public health services and community pharmacy

www.hertsdirect.org

Public Health Services and Community PharmacyA perfect match?

Jim McManus, Director of Public Health, Hertfordshire County Council

[email protected]

Maximising Patient Benefit and Pharmacy Outcomes

www.hertfordshire.gov.uk

Context

• Financial GAP in UK public finances

• Wanless

• NHS Five Year Forward View

• Public Health grant cuts

• £428m bridge in STP gap, prevention is a key strategy. But will they achieve it?

www.hertfordshire.gov.uk 3 Business Rates Retention and Public Health

100% Business Rates Retention – Possible model

Taken from Local Government Association presentation on Business Rates Retention.


Closing The

Financial Gap

Increase Funding

• Increase income levels• Generate new income

streams• Secure new grants• Growth in funding bases

Reduce Costs

• Efficiencies• Change service levels (eg

policy changes)• New service delivery

models

Reduce Demand

• Prevention• Triage and redirection

opportunities• Earlier intervention

Framework to categorise measures to close the funding gap in the IP

Invest to Transform Fund

as key tool to enable and service

re-design &cost saving initiatives


The LGA’s outlook

www.local.gov.uk


Deprivation and Health• There is a marked and real social gradient to health,

with people who are most deprived living shortest lives with most ill-health.

• Health and economic prosperity are intimately linked. The health of our population is a key asset for economic prospects, but equally a thriving economy is essential for good health.

• Life expectancy in Hertfordshire as a whole is increasing both for men and for women. But too many people still die at a younger age; and too many people spend much of their life in ill-health or disability.


So why is this?• Over 60% of deaths are due to lifestyle and behaviour

• Avoidable disability and a failure of long term condition management

• Historical underinvestment in prevention by NHS

• Preventable disease is a result of the common risk factors of smoking, obesity, poor diet, physical inactivity and alcohol consumption

• The burden of preventable mental ill-health is too high; and mental ill-health across the life-course is too high

• We need to do more to ensure our children have a healthy start in life and grow up healthy

• Avoidable ill-health and the risk factors for these are hindering efforts to reduce poverty and increase prosperity.


The Challenge for Public Health

• Complex large scale problem with no single solution

• Operating within a smaller financial envelope following budget cuts, changing demographic, increasing population

• Changing behavior is not easy!


Public Health – how do we achieve system change with a tiny budget?The entire annual PH budget for Hertfordshire is roughly the operating budget for one month of acute activity in a medium sized CCG


Priorities

Find it here

https://cmis.hertfordshire.gov.uk/hertfordshire/Calendarofcouncilmeetings/tabid/70/ctl/ViewMeetingPublic/mid/397/Meeting/433/Committee/50/Default.aspx


Joint Strategic Needs Assessment (JSNA)


Priorities - Starting Well and Developing Well (0-25 age group)• Health visitors and school nurses

• Health related behaviour questionnaire

• PHSE/resilience

• National Child Measurement Programme (NCMP)

• Chlamydia testing

• Child weight management

• Young People substance misuse

• Child physical activity

• Child mental health


Priorities – Staying Well

• NHS Health Checks

• Adult Mental Health

• Workplace health

• Reducing harm from Tobacco

• Tackling obesity

• Promoting physical activity

• Making Every Contact Count

• Sexual health

• Drugs and alcohol


Priorities - Influencing and Advice (using Public Health Expertise)

• Planning and place

• Support for Clinical Commissioning Groups (CCGs)

• District and Borough Councils

• Health protection


Priorities - Partnership working

• Police

• NHS

• District & Borough Councils

• Voluntary Sector

• Central Government

• HCC departments


Prevention Agenda

• Everyone needs to play their part

• Intervening in a system


Some golden rules• Shift clinical complexity

– more done by pharmacies, more done by primary care, less by acutes and better targets

• Prevent and Reverse

– Assertive management of risks through preventive pathways

• Whole person in front of you

– Everyone has a preventive role

• Reconfigure resources and pathways


What is the Prevention we need?

• All the primary prevention in the world wont get us quickly enough out of this problem

• The avoidance, whether permanent or temporary, of need for public service or an adverse event/hazard or exposure leading to need for public service

– SHORT TERM (up to 24 months)

– MEDIUM TERM (2-5years)

– LONGER TERM (5 years plus)

• Prevention is NOT rationing or restricting eligibility


Making Hertfordshire a Public Health Economy• Every service understands and takes ownership

of a public health role

• We skill and motivate people to self-manage their health and wellbeing

• We focus on the person and co-ordinate around them

• Physical, Social, Psychological and Spiritual are all part of the dynamics of health

• Mindset of staff, volunteers, carers and users


How you can help…

1. Where do we touch people where we can build resilience, motivation and opportunity to be healthy?

2. Where do we touch people in a way which mitigates against better health?

3. What do I want to know about evidence-based practice tools which will help me do my core role better?


County of Opportunity- consider:• The conditions for everyone to be healthy, from

conception to end of life

• The conditions for the poorest and worst off to be healthier

• Intervening early

• Public services which put this at the core of their business

• People thriving and prosperous


Prioritising Prevention – the Decision Cycle

What population?

What issue/need?

What outcomes do we want?

Which interventions fit

best?

How do we know it’s working?(Evaluation)

1. Service cost and demand

2. Needs (JSNA)

Define the outcomes clearly so you can really assess

feasibility

1. Financial Assessment2. Evidence Assessment

3. Logic mode where evidence silent

1. Financial Assessment2. Outcome Assessment

Questions to ask Tools for HCC


Feasibility Criteria

VeryPromising

Promising Unlikely to becost effective

Effectiveness High (10) Medium (5) No impact (-5)

Flexibility Very Positive (10) Positive (5) Neutral (0)

Sustainability Positive (10) Positive (5) Negative (-5)

Political Feasibility High (10) Medium (5) Low (-5)

Administrative Feasibility

High (10) Medium (5) Low (-5)

Time Short (10) Medium (5) Long (-5)

Cost High (0) Medium (5) Low (10)

Return on investment High (10) Medium (5) Neutral (0)Negative (-5)

The more of these you meet, the better the likelihood of outcome

public health services and community pharmacy

Health & Medicine