councils at the heart of health reforms ian gray cieh, chris shaw sheffield city council &...
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Councils at the Heart of Health Reforms
Ian Gray CIEH, Chris Shaw
Sheffield City Council&
Sandra Whiles Blaby District Council
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Today's MenuA bit about :• the challenges• the reforms• our potential • the outcomes frameworks• our offer• ladders of intervention• group work
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A Few Challenges• Health inequalities – people, places and power• An ageing population• Families with complex needs• Youth unemployment• System changes• Limited resources
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What's Going On?
Reform
• To improve or change for the better
• To give up a bad habit
Re-form
• To form anew
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NHS Commissioning
Board
Clinical Commissioning Groups (CCGs)
Public Health (PH) England
Local Government
The New Health System• Health Protection
Agency
• National Treatment Agency
• Regional PH teams
• PH Observatories
• Cancer registries
Most commissioning of healthcare services locally
• Health and Wellbeing Board
• Public health: improvement, protection, care
• Joint Strategic Needs Assessment (JSNA) (with CCGs)
• Joint commissioning
• Local Healthwatch • Primary care:
• GPs, Dentists, Pharmacists, Optometrists
• Specialised commissioning
• Prison health
• Immunisation
• Public Health 0-5yrs
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A Moment in Time?• Central strategic leadership to give a context
for local action• Locally led - councillors and GPs• A new vision for Public Health – “wellness”
should be central to all we do”• Outcomes frameworks to energise and
motivate• Dedicated resources for Public Health to
promote a strategic approach to prevention
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A Few Things to Keep us Busy?• Setting up new structures
quickly which engage, influence and deliver
• Big challenges with limited solutions or resources
• Learning new skills• Professional worries• Building new relationships• Establishing a sustainable
performing culture
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Special Relationships & Structures• Health &Wellbeing Board• Clinical Commissioning Groups• Local authority Health
Champions• Local Health & Well Being
Forums• Local Councils and the
Community• Local Health watch• Businesses• Third sector
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Health and Wellbeing?
Not being ill and feeling okay about life?
What makes folk feel okay about life?(salutogenesis )
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Planning
Housing
Environmental Health
Sport and Leisure
Waste
…and all the contacts the council has with the public
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What Will be Different in the Future?
Do we?• Give Pooh Bear a tablet• Take him into hospital to bandage his
head• Fit a stair lift• Install telecare equipment to support
Pooh Bear's independence• Change our policies to increase the
number of accessible homes
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Are You a Chadwick or a Snow or Doesn't it Matter?
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A Leicestershire Approach• A wider strategic approach to deliver better
outcomes in our place – around issue and place• Visible leadership around culture and healthy
challenge• Pragmatic doing - not waiting for permission • Risk management
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Leicestershire's Partnership Structures – Simplified!
Theme Commissioning Boards Specialist Groups Localities
Co
mm
iss
ion
ing
Bo
ard
-E
xec
uti
ve
Health & Wellbeing
Community Safety
Local Enterprise Partnerships
Children & Young People
Environment
Staying HealthyIntegrated Commissioning
Prevention & Early InterventionSubstance Misuse
JSNA Steering Group
Flood RiskWaste & Cleaner, Greener
Natural & Historic Environment Climate Change
Cross-cutting themesHousing, Planning, Infrastructure
Stronger Communities Transport
Sport & Physical ActivityVoluntary Community Sector
RuralHousing Services
Hinckley and Bosworth
North West Leicestershire
Blaby
Melton
Market Harborough
Oadby and Wigston
Charnwood
*Community Budgets are specific time-limited cross-service projects that demonstrate the Leicestershire Together ways of working
Community Budgets*• Families with complex
needs• Alcohol & Drugs• Access to Services
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What Levers Can We Use?
• Make the JSNAs and H&WBB strategies useful
• Integrated commissioning• Use the outcomes frameworks as a
performance management tool• Evidence of what works• Shared commitment to make the
difference• Reputation
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The Outcome Frameworks
• Public Health
• The NHS
• Adult Social care
What about children?
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Public Health Outcomes' Framework
“To improve the nations health and wellbeing and improve the health of the
poorest fast”
• Outcome 1 :Increased healthy life expectancy
• Outcome 2 : Reduced differences in life expectancy and healthy life expectancy between communities
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Public Health Outcomes Framework
• Improving the wider determinants of health
• Health improvement
• Health protection
• Healthcare public health and preventing premature mortality
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NHS Outcome Framework
• Preventing people from dying prematurely • Enhancing quality of life for people with long-
term conditions • Helping people to recover from episodes of ill
health or following injury • Ensuring that people have a positive experience
of care • Treating and caring for people in a safe
environment and protecting them from avoidable harm
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Adult Social Care Outcome Framework
• Enhancing quality of life for people with care and support needs
• Delaying and reducing the need for care and support
• Ensuring that people have a positive experience of care and support
• Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm
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Every Child Matters
• Be healthy
• Stay safe
• Enjoy and achieve
• Make a positive contribution
• Achieve economic well-being
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Public Health, Environmental Health:-So What?
Chris Shaw
Director of Health Improvement
Sheffield City Council
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We Get It , So What?
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Learning from History • PH in local government was led by medical men for much of
19th and 20th centuries• People working for them, engineers, inspectors of nuisances,
HVs• MoH, powerful influences on the work undertaken• MoH constrained - what council was willing to pay for and
what it believed would be effective• Webster - MoHs did not act
collectively esp on poverty• Up to 1974 responsible for
sanitation, prevention, housing, waste, health services for women and children, school health, etc
• Since 1974, attention dwindled, some arguing why should we do it, it’s the NHS job?
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Local Government – The Public Health Service
25%
Health Care
System
15% Genes
10% Physical Environment
50%
Social & Economic
Environment
An individuals life circumstances contribute more to health improvement than health care services
Local government is best placed to change life circumstances and improve health
Estimated Health Impact of ‘Determinants Of Health’ on Population Health Status Source: Canadian Institute for a Advanced Research
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Double Vision?
• Faculty of Public Health, CIEH – spot the difference
‘Leading, inspiring and delivering a safer, cleaner and healthier world.’
‘The world’s population achieves and maintains its fullest potential for health and wellbeing’
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Wave Theory
• Public health has delivered in waves over the decades – from the classic water and sanitation of 1800s, to scientific advances into 1950, the post war welfare developments (including the NHS) and risk factor and lifestyle issues from 1960 to now#
• This combination of reforms and a change in the health ‘concerns of the generation present a massive opportunity for redefining a relationship which has always existed but changed with progress in other fields
#Afternow – Phil Hanlon Glasgow University
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The EHO View of the World
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LA Services to PH Solutions
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What Are You Selling?
activity DPH Comments
Current regulatory That would happen anyway
Current Campaigns Show me the evidence of impact
Community focussed activity How is that better than ours?
New investment What should I stop doing?
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Observations• CCG’s have too much to do, you will do well to engage them or
GP’s, you have too much to do too.• Everyone wants a place on Health and Wellbeing Boards• DPH’s are not inclined to change their ‘commissioning’ plans• Members will be on your side. • PH practitioners do not know as much as you about
communities.• PH evidence isn’t all its cracked up to be.• EH will have to rethink its role and relationships if it is to be
involved, Institute can help. • Think health concerns – long term conditions, mental health,
older people• Think Political concerns- Inequality, vulnerable communities,
strategic priorities
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Ideas
• Health and safety- local accident data, Lofstedt, different intervention,
• Food – what are the PH threats? Food strategy, salt, transfats,
• Combine Protection with Improvement • Housing- vulnerable communities, private
rented , fuel poverty , Cat 1 hazards• Wellbeing + resilience – opportunity?
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We get it, so what –next ?
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Ladder of Interventions
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So What Do We Have to Offer?
Group work