Councils at the Heart of Health Reforms

Ian Gray CIEH, Chris Shaw

Sheffield City Council&

Sandra Whiles Blaby District Council

Today's MenuA bit about :• the challenges• the reforms• our potential • the outcomes frameworks• our offer• ladders of intervention• group work

A Few Challenges• Health inequalities – people, places and power• An ageing population• Families with complex needs• Youth unemployment• System changes• Limited resources

What's Going On?

Reform

• To improve or change for the better

• To give up a bad habit

Re-form

• To form anew

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

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

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

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

Health and Wellbeing?

Not being ill and feeling okay about life?

What makes folk feel okay about life?(salutogenesis )

Planning

Housing

Environmental Health

Sport and Leisure

Waste

…and all the contacts the council has with the public

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

Are You a Chadwick or a Snow or Doesn't it Matter?

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

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

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

The Outcome Frameworks

• Public Health

• The NHS

• Adult Social care

What about children?

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

Public Health Outcomes Framework

• Improving the wider determinants of health

• Health improvement

• Health protection

• Healthcare public health and preventing premature mortality

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

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

Every Child Matters

• Be healthy

• Stay safe

• Enjoy and achieve

• Make a positive contribution

• Achieve economic well-being

Public Health, Environmental Health:-So What?

Chris Shaw

Director of Health Improvement

Sheffield City Council

We Get It , So What?

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?

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

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’

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

The EHO View of the World

LA Services to PH Solutions

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?

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

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?

We get it, so what –next ?

Ladder of Interventions

So What Do We Have to Offer?

Group work