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Community Health Partnerships Consultation : Response of the Community Practitioners & Health Visitors Association
 

The Community Practitioners & Health Visitors Association (CPHVA) welcomes the opportunity to respond to the Community Health partnership paper.

We support broad principle that Community Health Partnership’s (CHP’s) should have a significant role in relation to community planning in order to tackle priority health issues. However, there does need to be clarity regarding the role of CHP’s in the community planning process, and in relation to how health issues will be prioritised with the local community it serves.

Partnership working between the National Health Service (NHS), the voluntary and other sectors must involve consideration of achieving a common vision and accountability. Arguably accountability should be shared between the Chief Executives of health and local authorities to ensure that responsibilities are not delegated without authority and tied into the Performance Review. Mechanisms for partnership working must include the principles of staff governance and be able to demonstrate how each stakeholder can influence strategic planning issues. A Public Patient Partnership Forum presents an opportunity to develop a vehicle for public involvement that takes a tangible and active role in informing the strategic planning process, assisting the local implementation plan and taking part in the accountability review process. In order for this involvement to be meaningful it may be necessary to consider what training and support may be required to develop the capacity and confidence of members of the public to influence the agendas.

It is rational that the CHP’s have an integral part in the community planning process. However, active recognition must be demonstrated of the impact that the wider determinants of health have on the health improvement agenda for populations, e.g. lifestyle changes may not be easy in poor living/ environmental conditions, with limited access to leisure, shopping, education facilities.

Health needs assessment should be regarded as an iterative process undertaken in partnership with the populations the CHP’s serve, and not merely as an end in itself. The concept of health improvement should be the shared goal across sectors, with service outcomes including not only the notions of treatment and cure but also to include prevention and promotion. CHP’s should consider how they could fulfil and monitor their role as public health organisations. Indicators for health improvement should be informed by Joint Health Improvement Plans priorities and CHP’s should plan and deliver services to achieve health improvement outcomes.

 

The four pillars of Improving Health in Scotland – The Challenge presents a useful philosophy to guide actions. However, to ensure cohesiveness it is essential that all stakeholders share a common understanding of what ‘the challenges’ are and what they mean. Joint resourcing and management structures make this even more key, so that funding streams are transparent and accessible across sectors. CHP’s should be encouraged to be co-terminous with local authorities to promote commitment to, joint ownership of and shared accountability to community planning. However, it is recognised that if the CHP's are too large that this may inhibit engagement of practitioners, the local community, etc therefore careful consideration must be given to the mechanisms that are in place at the inception of the CHP’s to seek processes to engage and communicate as an integral part of working practice.

As Local Health Care Co-operatives (LHCC’s) evolve into CHP’s there is a need for investment to enable public health activity, separate to service re-design approaches. Assistance for the CHP’s to develop must take into account support requirements that may be necessary to champion staff throughout the transition phase towards new ways of working. Public Health Practitioners in particular have expressed a view that they have found it difficult to press forward the public health agenda within their localities. NHS Boards need to demonstrate that they have considered the contribution that all stakeholders have, looking beyond the horizon of health to include social, statutory & non-statutory bodies, when evaluating & planning services. Also in seeking creative approaches, to plan how this may be strengthen by linking disparate departments with a view to developing a supportive network to develop capacity and support practice, e.g. active & pragmatic links between academic departments and practitioners to apply evidence where it exists and to develop evidence base where there are gaps.

Single shared assessment must also look broadly at professional roles that are appropriate and not focus merely on job titles and historical patterns of service delivery. However, it is essential that modern, compatible information management & technological systems be seen as fundamental to allow for relevant information sharing between sectors/ practitioners support this. Thought must also be given to the different structures within health and social care and how these may operate, e.g. co-terminosity an issue but what about linkage between local authority boundaries themselves regarding information sharing/ flow/ ‘patient tracking’?

Improving access by local communities to information is welcomed. However, from an economic standpoint there should to be a ‘taking stock’ of what information and resources are currently available, and of these what are useful, etc. Broad issues around literacy, language, culture etc must also be examined.

The development of Integrated Learning Communities, A Joint Future and the development of Children’s Services should not be missed, as an opportunity by CHP’s to work in partnership with community planning partners to address the health improvement agenda.

 
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