lower spending on antidepressants, such as Corby CCG with over 8% of the adult population registered as suffering with depression and the lowest spending (Figure 6). Detentions under the Mental Health Act are also higher than the national average in Leicester and Nottingham City CCGs (22.5 and 25.6 per 100,000 population compared to 15.5 nationally, respectively).

4.17 Attendances at A&E for psychiatric disorders are highest in Mansfield and Ashfield CCG at 424.3 per 100,000 population, and also higher than the national average (243.5) in CCGs in surrounding Nottinghamshire, Lincolnshire and Northamptonshire (black diamonds in figure 7). However, for Nene in Northamptonshire and Lincolnshire East CCGs the proportion of patients reporting that they have a long term mental health problem is lower than nationally. This may also indicate issues with reaching people who have mental health issues.

4.18 Although depression rates are lower than average in

Nottingham City CCG, the proportion reporting that they have a long term mental health problem is significantly higher than average in Nottingham City and Hardwick CCGs (the pale red bars in figure 7). This may indicate differences in the kinds of mental health issues that are prevalent in these populations or differences in the reporting of both measures.

4.19 NHS England estimate that people unable to work because of mental illness costs the UK economy approximately £70bn a year, equivalent to 4.5% of gross domestic product, once absences, productivity losses and benefit liabilities are taken into account:

� 800,000 people are currently signed off sick from work and claiming disability benefits for mental health issues.

� A further 400,000 people claiming other out of work benefits do so because of mental health reasons.

� On the other hand, 60-70% of people with common mental disorders (such as depression and anxiety) are in work and so there is a strong economic imperative to keep them in work and address their mental health.

� Further research has shown that 43% of those accessing homelessness projects in England suffer from a mental health condition.

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17 A Healthier Future for the East Midlands | February 2015

Figure 6 Proportion of the GP registered patients that have depression known to GP, 2012/13 and cost of GP prescribing for

antidepressant drugs, net ingredient cost per 1,000 standardised population (2013/14, Q4). Source: PHE Common Mental Health Disorders

Figure 7 % of people completing patient survey who reported a long-term mental health problem, 2012/13 and the rate of A&E

attendances for a psychiatric disorder per 100,000 population (2012/13). Source: PHE Community Mental Health Profiles

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1 “ - ” denotes data not available. These figures were based on figures extracted from local police force custody databases in response to the question: “How many Section 136 detentions did your force have from 1st April 2013 to 31st March 2014 that went directly to a police station?” (This figure does not to include anyone who was arrested for a substantive offence and subsequently arrested whilst in custody).

4.20 All too often, people with mental health conditions find themselves in contact with the police when more appropriate support is unavailable. Police sources estimate that responding to day-to-day incidents, where someone needs immediate mental health support, occupies 25-40% of police time. Data regarding the use of Section 136 of the Mental Health Act powers by police to detain people in need of ‘care and control’ provide some context about how we respond as a society to people experiencing a mental health crisis.

Conclusions

4.21 In most aspects, the health of the East Midlands is close to the national average. It is not the worst region in the country, but neither is it the best. However, within the East Midlands there are major health inequalities and these are widening across many parts of the region. As a region, we will never meet, or even get near to, national expectations of health outcomes unless some of these disparities are addressed. This includes tackling mental health issues with the same priority as physical health.

4.22 Improving health outcomes and correcting inequalities in outcomes in particular cannot be achieved solely through clinical interventions. Much has already been achieved through area initiatives - the linking of employment outcomes with health outcomes, community development,

and prevention measures around smoking, diet and exercise and housing services. The effectiveness of these measures needs to be better understood to convince decision makers, particularly within the health community about the value of wider preventative investment.

4.23 In the face of medical and economic evidence, the challenge is to address mental health with the same urgency as that for physical health. This should not only improve the outcomes for people with mental health problems but also save money and give taxpayers much better value for every pound we spend. Part of the solution lies in putting funding, commissioning and training on a par with physical health services, and working in a more integrated way, e.g. with the Institute of Mental Health - one of the leading mental health institutes in the UK.

England number (1)

All Under 18

Police Health Police Health

England Total 24,296* 829 18,461* 236 517*

Derbyshire Constabulary - 78 - 1 -

Leicestershire Constabulary 311 36 275 2 -

Lincolnshire Police 552 333 219 25 0

Northamptonshire Police 383 61 322 5 0

Nottinghamshire Police 1,037 321 716 14 36

Data source: Police Force IT Systems (All Forces and Constabularies of England) Copyright © 2014, Association of Chief Police Officers. All rights reserved.

“We deal with more vulnerable people each day than

we make arrests” Simon Cole, Chief Constable, Leicestershire Police.

Detentions under Section 136 in police and hospital based ‘places of safety’ (including detainees aged under 18), 2013/14

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19 A Healthier Future for the East Midlands | February 2015

4.24 Given its socio-economic profile, the East Midlands should be better than average in terms of health – and the wide variations in health outcomes are unjustifiable. Until the most effective measures to reduce inequalities are understood, then joint action, including securing the support of MPs for measures to address them, will be much more difficult. Health inequalities represent the ‘golden thread’ of this review; one that requires improvements to primary, acute and mental health care, better funding and leadership; while also dependent upon economic growth, housing, employment and skills development.

Recommendations

4.25 Key Recommendation: A clear statement of the most effective measures to improve health outcomes and reduce inequalities in physical and mental health is developed involving health agencies and local councils in the East Midlands that prioritises the allocation of resources and identifies best practice.

4.26 All Health and Wellbeing Boards should be informed by a Joint Strategic Needs Assessment (JSNA) that includes the information needed to plan services to integrate the mental and physical health needs of their populations.

4.27 Employment is central to mental health and as such employment status should be a routine and frequently updated part of all patients’ medical records. This will provide the baseline data for employment status to be an outcome of all medical specialties, including primary care.

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An Overview of Funding

5.1 Each year the Department of Health receives over £110bn to fund health services in England. It passes around 90% of this money to NHS England that has the responsibility for commissioning healthcare.

5.2 The vast majority of NHS funding comes from central (UK) taxation. The NHS can also raise income from patient charges, sometimes known as ‘co-payments’. Devolved administrations have control over the level at which these are set. Types of ‘co-payments’ include:

� Prescription charging

� Dental Charging

� Other sources of income, e.g. charging overseas visitors and their insurers for the cost of NHS treatment, car parking charges etc. In addition, NHS Trusts can earn income through treating patients privately.

5.3 Measuring health funding at the sub-national level is not straightforward. Expenditure is allocated on the basis of the region that benefited from the expenditure; or whom the expenditure was for - but these figures are only intended to give a broad overview and should not be regarded as a precise measure. This is because it is not always easy to decide who benefits from particular expenditure – aside from any simplifying assumptions made in compiling the data.

5.4 Notwithstanding the caution, the latest data released in July 2014 shows that health spending (both in total and per head) in the East Midlands during 2012/13 was some way below the average for England, Scotland, Wales and Northern Ireland.

5.5 Table 1 below shows total spending overall per region, ranked from lowest to highest spend. The East Midlands recorded the second lowest level of expenditure. Only the North East spent less. Table 2 shows that 2012-13 spending per head on health in the East Midlands was £1,850 (96%) against £1,912 England wide (99%), and £1,937 for the UK (100%).

Table 1: Total Spending per Region (2012/13)

Region £million

North East 5,595

East Midlands 8,451

South West 9,628

East 10,260

Yorkshire and the Humber 10,483

West Midlands 10,932

North West 15,066

South East 15,107

London 16,772

The East Midlands is underfunded across its health system – this is not only unjust but it also means that the region is unable to tackle the big issues that we know the health and public health systems face.

5 Funding for Healthcare in the East Midlands

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21 A Healthier Future for the East Midlands | February 2015

Table 2: Spending per Head of the Population (2012/13)

2012 - 2013 £ Health/head

Health/head, indexed

North East 2,150 111

North West 2,127 110

Yorkshire and the Humber 1,972 102

East Midlands 1,850 96

West Midlands 1,937 100

East 1,737 90

London 2,019 104

South East 1,731 89

South West 1,803 93

England 1,912 99

Scotland 2,115 109

Wales 1,954 101

Northern Ireland 2,109 109

UK identifiable expenditure 1,937 100

5.6 Again, the East Midlands appears to be losing out. Spending per head was higher in North East, North West, Yorkshire and the Humber, West Midlands and London. It was also higher England-wide and in Scotland, Wales and Northern Ireland. Only the East of England, South East, and South West received lower levels of spend per head.

5.7 In 2014/15, £79.1bn was allocated to individual commissioners through a funding formula:

� NHS England allocated £64.3bn (81% of the total) to 211 CCGs to commission hospital, community and mental health services.

� NHS England allocated £12bn (15% of the total) to its 25 area teams to commission primary care.

� The Department of Health allocated £2.8bn (4% of the total) to 152 local councils to commission pubic health services, e.g. smoking cessation programmes.

5.8 Not included is funding that NHS England manages centrally or separate administrative funding to CCGs and NHS area teams.

a) Funding for Clinical Commissioning Groups

5.9 Funding allocated to Clinical Commissioning Groups (CCGs) can be considered at a more local level. In 2015/16, CCG Programme Budget Baseline Allocations show that:

� Allocations per head for the East Midlands in 2014/15 are lower than the England average.

� A similar disparity will continue through to 2015/16.

5.10 Target allocations are calculated to give those local areas with greater healthcare needs a larger share of the available funding (their fair share). The allocations also aim to contribute to a reduction in health inequalities. In its recent report, ‘Funding Healthcare: Making Allocations to Local Areas’, the National Audit Office concluded that:

� There is wide variation in the extent to which £79 billion in central funding allocated to local health bodies differs from target allocations that are based on relative need.

� In 2014/15 for England overall, over three-quarters of local authorities, and nearly two-fifths of clinical commissioning groups, are more than 5% above or below their target funding allocations.

� There is a clear relationship between the financial position of CCGs and their distance from their target allocations. Specifically, the 20 clinical commissioning groups with the tightest financial positions received, on average, 5% less than their target funding allocation. Of these 20 CCGs, 19 received less than their target allocation. Of the 20 CCGs with the largest surpluses, 18 had received more than their target allocation.

� The Department and NHS England decide current funding allocations without fully considering the combined effect on local areas.

� NHS England has limited assurance around some key data underpinning the allocations. In particular, GP list data, which is used to estimate local population numbers, may not be accurate where there are transient populations or high inward migration.

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22A Healthier Future for the East Midlands | February 2015

5.11 The maps below show that 18 local areas received at least £100 more per person than their target funding allocation, of which none were in the East Midlands; and 20 CCGs (including Corby, in the East Midlands) received at least £100 per person less than their target funding allocation. From 2014/15 the Department and NHS England introduced new approaches to assessing need in calculating allocations for clinical commissioning groups which use more detailed data than the approach used in previous years, but an unacceptable number of CCGs remain too far removed from their target allocations.

Region £million

£ per person

North Derbyshire £88

Bassetlaw £71

South West Lincolnshire £48

Hardwick £28

Lincolnshire East £27

South Lincolnshire £24

Lincolnshire West £18

Nottingham City £0

Mansfield and Ashfield -£18

Newark and Sherwood -£20

Rushcliffe -£23

Nottingham West -£31

Nottingham North and East -£34

Erewash -£44

West Leicestershire -£67

Leicester City -£82

East Leicestershireand Rutland -£87

Nene -£88

Milton Keynes -£110

Corby -£186

5.12 In the East Midlands:

� CCGs which make up the Leicestershire & Lincolnshire Area Team are collectively expected to be -2.40% below their target allocations in 2014/15, and this pattern will continue into 2015/16 unless a new approach is adopted.

Figure 8Aggregated distances from target funding allocations for healthcare by local area, 2013-14

Eighteen local areas received at least £100 more per person than their target funding allocation, while 20 received at least £100 per person less

Source: National Audit Office analysis of Department of Health, NHS England and Office for National Statistics data

£ per head (number of local areas)

100 to 508 (18)

50 to 100 (39)

0 to 50 (45)

-50 to 0 (51)

-100 to -50 (38)

-186 to -100 (20)

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23 A Healthier Future for the East Midlands | February 2015

� In Northamptonshire, NHS Nene CCG is -6.99% below target and NHS Corby CCG, the worst hit, is -11.32% below target, with underfunding of -£186 per person. West London is the most overfunded, with +£508 per head over the target amount.

� The Midlands and East area is further below its target allocation than anywhere else in 2014/15, and will continue to be so in 2015/16.

5.13 The Committee of Public Accounts has challenged NHS England and the Department of Health on these funding disparities, and in particular the:

� Slow progress in moving allocations towards fair shares.

� Lack of coordination across the health allocations and with other government funding streams.

� Failure to engage with the advisory body early when developing the new primary care formula.

� Shortcomings in the population data, which may result in allocations not reflecting the additional needs of areas with high inward migration.

� Lack of evidence on what level of adjustment should be made for health inequalities.

� Decreasing proportion of health spending committed to primary care, despite this being a key factor in addressing inequalities.

5.14 In response, NHS England told the Committee that it planned to move local commissioners to their target allocations more quickly in the future. Recent developments have been positive with a welcome announcement of using part of the additional £1.1bn NHS funding to bring all CCGs to within 5% of their target allocation by 2016/17 whilst also directing funding towards distressed health economies. Specifically, for 2015/16, while every CCG will get real terms budget increase, more of the extra funding is going to under-target areas than had previously been expected. This will have a positive effect on allocations to the East Midlands (on average) since more areas were under- and over-funded.

b) Funding for Local Authorities

5.15 Local authority budgets include a range of resources and funding that could be applied more effectively through greater collaboration with the health sector within a whole place approach to reduce ill health.

Public Health

5.16 The National Audit Office published ‘Public Health England’s Grant to Local Authorities’ in December 2014. Its findings relate to local authority public health spending and outcomes, governance and accountability arrangements, and supporting and advising local authorities.

5.17 On value for money the NAO concludes: ‘PHE has made a good start at building effective relationships

with local authorities and other stakeholders. By design, PHE has been set up without direct, timely levers to secure the public health outcomes the Department expects, so PHE provides tools and data, support and advice to help local authorities to meet public health objectives. Its ability to influence and support public health outcomes will be tested in future should the grant cease to be ring-fenced. In parts of the system, local authority spending is not fully aligned to areas of concern. There is a difficult balance between localism and PHE’s accountability for improving outcomes, and it is too early to conclude yet on whether PHE’s support is delivering value for money’. 2

5.18 The issue this raises about aligning local authority spending to areas of concern is noteworthy. There is an expectation that local authorities will use the tools that PHE has developed to understand their public health needs and spending, yet the NAO’s analysis found that spending on different aspects of public health varies significantly between local authorities, noting that this is unsurprising given local autonomy and differing needs and circumstances. In the example quoted, local authorities where alcohol misuse worsened the most between 2010/11 and 2012/13 were spending significantly less on alcohol services in 2013/14.

5.19 The report also notes that poor data quality has at times limited the quality of both PHE’s and local authorities’ accountability and reporting. ‘Delays of up to 5 months in LA’s provisional spending data’, and the ‘flawed quality’ of some provisional data on public health spending will not improve the Local Authority case for enhanced freedoms and flexibilities. The recommendations in the NAO’s report are directed at PHE, but it is clear that LAs should ensure that they co-operate fully with the work of PHE and CLG to improve the quality of their final spending data if they are to be able to present a robust case for further devolution of powers.

2 http://www.nao.org.uk/wp-content/uploads/2014/12/Public-health-england’s-grant-to-local-authorities.pdf

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Adult Social Care

5.20 The bill for health and social care is one of the biggest components of council expenditure. The current arrangements for adult social care are inadequate to meet the demand-led pressures that continue to rise as the population ages. The East Midlands experienced a 10.3% increase in people receiving services in 2012/13, and was only one of two regions that experienced an increase. Capacity and options for further savings are limited; with over £335m savings across the region already secured. The Care Act 2014 requires local authorities to help prevent people developing care needs. This is likely to increase costs further.

5.21 This has a number of implications. For example, the reduction in those receiving home care from local authorities will make it more difficult for the NHS to reduce the length of stay in hospitals – the crisis in A&E waiting times this winter led many commentators to highlight the adverse effect of reducing social care spending. The pressures on adult social care budgets are likely to require larger cuts in other local authority services which will decrease the opportunities to use those services to reduce and prevent ill health.

The Better Care Fund

5.22 A summary of the Better Care Fund is included in the Appendix 2 to this report. The process has been beset by changes which have increasingly led towards the fund being focused on urgent care and acute health savings. Signing off BCF plans is a rolling programme; at 21st January 2015, 6 plans within the region were fully approved; the remaining areas resubmitted on 9th January and the outcome should be known in February 2015.

Other Resources 5.23 Other relevant resources and workstreams include

Transformation Funding, Troubled Families, housing capital funding and council borrowing, and health and the economy. The key points are summarised in the table on page 25, which follows the recommendations.

Conclusions

5.24 NHS organisations are experiencing an unprecedented pressure on their budgets. Further savings can be found from improvements in productivity and shifting more ‘care services’ out of the acute sector. However, if the cost of essential services is to be met, then the new funding must meet the costs of transforming services including effective community-based services, rather than short-term fixes or propping up unsustainable provision.

5.25 With the pressures on public finances, the effective and fair basis for the allocation of healthcare funding becomes ever more important. While health has been one of the protected areas of Government spending, funding has increased by an average of just 1.2% in real terms in the four years to 2014/15. This is exceeded by the cost inflation of many healthcare treatments, and occurs at a time of increasing demand for healthcare services. The challenges for the financial sustainability of the healthcare system are clear.

5.26 The current funding allocations are not only unjust but also mean that the region is unable to tackle the big issues that we know the health and public health systems face. However, this is not just another plea for more money. With the almost limitless potential for acute care to absorb any new money, more important is the need for a new model of collective leadership that can offer better outcomes by applying all measures and funding streams that can have a beneficial effect on health outcomes.

Recommendations

5.27 Key Recommendation: The Department of Health should require NHS England to move local commissioners to their target allocations within a maximum of 2 years.

5.28 NHS England and the Department for Health should develop more robust population measures to take account of more turbulent population flows which particularly affect areas with high inward migration or significant seasonal flows.

5.29 The region should take maximum advantage of one-off funding such as the Government’s Transformation Programmes.

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25 A Healthier Future for the East Midlands | February 2015

Funding/Workstream What are the opportunities?

Transformation Funding

There are various funding streams being made available by the government to fund service transformation. Much of the £110m made available so far by DCLG for local authorities has been used to create single management teams and shared services between local authorities. Overall only £5m (4.5%) has been won by East Midlands’ local authorities. Only 1 of the 9 successful East Midlands local authority projects have listed a health agency as a partner.

There is considerable opportunity to increase the share of transformation funding available in the region and for joint approaches with CCGs and other health agencies to achieve mutually beneficial objectives.

Troubled Families

The revised Troubled Families programme now explicitly includes health outcomes in the criteria for referring families for support but all of the criteria relate to health risk indicators.

The Government has indicated that it would make £200m available as reward funding in the next parliamentary term.

Housing

Housing plays an important role in the integration of health and care. Better alignment of existing services and support for people who continue to live in general needs housing is urgently needed, as is a wider range of choices offering housing-with-care.

EMC’s ‘East Midlands Prospectus for Devolution’ calls on Government to devolve full responsibility for housing capital budgets and to relax the rules that prevent councils building much needed housing.

Local Enterprise Partnerships and Health

The region is home to a powerful combination of healthcare assets including universities, teaching hospitals, research intensive NHS Trusts, and a strong base for life and bio-sciences start-ups that include BioCity, MediCity, and the Charnwood Biomedical Campus.

To put into context the economic significance of the health sector: � There are an estimated 251,000 people employed in the

health sector in the East Midlands.

� The East Midlands accounts for 8.5% of the England’s health sector workforce, accounting for just over 13% of the region’s employment.

For example, in the Greater Lincolnshire LEP area, it is forecast that the sector will increase its economic value from £1.55bn p.a. to £1.89bn p.a; 60,000 employees to 66,000.

Specific focus should be on securing better engagement between the health sector and Local Enterprise Partnerships (LEPs). This brings the potential to stimulate research, to improve the ‘attractiveness’ of the region to all clinicians and address the current shortages in primary and secondary care, with the aim of developing the East Midlands as a great place to study and remain.

Better engagement between the health sector and LEPs will: � Build a culture of partnership and innovation.

� Speed up the adoption of innovation into practice to improve product development and clinical outcomes.

Increase research participations and translate research into practice – making the East Midlands an attractive and cost effective provider of clinical research study delivery

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6.1 The country has an ageing population. In the East Midlands, the demographic pressures are likely to be particularly acute with a higher proportion of elderly population than nationally. Between 2012 and 2022, the East Midlands population aged 75-79 is projected to increase by 46%; and those aged 90+ by 57%. The positives of people living longer bring increased health care needs and costs.

6.2 The implications of a disproportionately ageing population are clear - the health workforce must have the capacity and skills to effectively manage an increase both in demand, and in the complexity of that demand due to a rise in the number of patients with multiple health needs. Currently, about 15m people in England have a long-term condition. By 2025, the number of people with at least one long-term condition will rise to 18m (The Kings Fund, 2013). However, fewer newly qualified doctors are choosing to become geriatricians, at the very time when increasing lifespans mean that more are needed.

6.3 The Royal College of GPs in 2013 estimated that by 2021 there could be 16,000 fewer GPs than are needed, while the Royal College of Nursing has forecast a shortfall of 47,500 nurses by 2016 and 100,000 by 2022, as more nurses retire, or go abroad to work, and fewer nurses start training. These are the ‘big’ nationwide headlines but regionally the situation is stark.

6.4 A report by the Royal College of Physicians found that there is a large variation in the number of consultant physicians per head of population across the country. Patients in London have almost double the number of consultants as patients in the East Midlands, and this region has the joint lowest numbers of consultants per head of the population than anywhere in the country.

Unless this region addresses the problems in healthcare recruitment and retention, then with the numbers of GPs and nurses either leaving or set to retire in the next few years, it will face a crises in primary care.

6 Recruitment and Retention of the Health Workforce

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“Given the association between senior hospital doctors and lower hospital mortality, such disparity across the country is concerning. There is a worrying correlation between hospital consultant staffing levels and hospital standardised mortality ratios…. This suggests that London has the right staffing levels and that the rest of the country needs to catch up.” 3

6.5 The region, with its two well-regarded medical schools, is a major centre for training - but medical graduates all too frequently leave once qualified. Of the 505 students who graduated from the medical schools in Nottingham and Leicester in August 2011, 53% moved out of the region for their foundation training over the next two years; and by August 2013, 61% were in further training positions outside the region. This inability to retain medical graduates from the region’s medical schools means a significant loss of expertise and capacity at every stage of training and career progression; making it one of the least popular target destinations for all types of medical training specialisms.

6.6 Part of the problem is down to ‘intake’ – the region’s medical schools generally draw students from outside the region who are therefore inclined to return home after graduation. Many will not ‘put down roots’ while here, as a central location with good transport links mean that many find it easy to return home at weekends during study. Alongside this, there are academic/professional concerns which are being addressed. The East Midlands is not seen as a prestigious training or working environment, and is considered to have limited opportunities, because of a lack of awareness of what the region has to offer. It is considered to be less competitive compared to other regions with a variable standard of educational experience across the region. There is also an awareness of the impact of service pressures affecting time for teaching/learning.

6.7 Recent data and analysis provided by Health Education East Midlands (HEEM) demonstrates the significant challenges filling GP training vacancies in this region, of which over 30% remained unfilled last year, against a 99% fill rate in London and a UK average of 90%. Nevertheless, steady expansion of GP numbers is planned with a national target of 3,250 by 2015, and a regional target of 280. In 2014, the target was 262, however, of those almost a third were unfilled.

6.8 There are similar concerns about recruitment and retention throughout the health system. For example, the East Midlands has one of the lowest levels in England of full time equivalent qualified, contracted nurses per head of population (5.21 nurses per 1,000 population compared to an England average of 5.58). 4

6.9 This problem remains, despite the best efforts of HEEM and others to improve recruitment and retention that include promoting the postgraduate medical specialty schools; championing the development of quality improvement skills in the East Midlands workforce; improving foundation training and increasing places in local communities; providing additional support and early intervention to help trainees achieve their potential, including international graduates adapting to British systems; and developing high quality educational fellowships.

6.10 However, in support of these measures, there are wider initiatives that could be implemented. If more health professionals are needed in the East Midlands – then more must be done to attract them to the region. There is a need to better market the opportunities and ‘offer’ of this region – and there are clear benefits; not just for better health outcomes but also in terms of economic value added, of skilled health professionals and their families coming into a local area.

6.11 One of the key findings of recent reviews of students and young doctors was the lack of knowledge about the East Midlands. Many medical students and qualified health professionals either do not know what this region has to offer or have misconceived ideas about its lack of offer. With effective and targeted marketing of this region, particularly in terms of leisure, culture, housing, improving transport accessibility, career prospects and wider quality of life, the East Midlands becomes more attractive to both medical students and trained health professionals. This is not just an issue for health sector partners – but requires the leadership of LEPs, local councils, wider East Midlands’ wide organisations such as the Academic Health Science Network and destination management partnerships.

3 ‘Hospital Workforce; Fit for the Future?’, Royal College of Physicians, March 2013 4 Source: Health Education England, 2014.

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6.12 Part of the approach also lies in making local communities more ‘welcoming’ to medical students and professionals. Not all are highly paid clinicians, and medical schools have indicated that a ‘package’ developed around medical students would make many areas of the East Midlands more attractive to student placements. In particular, in response to a specific community issue, i.e. a shortage of local health practitioners, local partners could offer transport and leisure discounts, or a wider package of measures designed to both attract and retain students and staff. This encouragement to interact and integrate into local communities would help young health professionals to put down roots in the region and help them to see the value in their individual contribution to the health of the local population, which is known to motivate career choice.

Conclusion

6.13 The problems of recruitment and retention of healthcare professionals are a fundamental obstacle in addressing the health priorities for this region. The problem is particularly acute for primary care; the numbers of GPs per head of the population are amongst the lowest in the country and the East Midlands has the lowest successful ‘fill rate’ for GP posts of any region. This is of particular concern as care is shifting closer to home and good primary care is known to reduce pressure on acute services including A&E.

6.14 Further work is required to encourage doctors to train in the East Midlands; and to ensure that those who do train here, stay here. The sector may learn from what works elsewhere. For example, in Ontario, Canada, preferential treatment is given to local applicants on the basis that local applicants are far more likely to stay in the local area after graduation than those elsewhere, and this is a direct intervention in meeting local need. Alongside this, tied scholarships, such as those operated in Queensland, certainly merit consideration. Whatever approach is

favoured, the region needs to better demonstrate good practice – with its strong record of health and research excellence, recruitment and retention will be improve if the region is seen to offer more in the way of career and professional development.

6.15 Improving the recruitment and retention of key healthcare staff is a priority – but the potential to do this is firmly within ‘local hands‘. This is dependent upon all parts of the East Midlands public sector getting behind efforts to make this region a great place for medics to train and work. As part of this, it is essential that the benefits of training in this region are better publicised. This requires health agencies, local councils and LEPs to better highlight the opportunities in the East Midlands and the benefits of place; both in terms of staying here or re-locating.

6.16 The new plan to expand the general practice workforce announced in January 2015 is welcome, but NHS England and partners should maintain a particular focus on the East Midlands given the issues this report has identified.

Recommendations

6.17 Key Recommendation: To improve the recruitment and retention of key healthcare staff all parts of the public sector in the region should collaborate to make this region a great place for medics to train and work – with a priority for an increased number of GPs.

6.18 Local Authorities, LEPs, East Midlands’ partnership organisations and HEEM should better promote the benefits of locating within the East Midlands. In developing a more positive profile, partners should effectively showcase both the career benefits of being based within the East Midlands, while LEPs and local councils promote the social and economic, cultural and leisure benefits.

6.19 The health sector, through the leadership of Health Education East Midlands, should be supported to develop and implement incentives to encourage key medical staff to train in the East Midlands; and to ensure that those who do train here, stay here.

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29 A Healthier Future for the East Midlands | February 2015

7.1 Despite the intent in Government policy, action by central government departments and agencies tends to continue on previous paths of ‘initiative-itus’ and central control. What is needed, however, is greater collaboration, unity of purpose and a collective sense of leadership at the sub-national level to address the deep-rooted health problems for this region.

7.2 There is a strong case for change:

� Nationally, policy and opinion is moving towards prevention, community and person centred approaches all of which local authorities are best placed to lead.

� Health reforms have moved commissioning to more local agencies (CCGs, NHS Area Teams and Local Authorities) with Health and Wellbeing Boards making good progress towards co-ordinating local health systems.

� Unacceptable health inequalities in the region have existed for many years and successive health regimes have failed to reduce them.

� National approaches have failed to address disparities in the distribution of health professionals.

Local Leadership – A Role beyond the Public Health Grant

7.3 With public health now settled in local government, there is an immediate opportunity for local councils to consider their broader role in improving health and reducing inequalities by applying a whole systems/approach to their public health responsibilities.

7.4 The public health debate needs to move beyond a focus on how the public health grant is spent. In order to make better use of the opportunity of being based in local authorities, public health should prioritise its advocacy and influencing role with other council departments, thus developing a ‘whole local government approach’ to reducing health inequalities. However, this is likely to require a big change

The scale of the challenges that lead to, or are caused by, ill health will not be solved without effective collaboration, a new collective sense of leadership and unity of purpose between the health sector, universities, councils and LEPs. Failure to take action is morally and financially unsound.

7 Collaboration and Leadership

in thinking about how staff are allocated and financial resources used to prioritise health inequalities.

7.5 As a local partner, councils can lead organisations across health, education, social care, the economy and transport in helping them understand the impact on health which they can have. At a policy level, councils can maximise their health impact by applying concepts such as Health in All Policies (HiAP) and toolkits like Health Impact Assessment (HIA).

Integration

7.6 Local government must be given more freedom to lead effective integration in order to take advantage of opportunities for cross-sector working to meet local needs. This would entail moving from a standardised ‘one size fits all’ approach to one in which procurement of local services is able to reflect the circumstances and needs of each locality. Two facts should give the Government confidence to allow this degree of flexibility; local authorities’ track record of consistently balancing their budgets and because Health and Wellbeing Boards, although still relatively new, have made great strides in building relationships and creating mechanisms to bring the health system together at the local level.

7.7 Demographic changes, technological advances and the changing pattern of disease are pushing up the numbers of patients with complex needs who require treatment in the community. There is the opportunity to implement radical reforms that will have real benefit for the health outcomes of local communities while driving down the costs associated with care in the acute sector. This is not about structural reform. With local authorities better placed to take a population health-based approach to designing services, health and social care can be delivered in a more orderly way with the NHS focusing its resources on meeting people’s acute healthcare needs, while the ‘care’ service including mental health care, adult social care and care in the community is locally-led, commissioned and resourced.

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30A Healthier Future for the East Midlands | February 2015

7.8 There is a need to redefine the approach to primary care and to build better working relationships – current levels of confidence and trust are not conducive to joint leadership between the health sector and local government. Genuine co-commissioning remains some way off but as an absolute minimum, collaborative work and leadership should be consolidated through the full alignment of commissioning that will support the move from individual schemes (e.g. BCF) to more joint commissioning and ultimately to full integration and a co-commissioned model.

Collective Leadership on Health

7.9 The General Election will come at a pivotal time for health and social care; financial pressures are set to increase further as the costs of treatment continue to rise through in an increasing and ageing population – alongside increasing public expectations of levels of care. All this is set alongside substantial reductions in local council budgets which have led to significant cuts in adult social care.

7.10 At a time when operational pressures risk crowding out other concerns (the current A&E winter crisis is a good example), the need for confident leadership in articulating a clear and compelling vision has never been more important. Politicians, both at the national and local level, need to be honest with the public about the scale of these challenges; it is not solely how to provide adequate levels of funding to meet future demand for health and social care – but it is also how to reform decision-making and resource allocation in order to unlock better outcomes at reduced cost.

7.11 There currently does not exist any forum where the regional decision makers are able to come together to address key health priorities. There are sector partnerships, but these are inevitably limited in scope. If the important issues are to be addressed through health and the wider public and private sector, then bringing together key decision makers from all sectors to jointly consider the priorities and agreed approach is the only way forward.

7.12 This work should build upon the East Midlands’ strong reputation for engagement and collaboration. 5 This exists in some parts of the healthcare profession – but is lacking elsewhere, particularly between sectors. Brokered in partnership with organisations including East Midlands Leadership Academy, and Academic Health Science Network, a leadership summit is needed to bring together leaders from the NHS, universities, LEPs, industry, the VCS and local councils to develop strong and powerful partnerships in order to drive improvements in healthcare across our region. Particularly important is the way in which leaders are supported and developed to work effectively across organisational and geographical boundaries, with the ability to influence and join-up services where necessary.

7.13 Health and Wellbeing Boards must continue to be at the forefront of reform with local areas having the responsibility for developing their own priorities for improving health and wellbeing and putting in place a range of support, services and information to meet their population’s needs. The collective weight of GPs, local government and health partners gives Boards added value and should enable them to begin to set the agenda for integrated care locally. However, to meet this responsibility, the leadership and capacity of these boards must continue to be genuinely ‘geared up’.

A New Model of Local Leadership

7.14 A new approach to NHS reform is needed where the Government devolves more power and accountability to local councils and the NHS organisations responsible for delivering care. The role of Westminster politicians should be strategic; making decisions about funding, setting the direction of policy and being accountable to Parliament for the performance of the NHS as a whole – leaving leaders in local government and the health sector to improve the focus and quality of services and develop new models of care against local priorities. The NHS Five Year Forward View (October 2014) setting the new way of working is illustrative of the challenge - and the need for councils to be seen as a genuine and full partner - as it contains little reference to social care and local government.

5 As evidenced by a number of partnerships within health; e.g. Health Education East Midlands, East Midlands Leadership Academy, East Midlands Academic Health Science Network, East Midlands Strategic Clinical Senate, Collaboration for Leadership in Applied Health Research and Care East Midlands.

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31 A Healthier Future for the East Midlands | February 2015

7.15 A new model of leadership will involve NHS England Area Teams having the freedom to direct resources in a more innovative way that involves varying the national model of ‘expected outcomes’ with the use of funding against actual local priorities. This would require support from Department of Health/NHS as local partners and delivery should not be held to account in the same way as before – rather local leadership would be accountable against the outcomes agreed through local political negotiation and agreement.

7.16 Alongside this, public health budgets should no longer be ring-fenced with the understanding that local authorities will take a whole place approach to reducing ill health using all the levers that have been referred to in this report so that the overall impact on health outcomes will be much greater than the impact of public health spending alone.

Recommendations

7.17 Key Recommendation: Council and NHS leaders should together develop a new model of collective leadership to improve health outcomes which requires:

� Greater local autonomy for policy setting and integration of funding.

� A collaborative approach with other parts of the public sector including police, universities and LEPs.

� Working towards a fully integrated whole place/whole system approach backed by place-based budgets for the prevention and treatment of ill health.

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32A Healthier Future for the East Midlands | February 2015

8 Appendix 1: Health Profile

% aged 0-15 living in income deprived households, 2010 - source: DCLG

% of people who live in pension credit Affecting Older People Index, 2010 – source: DCLG

Births with birth weight less than 2,500g as a proportion of live and still births with valid weight, 2008-2012 – source: ONS

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33 A Healthier Future for the East Midlands | February 2015

Proportion of the population aged 16-64 that reported day-to-day activities were limited, 2011. Source: NOMIS Census 2011

The percent of working days lost due to sickness absence by LA, 2010-2012. Source: Public Health Outcomes Framework (PHOF)

12

10

12

England

8

64 y

ear

old

popu

lati

on

6

64 y

ear

old

popu

lati

on

4

% o

f 16-

64 y

ear

old

popu

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0

2

0

4.5

5

The

perc

ent

of w

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lost

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3

3.5

4

The

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England

2

2.5

3

The

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34A Healthier Future for the East Midlands | February 2015

The rates of under 75 mortality from preventable causes (CVD, cancer, liver and respiratory disease) and overall mortality from communicable disease, 2010-2012. Source: Public Health Outcomes Framework (PHOF)

120

100

120

Under 75 mortality rate from

80

100

Rate

per

100

,000

spe

cifie

d po

pula

tion

cardiovascular diseases considered preventable

Under 75 mortality rate from cancer considered preventable

60

80

Rate

per

100

,000

spe

cifie

d po

pula

tion

preventable

Under 75 mortality rate from liver disease considered preventable

40

Rate

per

100

,000

spe

cifie

d po

pula

tion

Under 75 mortality rate from respiratory disease considered preventable

Mortality from

20

Rate

per

100

,000

spe

cifie

d po

pula

tion

Mortality from communicable diseases

0

Tables: Public Health Outcomes Framework (PHOF); Overarching Indicators and Wider Determinants

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37 A Healthier Future for the East Midlands | February 2015

Local government and health partners have worked hard on agreeing and concluding the Better Care Fund negotiations. This has been a difficult process made more so as it kept changing.

The £3.8 billion Better Care Fund (BCF) was announced by the Government in the June 2013 Spending Round, to support transformation and integration of health and social care services to ensure local people receive better care. i BCF was introduced as:

‘A single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities… with the aim of delivering better, more joined-up services to older and disabled people, to keep them out of hospital and to avoid long hospital stays’

Local authorities across England received £200 million in 2014/15 from the Department of Health to prepare for the first full year of the Fund in 2015/16. The Fund consists of existing funding, with no new money except a small proportion allocated in support of early work on the implementation of the Care Act (£135m nationally).

The minimum amount to be pooled for the Better Care Fund is £3.8bn. In the 2013 spending round the planning assumption was that £1bn savings would be realised from the implementation of the BCF in 2015/16.

This has been a complex and difficult process to implement especially as the framework for the BCF has been subject to multiple policy changes and changing benefits assumptions over the course of 2014/15.

A report from the National Audit Office, ‘Planning for the Better Care Fund’ has reviewed the process to date. It reports that the initial BCF plans submitted in April 2014 did not meet ministers’ expectations or offer the level of savings expected. Also the level of engagement with acute provider trusts was found to be variable, and in some areas did not provide sufficient assurance that plans had been locally agreed.

Local areas said in their April 2014 plans they would save £731m; but NHS England estimated that the same plans would only generate £55m of credible annual savings from the Fund. Local areas were instructed to submit revised plans based upon stronger evidence by September within the following framework:

� The introduction of pay for performance scheme linked to achieving a reduction in total emergency admissions of 3.5%.

� £1 billion of the NHS additional contribution to the BCF had to be commissioned by the NHS on out of hospital services or be linked to the corresponding reduction in total emergency admissions.

In their September 2014 plans local areas proposed savings of £532m in 2015/16, of which £314 million would be saved for the NHS from fewer emergency admissions to hospitals and fewer delayed transfers from hospitals.

In November 2014,ii the NAO report found that the Better Care Fund will not deliver even a third of the planned £1bn savings as early preparations were ‘inadequate’ and ‘did not match the scale of the ambition’.

‘The Better Care Fund is an innovative idea but the quality of early preparation and planning did not match the scale of the ambition. The £1 billion financial savings assumption was ignored, the early programme management was inadequate, and the changes to the programme design undermined the timely delivery of local plans and local government’s confidence in the Fund’s value…….To offer value for money, the Departments need to ensure more effective support to local areas, better joint working between health bodies and local government, and improved evidence on effectiveness.’

Amyas Morse, head of the National Audit Office.

The changes introduced during this summer risk undermining the Fund’s core purpose of promoting locally led integrated care, and reduce the resources available to protect social care and prevention initiatives. Both the LGA and the Association of Directors of Adult Social Services are concerned that linking only NHS emergency admissions to payment for performance undermines the programme’s aim of integrating health and social care better to improve outcomes for service users.

9 Appendix 2: The Better Care Fund

i HM Treasury, Spending Round 2013, June 2013, available at: https://www.gov.uk/government/publications/spending-round-2013-

documents

ii Planning for the Better Care Fund

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The East Midlands Position

As noted above, revised BCF plans were submitted by 19th September and subsequently went through a Nationally Consistent Assurance Review (NCAR) process. The outcome of the NCAR categorised plans into one of four assurance categories: approved, approved with support, approved subject to conditions, or not approved.

Plan Approvals: Comparison of Plans

Status England-wide East Midlands Common issues driving status

Approved 6 1High quality plans where any actions were easy to resolve and delivery risk was low.Plans were well articulated.

Approved with Support 91 5 Outstanding actions but could be resolved in a relatively straightforward way

Approved with Conditions 49 2Material actions that need to be addressed that will take some effort to resolve.Material outstanding risks relating to the National Conditions or non-elective targets.

Not Approved 5 1 Plan not submitted Plans not jointly owned.Plan of poor quality.

Signing off BCF plans became a rolling programme as areas in the ‘approved subject to conditions’ and ‘not approved’ categories resubmitted updated plans. By the end of December 2014 6 plans within the region were fully approved. The remaining areas resubmitted on 9th January and the outcome should be known in February.

Area NCAR Outcome January 2015

Derby City Approved with Conditions

Should be confirmed early Feb 2015

Derbyshire Approved with Support Approved

Leicester City Approved with Support Approved

Leicestershire Approved with Support Approved

Lincolnshire Approved with Conditions

Should be confirmed early Feb 2015

Northamptonshire Not Approved Should be confirmed early Feb 2015

Nottingham City Approved Approved

Nottinghamshire Approved with Support Approved

Rutland Approved with Support Approved

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Mansfield District Council Hospital Discharge Scheme Pilot

Mansfield District Council is working in collaboration with Adult Social Care and Health to secure early intervention and discharge from hospital and residential care. The Council’s Housing Needs staff work alongside colleagues at Kings Mill Hospital and help speed up discharge of medically fit patients. During the initial 8 week period the pilot secured appropriate outcomes for over 40 cases. The scheme formally commenced in October 2014 and will run to the end of March 2015. The support provided by the Council includes:

� Locating alternative suitable accommodation across the rented sector

� Providing key safe installation and minor adaptations

� Installing lifeline and telecare

� Prioritising existing adapted accommodation to meet the needs of those requiring discharge

� Providing temporary accommodation to facilitate discharge

� Provide specialist support for those with complex needs

� Signposting and arranging for appropriate support to be delivered to meet individual need and improve health and wellbeing

� Treating all hospital and residential care discharges as a priority

� Developing a 24/7 supported assessment unit

� Supporting the A&E Department engaging with those who have a social need and freeing up hospital staff to deal with medical emergencies, including a weekend pilot to build resilience against winter pressures.

The Light Bulb Project in Leicestershire

The Leicestershire Light Bulb Project is part of a wider approach of reducing health inequalities by tackling the wider determinants of health. Public health has had a key partner role as part of the Better Care Fund (BCF), working with district councils, adult social care, and health and voluntary organisations to develop an evidence based approach.

The Light Bulb Project is an innovative project that will enable and empower people to remain independently at home by delivering integrated practical housing support. This will be through a single, trusted and easily accessible service that is tenure neutral, income generating, stigma free and shaped around a person’s needs – not an organisation’s threshold or capacity.

The project brings together housing support budgets across Leicestershire’s seven district and county councils to provide a range of services including home adaptations, disabled facilities grants, affordable warmth, home safety, housing based support, handy person services, assessments, aids and equipment assistive technology.

It will improve system efficiency, quality, access and reduce avoidable hospital admissions (especially due to home injuries), hospital bed days and falls. In providing a ‘proportionate universal’ service, it is available to local people, regardless of tenure or levels of income although people not eligible for publicly funded housing support would be able to pay for services, thus contributing towards the on-costs of the organisation.

10 Appendix 3: Good Practice Examples

Meeting Accommodation Needs - Good practice case study:

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Cost Rationale The Light Bulb Project is developed on evidence that housing adaption is a cost effective intervention for health and social care, with the NHS spending £2.5bn a year on illness due to poor housing, £146m treating accidental home injuries in children and young people, and £2bn on falls and fractures in over-65s.

Specifically for this project, the National Institute for Health and Care Excellence has also estimated that offering home safety assessments to families with young children and installing safety equipment in the most at risk homes would cost £42,000 per average local authority. If this prevented 10 per cent of injuries, it could save £80,000 in prevented hospital admissions and emergency visits, with further savings in associated GP visits and for ambulance, police and fire services.

Effective use of public health’s partner role, such as the Light Bulb Project, will therefore deliver significant overall health and wellbeing outcomes to the Leicestershire population, while supporting a reduction in health inequalities across the county.  A phased rollout is due to start in April 2015/16.

Health and Care in Greater Lincolnshire - The Way Forward 2014

Greater Lincolnshire Local Enterprise Partnership (LEP) is committed to championing a world-class health and care sector in Greater Lincolnshire which is strong and vibrant, and based on innovative and collaborative partnerships. Lincolnshire’s Director of Public Health is a member of Greater Lincolnshire LEP’s Board and has led the preparation of a strategy for growing the economic value of the health and social care sectors: Health and Care in Greater Lincolnshire - The Way Forward 2014.

The LEP wants to see the Health and Care Sector as being a vibrant sector that offers great places in which to work and have a career, and which provide the right environment for local research, innovation, technology and service provision that leads to economic growth.

http://www.greaterlincolnshirelep.co.uk/assets/downloads/285_GLLEP_Care_Sector_Brochure.pdf

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NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC East Midlands)

It is one of 13 regional CLAHRC partnerships funded by the National Institute for Health Research (NIHR).

It works with more than fifty local partners from universities, the NHS, industry and the public to improve health outcomes across the region: delivering and implementing world class health research to ensure healthier and longer lives for East Midlands’ residents.

East Midlands Academic Health Science Network (EMAHSN)

It is one of 15 regional Academic Health Science Networks around the country.

It was set up by NHS England in 2013 and its remit is to identify and spread innovation at pace and scale: bringing

together the NHS, universities, industry and social care to transform the health of the 4.5m East Midlands residents and stimulate wealth creation.

Health Education East Midlands (HEEM) It works as part of NHS Health Education England (HEE) and

its goal is to develop a high quality, safe and sustainable workforce with the best possible education and training for students, trainees and staff.

It acts as a ‘convenor’ of the East Midlands health system: bringing people together across NHS, social care and the third sector: working on large scale change, championing education and training as a lever for improvement and acting as an exemplar for workforce best practice and innovation.

11 Appendix 4: Wider Health Partners

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42A Healthier Future for the East Midlands | February 2015

East Midlands Leadership Academy It serves the leadership and development needs of all NHS

organisations in the East Midlands, and also provides the regional home for co-ordination of national leadership activity and government priorities.

It promotes and delivers senior development across the region: building leadership capacity and capability in all of its member organisations by designing, commissioning and delivering high quality leadership development interventions and activity.

East Midlands Strategic Clinical Networks (EM SCNs)

It supports improvement in the quality and equity of care and outcomes of the East Midlands population with a focus on cancer, mental health, children’s and maternity services and cardio-vascular disease.

It brings together those who use, provide and commission the service to make improvements in outcomes for complex patient pathways using a ‘whole system’ approach: supporting decision making and strategic planning, and working across the boundaries of commissioner, provider and voluntary organisations as a vehicle for improvement for patients, carers and the public.

East Midlands Strategic Clinical Senate (EM Senate)

It plays a unique role in the commissioning system by providing strategic clinical advice and leadership across the East Midlands to clinical commissioning groups (CCGs), health and wellbeing boards and the Area Team of NHS England.

It provides multi-disciplinary clinical leadership: working with patients and the public to provide independent advice on issues that will transform health care, better integrate services and ensure future clinical configuration of services are based on the considered views of local clinicians, and are in the best interest of patients.

NIHR Clinical Research Network East Midlands (NIHR CRN EM)

It is one of 15 regional CRNs, and provides the infrastructure that supports high quality clinical research to take place, ensuring East Midlands patients benefit from new and better treatments.

It achieves this by helping researchers to set up studies quickly and effectively, supporting the life sciences industry to deliver research programmes, providing health professionals with research training, and working with patients to ensure their needs are placed at the heart of research activity.

NIHR MindTech It is one of eight NIHR Healthcare Technology Co-

operatives in England. Each one concentrates on different areas of unmet need – their focus is mental healthcare and dementia – and they bring together healthcare professionals, researchers, industry and the public.

It achieves this using clinical and technical expertise to build collaboration: developing and testing a range of new technologies, and provides advice and knowledge exchange to help increase their adoption.

Institute of Mental Health It is the UK’s prime location for inter-disciplinary research

in the mental health field. A partnership between Nottinghamshire Healthcare NHS Trust and the University of Nottingham, they bring together the healthcare and education sectors to promote research, support clinical practice, provide educational courses and act as an expert resource in promoting best practice.

Since its formation in 2006 they have pioneered education provision and innovative service-facing research that supports their mission: to improve people’s lives through innovating, developing, exploiting and distributing knowledge about mental health.

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43 A Healthier Future for the East Midlands | February 2015

East Midlands CouncilsT: 01664 502 620E: [email protected]: www.emcouncils.gov.uk @EMCouncils

East Midlands CouncilsPera Business ParkNottingham Road, Melton MowbrayLeicestershire, LE13 0PB

For more information please call 01664 502 620 ore-mail: [email protected]

This document has been printed on recycled paper.

Published February 2015.

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Improvement and Transformation Board 2nd March 2015

EMC Business Plan

Summary The following report invites Members to inform the development of the EMC Business Plan 2015/16 with particular focus on two proposed reviews: a) The impact and implications of the local government funding settlement. b) Housing pressures in the East Midlands.

Recommendations Members of the Regional Improvement and Transformation Board are invited to inform the development of the EMC business plan with specific reference to proposed reviews on: The local government funding settlement.

Housing pressures in the East Midlands.

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1. Introduction 1.1 The Executive Board will meet on 20th March to consider and agree a draft business

plan for 2015/16 that will include a statement of EMC’s objectives and proposed activity over the next 12 months. As a membership body, the priorities of EMC should be developed and agreed by member councils and clearly presented for review, not just in order to promote an understanding of the roles and responsibilities of EMC, but also as a measure against which our performance and value as an organisation should be judged.

1.2 Against this business plan, EMC must be flexible and respond to the changing priorities

and challenges faced by the sector. Therefore, the activities within it may change if Members require it to. However, within this context, the business plan should reflect issues highlighted through initial consultation with our membership and so provide the basis for work in the coming year.

1.3 To inform the EMC Business Plan, Members of the Regional Improvement and

Transformation Board are invited to consider those issues to focus its activity on during 2015/16. In particular, Members are invited to highlight those areas upon which it can provide leadership and oversight.

1.4 Recent examples include the welfare reform and health reviews. Both these reviews

are key elements of the all-member and policy development approach, and the Board provided effective governance to the development and completion of this work.

2. Background 2.1 The focus for the Business Plan is provided by the new ‘4 pillar’ approach unanimously

agreed by Members, as shown by diagram below and business plan summary attached as Appendix 8(a): All-Member Organisation. Policy Development. Collective Work and Lobbying. Improve Communication.

2.2 Pillar One: EMC established as an ‘all-member’ organisation through securing greater

member involvement. A fundamental change is that instead of an organisation that focuses on the limited number of councillors who comprise the actual membership of East Midlands Councils, EMC has become more of an ‘all member’ organisation through offering opportunities for all councillors in the region to be actively involved in some way in the work of EMC.

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Item 8

2.3 Pillar Two: A focus on policy development, with the membership providing the mandate for action (based upon an annual work programme).

2.4 Pillar 3: More effective collective work and lobbying. The identification of practical

solutions and policy responses should link campaigning to the collective work of member councils, specifically in conjunction with the work of the All-Party Parliamentary Group of MPs (East Midlands) and LEPs.

2.5 Pillar 4: Improve communication with the membership and outside partners to better

promote the identity and profile of the region alongside the value of the organisation. While aware of the political sensitivities of the ‘region’, there is nevertheless a need to better promote this region and to support better joint working (as exists in other regions). The concern is that a failure to do so will do nothing to stop the region continuing to lose out in securing resources and wider investment.

2.6 The 4 pillar approach will continue to provide the framework for the proposed

programme of work. While some issues inevitably relate to more than one pillar of work, this approach does provide clarity on the focus of organisational activity against the priorities identified by the independent review and unanimously agreed by Members.

3. Policy Development and Member Engagement 3.1 In undertaking reviews on issues of importance to the region, e.g. health and welfare

reform; both the local government funding settlement and housing pressures in the region have been highlighted. If these reviews are to be progressed, Members should inform the development of the terms of reference and provide oversight on undertaking and completing any subsequent review.

Pillar 1 All-Member organisation

Pillar 2 Policy

Development

Pillar 3 Collective Work and Lobbying

Pillar 4 Improve

Communication

East Midlands Councils Councillor-Led and Voice for the Region

Governance: Full EMC Membership Management Group, Executive Board and Regional Boards

EMC budget 2014/15 - £963,500

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a) Local Government Funding Settlement 3.2 The provisional Local Government Finance Settlement 2015-16 which was published

by Government at the end of 2014 confirmed that councils would continue to face significant spending cuts and huge financial challenges.

3.3 Although councils in the East Midlands have so far done their best to largely restrict

the impact of cuts on their residents, this latest settlement is going to further increase pressure on many core services, including children’s and adult social care and highways.

3.4 EMC published a summary of the provisional settlement figures in the East Midlands

for 2015/16 that showed: A reduction in the Revenue Support Grant (RSG) for the East Midlands of 28.4%,

compared to 27.4% for England as a whole, which equates to a £272.5 million cut for the region.

Lincoln City Council has the greatest percentage cut in RSG at 31.9%, followed by Ashfield District Council and Borough of Wellingborough (both see a 31.8% cut).

Bolsover District Council had the lowest cut at 23.3%. Derby, Nottingham and Leicester Cities have cuts in their RSGs of 29.6%, 30.7%

and 30.0% respectively. Nottinghamshire suffered the largest cut in RSG of the county authorities in the

region at 28.0%, compared to an average cut for the county authorities of 27.2%. 3.5 Following consultation the Settlement was confirmed on 3rd February. Upper tier

authorities were awarded an additional £74m in 2015/16 to cover rising costs of social care and demand for welfare. Whilst the Government states the final settlement will bring the reduction in councils’ spending power down 0.1% to 1.7%, organisations including CIPFA, whilst welcoming the additional funding, believe it ‘unlikely that £74m will be enough to meet the challenges that many councils are facing in caring for their most vulnerable citizens’. The equivalent average cut faced by authorities in the East Midlands is 1.3%. As part of the announcement the Government confirmed there will be no other changes to the provisional settlement and the trigger for a referendum on council tax increases would remain at 2%.

3.6 A summary table of the provisional financial settlement for local councils and fire and

rescue authorities in attached as Appendix 8(b). The table also show data for ‘Funding Assessment’ and ‘Revenue Spending Power’ (with some councils in the East Midlands facing cuts of up to 6.4%).

3.7 Initial feedback from a number of council leaders includes a suggestion that East

Midlands Councils should support its membership in working with Government in addressing their financial challenges. We have already seen a number of ‘individual

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Item 8

representation/delegations’ and there could be an opportunity to highlight the particular challenges facing councils in this region.

3.8 Similar to wider collective work, a joint approach can support a more substantive case not just to Government, but also offers an opportunity to highlight the specific issues local to our ‘patch’ to both the LGA and MPs (through the EM APPG).

b) Housing Pressures in the East Midlands

3.9 The availability of housing remains a major concern for councils and communities across the East Midlands. Recent regional research by the National Housing Federation has highlighted the persistent gap between housing need and the delivery of new stock, and the rising disparity between house prices/rents and wages.

3.10 Cuts to the HCAs capital budget and restrictions on the use of Section 106 Planning Obligations have limited the delivery of affordable housing, particularly in rural areas; and recent official data has indicated that social housing lost through ‘right to buy’ is not being replaced at the same rate. At the same time, changes to housing benefit and other welfare payments has increased demand for social housing, particularly for smaller units.

3.11 In 2012, East Midlands Councils, the HCA and the National Housing Federation introduced the ‘East Midlands Declaration on Affordable Housing’, designed for individual councils to sign and comprising a set of core commitments to meet housing need locally. Over 30 councils in the East Midlands adopted the Declaration, attached as Appendix 8(c).

3.12 Three years on, it seems appropriate for EMC to revisit the issue and to undertake a review of housing in the East Midlands, similar to recent work on welfare reform, migration, flooding and public health, for publication at EMCs July 2015 AGM. This could focus just on affordable housing, the impact of the East Midlands Declaration and inter-actions with the reformed benefits system. Or it could take a broader perspective and look at the challenges around the delivery of all housing and the relationship between housing markets and local economies in the East Midlands.

3.12 Whatever scope Members agree, there is likely to be an opportunity to work with the National Housing Federation and potentially other housing interests to deliver a housing focussed review over the next few months.

4. Recommendation

Members of the Regional Improvement and Transformation Board are invited to:

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4.1 Inform the development of the EMC business plan with specific reference to proposed reviews on: a) The local government funding settlement.b) Housing pressures in the East Midlands.

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Appendix 8(a)

East Midlands Councils Councillor-Led and Voice for the Region

Pillar 1: All-Member Organisation Pillar 2: Policy Development Pillar 3: Collective Work & Lobbying Pillar 4: Improve Communication

Outcomes: Councillors better able to promote and adopt

best practice locally and regionally. Councillors better able to engage and inform

the work of EMC. Secure greater resources/benefit to the region

through an enhanced profile.

Outcomes: Councillors better able and supported to provide leadership on key

issues. Councillors are more effective in lobbying on key regional issues and

securing a better funding deal/investment and resources for the region. More effective and collective approach between councillors, MPs, MEPs,

business leaders and other partners. Enhanced public profile for EMC and its leadership. The East Midlands has a greater profile and ‘speaks’ authoritatively on

key issues.

Outcomes: Councillors have a better understanding and

engagement with policy of relevance andimportance to the region. Councillor, MPs, MEPs or other partners (e.g.

business leaders) have an effective relationshipand joint approach. Policy is better informed by, and reflects; local

priorities, concerns and opportunities. EMC is able to more effectively represent member

councils at the national level.

Outcomes: Councillors are more informed on issues that

matter to them. Councillors are able to plan for and

implement new policies in their local council. Councillors have greater ‘ownership of EMC.

Services: Every councillor offered opportunities for

member development and to inform thepolicy work of EMC. New councillor inductions after council

elections. Online forums. Member Development events, action learning

and peer mentoring. Provision of bespoke and cost effective HR

and organisational capacity support. Provision of discounted services for member

councils, e.g. pay benchmarking database, ITsecurity and online recruitment portal.

Actions: Audit of learning and development needs. An expanded member development

programme (delivered both regionally andlocally). Member briefing and consultation events on

key/significant issues. Roll-out of mentoring/coaching offer and

support. Widen opportunities for member-leads on

specific issues/priorities. Facilitating personal development plans for

councillors.

Services: Refreshed weekly Policy Brief. All councillors offered the opportunity to inform

the development of EMC policy/response. Reviews focused upon clear conclusions and

recommendations. Represent the region on a range of key issues of

collective concern; economic growth andinfrastructure, migration, health and well-being,children’s and adults services, regional paynegotiations and consultation, and climate changemitigation and adaptation.

Actions: Respond to changing policy environment and

provide platform for Councillor leadership on keypolicy issues: e.g. welfare reform, New HomesBonus, CIL, affordable housing investment. Develop policy forward plan that reflects risk,

opportunities and actions required. Regular MP and MEP briefings. Regular councillor and officer briefing

opportunities. Councillor-led task and finish groups develop

collaborative policy on specific issues; health,migration and European funding. Promote more effective LEP co-ordination. Promote social care and NHS integration. Promote and develop regional leadership on

climate change adaptation and mitigation.

Services: High quality briefings and support fro councillors on priority issues. A greater number of events on specific issues to provide a platform to

influence and lobby. Enhanced councillor leadership and support for ‘portfolio leads’ amongst

Executive Board members. Enhanced links with the national (trade press), regional and local media. Update prospectus on investment and infrastructure opportunities. Secretariat and co-ordinating role for EM APPG (MPs) and MEPs. Hosting Climate East Midlands.

Actions: More active approach to communications and media work. Coordinate joint external/lobbying work of EM APPG, business, trades

unions and VCS, Government Departments. Identify lobbying opportunities and provide a platform for councils’ voice. Undertake specific and time-limited reviews, led by task and finish groups,

on growth and infrastructure, European funding, migration and health. Respond to consultations/calls for evidence/select committees to provide

single voice on issues of common concern. Campaign of key issues that include wider levels of public funding, rural

issues, efficiency and innovation. Showing best practice amongst regional and national partners (e.g. South-

West Councils, LGA). Focused work to secure a greater share of investment through: Joint work on A5 (Staffordshire–Leicestershire–Northamptonshire) Castle Line (Lincoln-Newark-Nottingham Rail Corridor) The upgrade and electrification of the Midlands Mainline Establish HS2 Programme Board for the East Midlands Increase levels of investment in affordable housing Securing additional investment in strategically important flood defences

Services: Highlight best practice and case studies. Online forum for councillors, officers and

partners. Peer challenge and support. Joint procurement to secure efficiencies for

sector. Opportunities for councillors to share thinking

with wider sector. A refreshed weekly Policy Brief.

Actions: Better use of EMC website including a

discussion facility, Twitter and other socialmedia. Targeted promotion of specific regional/sub-

regional issues. Calls for evidence from the sector to identify

best practice within region and nationally. Specific events on best practice and wider

opportunities for the sector. Further developed links with the LGA, e.g. peer

challenge, joint events. Further develop links with partner

organisations, e.g. Government Departments,voluntary and community sector, businessorganisations.

Governance: Full EMC Membership Management Group, Executive Board and Regional Boards

EMC budget 2014/15 - £963,500

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Item 8, Appendix (b)

Local Authority figures for each component in Provisional Spending Power 2015-16

CLASS rcode

Local Authority Adjusted 2014-15 Revenue Spending

Power

Estimated 2015-16 Revenue Spending

Power including Better Care Fund and

Efficiency Support Grant

Change in estimated 'revenue

spending power' 2015-16 including

Efficiency Support Grant

2014-15 Allocation: Adjusted Revenue Support Grant

2015-16 Allocation: Revenue Support Grant

Reduction in RSG Reduction in RSG 2014-15 Allocation: Settlement Funding Assessment

2015-16 Allocation: Settlement Funding Assessment

Reduction in funding 2015-16 (autocalculated)

Reduction in Funding Assessment 2015-16

£m £m % £ % %

TE England 52,598.090 51,484.104 -2.1% 13,001,330,999 9,435,365,360 3,565,965,639 27.4 24,112,194,945 20,758,538,808 3,353,656,137 13.9%nonGLA England except the GLA 49,796.109 48,876.714 -1.8%

GLA R570 Greater London Authority 2,801.981 2,607.390 -6.9%

East Midlands SD R52 Amber Valley 13.538 12.834 -5.2% 3,337,072 2,313,057 1,024,016 30.7 6,206,893 5,237,715 969,178 15.6%SD R229 Ashfield 15.296 14.834 -3.0% 3,920,897 2,674,626 1,246,271 31.8 7,381,077 6,200,924 1,180,153 16.0%SD R230 Bassetlaw 14.623 13.705 -6.3% 4,095,722 2,800,513 1,295,209 31.6 7,708,209 6,482,029 1,226,180 15.9%SD R185 Blaby 9.833 9.490 -3.5% 2,266,842 1,558,579 708,262 31.2 4,253,097 3,582,788 670,309 15.8%SD R53 Bolsover 10.752 10.111 -6.0% 4,042,430 3,102,529 939,901 23.3 6,648,696 5,758,596 890,100 13.4%SD R194 Boston 9.497 8.890 -6.4% 2,767,701 1,908,326 859,375 31.1 5,174,978 4,361,602 813,376 15.7%SD R231 Broxtowe 12.044 11.273 -6.4% 3,008,476 2,090,741 917,735 30.5 5,588,974 4,720,548 868,426 15.5%SD R186 Charnwood 18.086 17.667 -2.3% 4,412,424 3,043,284 1,369,140 31.0 8,235,566 6,939,480 1,296,086 15.7%SD R54 Chesterfield 11.728 10.977 -6.4% 3,441,213 2,362,741 1,078,472 31.3 6,445,677 5,424,615 1,021,062 15.8%SD R208 Corby 9.791 9.636 -1.6% 2,174,673 1,502,604 672,069 30.9 4,057,877 3,421,793 636,085 15.7%SD R209 Daventry 8.851 8.685 -1.9% 2,136,402 1,472,538 663,864 31.1 4,022,573 3,394,750 627,822 15.6%UNITARY R621 Derby 217.185 209.904 -3.4% 63,272,743 44,515,908 18,756,835 29.6 114,678,712 96,904,156 17,774,556 15.5%SC R634 Derbyshire 551.551 550.385 -0.2% 128,052,751 92,293,448 35,759,304 27.9 228,579,063 194,740,645 33,838,419 14.8%SD R60 Derbyshire Dales 9.615 9.322 -3.1% 1,861,145 1,370,650 490,496 26.4 3,352,997 2,891,008 461,989 13.8%SD R195 East Lindsey 18.865 17.658 -6.4% 6,306,653 4,355,447 1,951,206 30.9 11,784,770 9,938,241 1,846,528 15.7%SD R210 East Northamptonshire 9.940 9.667 -2.7% 2,478,311 1,709,463 768,848 31.0 4,624,590 3,896,754 727,836 15.7%SD R56 Erewash 13.326 12.628 -5.2% 3,433,190 2,377,398 1,055,792 30.8 6,393,658 5,394,435 999,223 15.6%SD R232 Gedling 13.496 13.013 -3.6% 3,124,799 2,146,229 978,569 31.3 5,864,686 4,938,471 926,215 15.8%SD R187 Harborough 10.717 10.769 0.5% 1,909,349 1,367,419 541,930 28.4 3,486,226 2,974,427 511,799 14.7%SD R57 High Peak 10.669 10.131 -5.0% 2,487,424 1,748,251 739,173 29.7 4,596,115 3,897,236 698,879 15.2%SD R188 Hinckley and Bosworth 10.696 10.437 -2.4% 2,669,064 1,838,548 830,516 31.1 4,983,541 4,197,250 786,290 15.8%SD R211 Kettering 13.001 12.799 -1.6% 2,656,943 1,866,954 789,989 29.7 4,905,125 4,158,094 747,030 15.2%UNITARY R628 Leicester 327.506 309.748 -5.4% 110,568,984 77,430,905 33,138,079 30.0 200,810,542 169,396,824 31,413,718 15.6%SC R639 Leicestershire 399.494 405.979 1.6% 74,290,191 55,754,468 18,535,723 25.0 129,395,853 111,913,105 17,482,748 13.5%SD R196 Lincoln 15.204 14.433 -5.1% 3,798,697 2,585,331 1,213,366 31.9 7,195,621 6,047,165 1,148,456 16.0%SC R428 Lincolnshire 515.929 513.187 -0.5% 129,081,307 93,751,625 35,329,682 27.4 228,351,284 194,918,480 33,432,804 14.6%SD R233 Mansfield 13.891 13.117 -5.6% 3,836,344 2,651,517 1,184,827 30.9 7,160,091 6,038,776 1,121,315 15.7%SD R190 Melton 6.861 6.476 -5.6% 1,424,572 1,019,696 404,876 28.4 2,606,962 2,224,680 382,283 14.7%SD R234 Newark and Sherwood 14.888 14.120 -5.2% 3,794,246 2,623,636 1,170,610 30.9 7,069,645 5,961,622 1,108,022 15.7%SD R58 North East Derbyshire 11.231 10.514 -6.4% 2,855,236 1,970,753 884,483 31.0 5,350,626 4,513,826 836,801 15.6%SD R197 North Kesteven 13.276 12.696 -4.4% 3,150,448 2,175,883 974,565 30.9 5,923,532 5,001,956 921,576 15.6%SD R191 North West Leicestershire 11.656 11.657 0.0% 2,510,939 1,749,418 761,521 30.3 4,651,605 3,930,989 720,616 15.5%SD R212 Northampton 30.093 29.278 -2.7% 7,109,567 4,943,552 2,166,015 30.5 13,193,887 11,144,133 2,049,754 15.5%SC R430 Northamptonshire 471.023 472.510 0.3% 105,582,907 77,239,943 28,342,964 26.8 187,533,893 160,756,871 26,777,022 14.3%UNITARY R661 Nottingham 325.966 308.087 -5.5% 105,445,090 73,074,858 32,370,232 30.7 191,458,156 160,731,487 30,726,670 16.0%SC R669 Nottinghamshire 572.527 571.877 -0.1% 124,166,513 89,416,935 34,749,578 28.0 221,151,811 188,255,455 32,896,355 14.9%SD R192 Oadby and Wigston 6.875 6.475 -5.8% 1,616,025 1,129,857 486,168 30.1 2,989,576 2,529,654 459,921 15.4%SD R236 Rushcliffe 11.752 11.436 -2.7% 2,435,439 1,679,417 756,023 31.0 4,558,922 3,843,476 715,447 15.7%UNITARY R629 Rutland 32.823 33.417 1.8% 5,362,579 4,072,578 1,290,001 24.1 9,329,724 8,115,528 1,214,196 13.0%SD R59 South Derbyshire 11.540 11.362 -1.5% 2,613,455 1,811,467 801,987 30.7 4,861,159 4,102,122 759,038 15.6%SD R198 South Holland 12.150 11.395 -6.2% 3,443,089 2,381,045 1,062,044 30.8 6,422,809 5,417,703 1,005,107 15.6%SD R199 South Kesteven 16.455 16.037 -2.5% 3,764,176 2,612,201 1,151,976 30.6 7,032,025 5,942,492 1,089,533 15.5%SD R213 South Northamptonshire 10.871 10.857 -0.1% 2,032,331 1,452,138 580,193 28.5 3,711,840 3,163,739 548,101 14.8%SD R214 Wellingborough 8.843 8.277 -0.064 2,438,101 1,663,567 774,534 31.8 4,593,768 3,860,425 733,343 16.0%SD R200 West Lindsey 13.089 12.615 -3.6% 3,136,877 2,198,141 938,737 29.9 5,828,894 4,941,598 887,297 15.2%

Total 3867.044 3810.366 -1.47% 958,313,336 685,808,182 272,505,154 28.4 1,720,155,326 1,462,207,662 257,947,664 15.0%

SFIR R972 Nottinghamshire Fire Authority 43.326 41.846 -3.4% 12,466,087 10,342,297 2,123,790 17.0 22,125,925 20,186,718 1,939,207 8.8%SFIR R961 Leicestershire Fire Authority 36.653 35.342 -3.6% 10,154,966 8,386,749 1,768,217 17.4 18,177,165 16,562,238 1,614,927 8.9%SFIR R956 Derbyshire Fire Authority 38.752 37.562 -3.1% 10,363,301 8,610,267 1,753,034 16.9 18,363,727 16,763,567 1,600,160 8.7%

Lincolnshire Fire Authority 7,720,665 6,478,561 1,242,104 16.1 13,506,226 12,374,675 1,131,552 8.4%Northamptonshire Fire Authority 6,256,417 5,210,642 1,045,775 16.7 11,065,878 10,112,004 953,875 8.6%

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The East Midlands Declaration on Affordable Housing

We acknowledge that:

A lack of affordable housing can have an adverse impact on local people,communities and businesses.

The construction of new affordable housing will support local jobs, benefit the widerlocal economy and promote social mobility.

Central Government grant to support the development of new affordable housing islikely to be constrained for the foreseeable future.

New and innovative approaches to delivering affordable housing will need to bedeployed if local needs are to be met.

We commit our Council from this date to work constructively with developers, housing associations and the HCA to maximise opportunities and resources to deliver well designed new affordable housing on suitable sites, through:

ensuring robust research is undertaken to identify the scale and nature of affordablehousing need;

seeking to make best use of council and publicly owned land, capital resources andcommunity assets in ways that encourage economic growth and the delivery ofaffordable housing;

using planning powers creatively and pragmatically; working constructively with local communities to make the case for development and

challenging local opposition with evidence where necessary; working collaboratively with relevant partners to identify joint opportunities for

development; monitoring the delivery of new affordable housing against the level of established

need and publishing the results on an annual basis; and freely sharing learning by providing EMC with relevant case studies

Leader Council

Chief Executive Council

Cllr Martin Hill Chair EMC

Date:

Supported by:

Item 8, Appendix (c)

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