Leading better together – working with local government
Martin Seymour
Principal Consultant, Healthy Communities Programme
About the Healthy Communities Programme
Helping local government to tackle health inequalities and improve the health of
their communities
Healthy Communities Programme• Peer support and peer reviews• Healthy Communities benchmark• The leadership academy• Knowledge website• Communities of Practice• Valuing Health – the business case• Community engagement and community asset mapping• JSNA• Partnerships• Total Place and health• Thematic and topical work, eg, coastal and rural health,
childhood obesity• The Communities for Health regional networks• Strategic planning
Social Determinants of Health
Developing a broader understanding of the impact that local authorities and their partners can have on heath inequalities
Strategic Review of Health Inequalities in England post 2010 – Key themes
•Reducing health inequalities is a matter of fairness and social justice – inequality is avoidable.
•Action is needed to tackle the social gradient in health – Proportionate universalism
•Action on health inequalities requires action across all the social determinants of health
•Reducing health inequalities is vital for the economy – cost of inaction
•A move beyond economic growth to well-being of society: sustainability and the fair distribution of health
Marmot review - delivery
• Taking a whole system approach – nationally, regionally and locally.
• Empowering people: securing local solutions.
• Creating the conditions in which people and communities take control
• Regional working - NW and London
"Public Health is delivered by a workforce most of whom do not have 'health' in their job title."
“Securing Good health for the Whole Population” Wanless Feb 2004
A history lesson: local councils and health
C19th – building the protective infrastructure and systems of regulation
C20th – provision of hospitals, health and social care services to meet need
C21st – helping people to change their behaviours and strengthening the social determinants for good health
The context for local governmentPolicy documents
Acheson reportTackling health inequalities: programme for actionChoosing HealthFair Society, Healthy Lives
Health service reviewsWanlessDarzi
Local government reviewsLG Act 2000 - Powers of well-beingLG and public involvement in health act 2007Lyons Report 2007 - Place shaping
Local performance framework
Local Strategic PartnershipsSustainable Community StrategiesLocal Area AgreementsComprehensive Area AssessmentsJoint Strategic Needs Assessments
Partnerships for health improvement
Evaluating partnerships
Process issuesEngagement of Senior managers in partnershipReorganisation impactLack of financial and human resourcesInformation sharing and best practiceCoterminosityNeed for quick wins
OutcomesHealth outcomesMonitoring and evaluation problems
Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press
Defining health and health improvement
External Contextual Challenges
Stability
Political and policy changes
Power
Boundaries
Internal Process issues
Partnership working
Shared vision and place
Engagement
Resources
Data and knowledge
Organisational culture
The need for quick wins
Added value outcomes
Process outcomes
Health improvement outcomes
Maturing partnership
Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement
ImmaturePartnership
Little added value
MaturePartnership
Showing Added value
Gaining collaborative advantage for health improvement
Maturing partnership
Increasingly acting on social determinants of health
Process factors
External contextual factors
A Theory of Maturing Partnerships for Health Improvement
No shared vision
Dominant partner
Top down
Project focussed
Quick wins
Funding constraints
Grant giving
Internal focus
Individual ownership
Health an NHS issue
Medical Model
Confidence in partners
Shared identity
Shared vision
Joint ownership
Alignment
Joint posts
Citizen engagement
Accountability
Holistic
Health everyone's business.
Addressing SDH
Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.
Significant challenges to deliveryTraditionally not seen as ‘core’ business – how can Fair Society,
Healthy Lives reinforce the view that this is the core business of local government?
How will Marmot be interpreted?
Reduced resources – impact on public health budgets
Accountability – who is responsible?
Partnerships dependent on personalities rather than embedded in culture
…and opportunities
• Financial constraint – never let a good crisis….
• Total Place - and parallel places
• Localism
• General power of competence for councils
• Big Society - “put more power and opportunity into people’s hands”.
Martin Seymour
Healthy Communities Programme
www.idea.gov.uk/health