Improving outcomes and reducing inequalities through

integrating public health

Dr Peter MarksDirector of Public Health

Leicestershire and Rutland

Presentation

• Why public health in local government?• Where are we in Leicestershire?• A vision of integrated public health• Fit for Work – one example of partnership

working in action• Opportunities and challenges for Health and

Wellbeing boards

The determinants of health

Health and WellbeingWhat makes folk feel okay about life?

Why public health in councils?

• Influence on many of the determinants of health

• Democratic legitimacy and community leadership

• Contacts with people

“Public health is coming back to local government”

Transition in Leicestershire• Shadow Health and Wellbeing Board established

– chaired by county and district councillor– two district councillors as members– interim strategic priorities agreed– JSNA refresh underway

• Health Member Champions in each DC linked into H&WBB• Two shadow CCGs • DPH member of Corporate Management Team in LCC• Two consultants provide link to CCGs• Public health staff moved to County Hall, retaining desks with PCT• Senior PH staff co-located in districts• Virtual Public Health Team• H&WBB linked into wider partnership approaches to strategic

commissioning and “community budgets”

Devolved Public Health Team

Shifting the balance

Virtual PH team

• Need for relationships at all levels – Strategic – HWBB– Tactical – Staying healthy partnership– Operational – co-located team

• Ability to influence other organisations• Empowering, devolved working, increasing

trust with organisations• Structures important but personal working

relationships are also key

Leicestershire Fit For Work

• Original remit to ensure that people at risk of long-term sickness absence receive timely, co-ordinated back-to-work interventions focused on preventing them from losing their employment

• Move management of sickness absence from the medical model into vocational rehabilitation.

• Move vocational rehabilitation closer to mainstream primary care.

Commissioning Partnership

What FFW currently does

• Employer liaison • Case co-ordination, to facilitate timely intervention • Employment advice • Wider social support such as debt or housing advice • Learning and skills advice • Conciliation to overcome escalated disputes between

employees and employers

OutcomesApril 2011-August 2011

Return to work 58%

Stayed at work 19%

Still off sick 11%

Unemployed 7%

Disengage from return to work plan 5%

Absentees return to work 77%

Presentees stay at work 88%

Totals

Specific

Mediation/Negotiation 38%

Help with new employment 23%

Personal support 17%

Musculoskeletal 15%

Mental health 7%

‘Main intervention’ that made a difference April 2011-August 2011

Questionnaire responses from 67 cases based on client questionnaire completed after case closed

FFW-the future

• Continuing to improve the management of sickness absence

……but now also through joint working with employers, local authority and NHS:

-Increasing focus on improving the health and wellbeing of all

working age people

-Championing health promotion in the workplace

Health and Wellbeing Boards

Opportunities• Strong partnership working

at strategic level• Shared understanding of

JSNA• Shared vision in Joint Health

and Wellbeing Strategy• Bringing together political

leaders, officers and HealthWatch

• Democratic legitimacy

Challenges• Only part of the picture –

needs partnership at all levels• Not all the relevant partners

will be around the table – needs wider engagement

• Effective partnership is not just about structures

• Ensuring those with the greatest needs are heard

• How will HWBBs hold partners to account?