Presentation on theme: "Will Blandamer Director, GM Public Health Network"— Presentation transcript:
1 Will Blandamer Director, GM Public Health Network “Public Health Prioritiesand Actions for Greater Manchester”GMCVO Workshop20th January 2011
2 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions
3 Contents Context – New Public Health System Local Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions
4 “Healthy People Healthy Lives – A Public Health Strategy for England” Commitment toprotecting the population from serious health threats;helping people live longer, healthier and more fulfilling lives;improving the health of the poorest, fastest.Life course opportunities to improve health4
5 Policy LinkagesThe White Paper is also a formal response to the review by Sir Michael Marmot of inequalities in health.The Paper should be seen in the wider context of the NHS, and Social Care White Papers respectively, with which it has considerable resonance5
6 Strategic Drivers 1 – Marmot Review The recent Marmot Review Fair Society, Healthy Lives (DH, 2010) identifies 6 key policy areas to tackle Health Inequalities and priority actions: Give every child the best start in lifeEnable all children, young people and adults to maximise their capabilities and have control over their livesCreate fair employment and good work for allEnsure healthy standard of living for allCreate and develop healthy and sustainable places and communitiesStrengthen the role and impact of ill health prevention6
7 Strategic Drivers 2 – Boorman Review The Boorman Review, NHS Health and Wellbeing 2009, sets out ways in which staff satisfaction could be improvedImplementing the review could save the NHS up to £555 million nationallyFocuses on prevention and health improvement, providing efficient support for staff who present with ill health, being proactive in tackling the causes of ill health (both work and lifestyle related) and, where there are clear benefits, providing early intervention servicesImplementation of the Boorman Review is a priority in the NHS Operating Framework for 2010/11. Trusts will be assessed on it by the Care Quality Commission7
8 Further PolicyDuring 2011, the Department of Health will publish documents that build on this new approach, on mental health, tobacco control, obesity, sexual health, pandemic flu preparedness, health protection and emergency preparedness.Workforce strategy by Autumn 20118
9 The Approach of Healthy People Healthy Lives reach across and reach out.responsive – owned by communities and shaped by their needs;resourced – with ring-fenced funding and incentives to improve;rigorous – professionally-led, focused on evidence, efficient and effective;resilient – strengthening protection against current and future threats to health9
10 Key Developments 1Local Authorities – strategic leaders for health & wellbeing – Joint Health & Well-being StrategyStatutory Health & Well-being BoardsPublic Health England (NTA,HPA, SHA, other PH)DPH joint appointment with enhanced powers in all upper tier authoritiesJSNA – an obligation on all commissionersRing-fenced national PH budget - LAs plus central (shadow budgets during )10
11 Key Developments 2 New Health Premium New National Institute for HealthResearch (NIHR) School for Public Health Research and a Policy Research Unit on Behaviour and Health.Public health will be part of the NHS Commissioning Board’s (NHSCB)mandate.CMO will lead a professional network for all those responsible for commissioning or providing public health.11
12 The Director of Public Health Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local populationWill be play a key role in the proposed new functions of local authorities in promoting integrated workingContribute to the development of the local joint strategic needs assessment (JSNA) and the joint health and wellbeing strategyBe an advocate for the public’s health within the communityProduce an authoritative independent annual report on the health of their local population12
14 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators Proposed4. Population Health in Greater Manchester5. GM Public Health Network - Priorities and Actions
15 1. Director of Public Health Key member of health and well being boardLead development of JSNAEnsure high quality public health advice is available to commissionersAdvocate for the publics health within the communityReport on the health of their local population
16 2. Health and Well Being Board Restoring democratic accountability for healthEnsuring all partners deliver their organisations commitmentPoint of intersection betweenPublic healthSocial careChildren's health and well beingNHS CommissioningJoint NHS Commissioning
17 3. Public Health EnglandLocal health and well being boards supported by “power and efficiency” of PHESupported by the joint appointmentParticular link on health protectionAllocation of ring fenced budget
18 4. Supra local networksEconomies of scale in supporting local functionEmergency planning, tobacco control, education and training, intelligence and evidence gatheringSharing knowledge/enhancing capacityEngagement with PHE and NCB
19 5. New approach to public health policy “creating the conditions where people can take responsibility for their own health and well being”Instead of focusing on deficits problems and needs this new approach will build on the assets of individuals families and communities and strengthen civic society
20 6. Effective intelligence and research JSNAEvidence of effective and cost effective programmes/interventionsModelling to demonstrate impact of interventionsSurveillance and monitoring of hazardsHealth Impact Assessment and Health Equity Audit
21 7. WorkforcePublic Health professionalismPublic Health capacity building across sectorsUnlock the potential of voluntary, business, GP consortia and others to define outcomes and deliver interventions
22 8. Commissioning and Business Planning Commissioning of Public Health Programmes – effective and proven –evidence of ROIEngagement with NHS Commissioning Board re screeningWorking with GP consortia (e.g. uptake for screening)
23 9. Health ProtectionLocal Authorities will need to ensure that they have access to sufficient resources and professional expert advice through their DPH to fulfil their statutory duties on health protection as part of civil contingencies planning and response, includingMajor incidentsInfectious disease outbreaksPort health
24 10. Health Improvement and Population Well being Transfer of public health leadership back to local authorities allows focus and ownership of causes of inequality –”systematic scaled up and sustainable impact”Damaging health behaviour – smoking, alcohol harm, nutritionSocio-economic determinants – finding work, managing debt, early years, school, transport and housing
25 11. Population HealthCare Joint commissioning of population health services -screening, immunisation, drug and alcohol services, sexual health servicesServices for potentially excluded groups – homeless, prisoners and offenders, travellersEquitable access to servicesSupport to clinical pathway redesign in line with JSNA prioritiesHeath services accepting responsibility for health protection, emergency planning etc
26 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions
27 Domain 1: Health Protection and Resilience The activities to deliver this domain can most appropriately be coordinated nationally by Public Health England and local authorities will contribute to these outcomes particularly in their role in leading local resilience arrangements and in providing surveillance information.Proposed indicators:Comprehensive, agreed, inter-agency plans for a proportionate response to public health incidents are in place and assured to an agreed standard.Systems in place to ensure effective and adequate surveillance of health protection risks and hazards.Life years lost from air pollution as measured by fine particulate matter.Population vaccination coverage (for each of the national vaccination programmes across the life course).Treatment completion rates for TB.Public sector organisations with a board approved sustainable development management plan.
28 Domain 2: Tackling the Wider Determinants of Ill Health Locally, Health and Wellbeing Boards will take a broad approach to health improvement requiring the full participation by all partners to focus on improving the wider determinants of health that drive poor health outcomes especially in the most disadvantaged.Proposed Indicators:Children in poverty;School readiness;Housing overcrowding rates;Truancy rates;Incidents of domestic abuse;Statutory homeless households;Fuel poverty;Access and utilisation of green space;Reduction in proven re-offending;Social connectedness;Cycling participation;Rates of violent crime;First time entrants to the youth justice system;Rates of adolescents not in education, training or employment;Proportion of people with mental illness and/or disability in settled accommodation and/or in employment;Proportion of people in long term unemployment;Employment of people with long term conditions;Killed or seriously injured casualties on England’s roads;The percentage of the population affected by environmental, neighbour and neighbourhood noise;Older people’s perception of community safety.
29 Domain 3: Health Improvement Helping people to live healthy lifestyles and make healthy choices)Nationally, there is a clear role for Government in contributing to delivering these indicators – through legislation or regulation, through partnerships with business and industry, through national campaigns. However, much of the delivery will take place at the local level – led by the Director of Public Health in partnership with Health and Wellbeing Boards, using the ring-fenced public health budget.Proposed Indicators:Prevalence of healthy weight in 4-5 and year olds;Prevalence of healthy weight in adults;Smoking prevalence in adults;Rate of hospital admissions for alcohol related harm;% of adults meeting recommended guidelines on physical activity;Hospital admissions caused by unintentional and deliberate injuries to 5-18 year olds;Number leaving drug treatment free of drug dependence;Under 18 conception rate;Rate of dental caries in children aged 5 years;Self-reported wellbeing.
30 Domain 4: Prevention of Ill Health Nationally, the role of Government (in partnership with business and industry) will be critical. Across local Health and Wellbeing Partnerships, public health would share responsibility with the NHS, adult social care and children’s services.Proposed Indicators:Prevalence of recorded diabetes;Work sickness absence rate;Screening uptake;Chlamydia diagnosis rates;Child development at yrs;Maternal smoking prevalence;Hospital admissions caused by unintentional and deliberate injuries to under 5s;Rate of hospital admissions as a result of self harm;Incidence of low-birth weight of term babies;Breastfeeding initiation and prevalence at weeks after birth;Proportion of persons presenting with HIV at a late stage of infection;Smoking rate of people with serious mental illness;Emergency readmissions rates to hospitals within 28 days of discharge;Health related quality of life for older people;Acute admissions as a result of falls or fall injuries for over 65s;Take up of NHS Health Check programme by those eligible;Patients with cancer diagnosed at Stage 1 and 2 as a proportion of cancers diagnosed.
31 Domain 5: Prevention of premature mortality At the local level, improvements in these indicators will be driven by local Health and Wellbeing Partnerships with shared responsibility across the NHS, public health and care services. Some delivery will be for other local partners to prevent seasonal mortality, National contribution across Government, the NHS Commissioning Board and other national bodies in setting policy or to avoid mortality as a result of major emergencies.Proposed Indicators:Infant mortality rate;Suicide rate;Excess seasonal mortality;Mortality rate of people with mental illness;Mortality rates from the following diseases in the u75s: communicable disease; cardiovascular disease; cancer; chronic liver disease; chronic respiratory disease.
32 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions
37 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions
38 GM Leadership – An Audit Commission View “Greater Manchester knows what the health inequalities issues are –BUT There is no health vision for Greater Manchester and a lack of champions. Concerted, radical action is required to make a difference and reduce the health inequalities gap”Audit Commission May 2006I believe it is worth recognising that our work over the past two years has taken place under the spotlight of a uniquely wide ranging Audit Commission review of Health Inequalities. Significantly, the 2006 analysis reflected GM arrangements which contained a Strategic Health Authority. The 2008 judgement is made on a Greater Manchester whose strategic lead for health is provided by the Association.In addition to the role of the Association in supporting GM level partnerships across the public sector, the review also made very positive mention of our work underpinning whole system commissioning across the GM health economy and I am keen to reflect on areas of real progress there.
39 Public Health – What Works locally and quickly and is in local gift Achievement of target to reduce smoking in manual social groups:smoking cessation & tobacco control.Targeted smoking cessation at patients with CVD and COPD = 2% reduction in unplanned admissions within 1 year.Prevention and effective management of other risk factors in primary care e.g. high blood pressure, diabetes, weight management etcTargeting over-50s where the greatest short-term impact on life expectancy will be made through achievement of flu vaccination/pneumococcal targets.Evidence of active engagement with key local partners on issues affecting life expectancy -e.g. joint health social care investment plans, falls prevention in older people, tobacco control, school food.Brief focal interventions for alcohol misuse in Primary care.Establishing a pulmonary rehabilitation programme could result in a reduction of 26.3% respiratory readmissions and 44.8% bed days a year.Targeted primary care nurse –led heart failure management: up to 50% of readmissions of heart failure patients may be preventable39
40 Collaborative Work on Public Health in GM - Projects Public health underpinning of stroke service reconfigurationHepatitis C StrategyManagement of Screening ProgrammesLeadership on AlcoholSocial Marketing and Promotional ActivityCancer Inequalities StrategyCardiac Inequalities StrategyGM Suicide Prevention PartnershipAAA Screening Implementation
41 More projects… Gm Fuel Poverty Project Collaborative implementation of health trainersPathway development for healthy weight servicesTobacco control joint working on promotion and prioritisation of illicit tobaccoChlamydia Screening ProgrammeMedia Partnerships – “iloveme”Prioritisation of Domestic ViolenceSalt Reduction
42 Creation of Capacity Public Health Practice Unit Arts and Health NetworkGMCVO - capacity in voluntary sectorClose working with HPARegional Health Work and Well Being ProgrammeRegional Health and Migration ProjectRegional A/N and N/B Screening programme
43 Partnerships – building influence AGMA – CommissionsCommission for New Economy partic.GMPGM Fire and RescueGM SportGMPTEUniversitiesManchester – e.g. obesity atlas, suicide auditSalford – e.g. Child health inequalityMMU – e.g. CPD development
44 GM Organisational Coherence The Architecture for Greater ManchesterBecause of this interdependency Greater Manchester has the most developed system of cross-city region collaboration in the UK outside London. The city region has, and is developing further, a powerful sense of place for Greater Manchester driven through a number of mature partnerships and organisations including:A partnership of the 10 local authorities acting as the Association of Greater Manchester Authorities [click]A single economic development agency for the city region (Manchester Enterprises) [click]Greater Manchester PoliceGreater Manchester Fire & Rescue Service [click]A unified Chamber of CommerceThe Greater Manchester Centre for Voluntary Organisation [click]
46 Economic Coherence (Reference Manchester Independent Economic Review) Most significant economic agglomeration outside LondonA single functional economy2.5 million residents across 10 boroughs1.7 million working age population£40 billion GVA annually (5% of UK GVA, 40% of North West)94,000 workplaces – 79,000 of which <10 employeesLocal Economic Partnership
47 GM – Acute Patient Flows (2007/08) PCT3%BuryWWL66%3%Bolton3%53%7%AcuteALW6%86%11%7%3%0.2%5%4%4%8%HMR6%7%17%4%4%2%3%MH75%3%5%Bolton8%4%SalfordOldham18%BSTMHPennine Acute0.01%59%17%52%5%13%9%Salford3%4%5%PennineCareCMMC19%That GM wide working and leadership is required reflects the interdependent of the boroughs across the city region of Manchester. This schematic of the clinical flows in the health system also demonstrate that it is impossible for the pcts to consider the type of fundamental system reform required without a mechanism to transact business between them – this is very much the rationale for the Association of GM PCTsI could show you a similarly complicated picture for traffic flows, employment and other key determinants of economic regenerationStockport2%3%Trafford0.01%47%16%13%T&GMCR4%15%Christie3%3%4%47%TraffordMCRMH14%4%51%Tameside5%33%6%4%Stockport2%23%11%27%UHSMFT14%7%11%
48 GM Leadership – An Audit Commission View “Greater Manchester knows what the health inequalities issues are –BUT There is no health vision for Greater Manchester and a lack of champions. Concerted, radical action is required to make a difference and reduce the health inequalities gap”Audit Commission May 2006“There is much to be proud of. We outlined at that time what we hoped our report might look like in We can report with some confidence that this is now a good description of the position as it currently exists across Greater Manchester in This is a remarkable achievement in a short space of time.”Audit Commission October 2008I believe it is worth recognising that our work over the past two years has taken place under the spotlight of a uniquely wide ranging Audit Commission review of Health Inequalities. Significantly, the 2006 analysis reflected GM arrangements which contained a Strategic Health Authority. The 2008 judgement is made on a Greater Manchester whose strategic lead for health is provided by the Association.In addition to the role of the Association in supporting GM level partnerships across the public sector, the review also made very positive mention of our work underpinning whole system commissioning across the GM health economy and I am keen to reflect on areas of real progress there.
49 Current Focus of GM wide Partnership Work GM Strategy DeliveryWork Programme ImplementationSupport to Early Years prioritisationSupport to LTP3Submission of Local Sustainable Travel FundPromotion of Fuel Poverty agenda on Urban RetrofitInforming GM Spatial Planning FrameworkSupport to “Changing Lives” – AGMA Sport and Physical Activity StrategyGMP re Domestic ViolenceWork across AGMA re Minimum Unit PricingWorking with professional sports clubsWorking with Healthcare providersDevelopment of GM Health Commission roleCommunity Budget ImplementationRaised profile of tobacco controlCancer Awareness Campaign ImplementationPromotion and Awareness of 20mph limits
50 GM wide public health functions Focused on creation of added value locally – seeking collaborative advantageSharing expertiseEconomies of ScaleMechanism for influencing policy at GM level through Combined Authority etcEngagement of organisations with GM spatial footprintSecuring GM as the lowest possible spatial level (e.g. National Commissioning Board)Building where GM already has a national reputation for public health leadershipSupport for a GM Health and Well Being Board?
51 Orientating Capacity to deliver excellent support to local public health function GM Health Protection UnitReview of public health intelligence capacityAGMA public protection partnershipAcademic Public HealthGM ScreeningGM Emergency Planning FunctionNHS Commissioning Expertise
52 ContentsContext – New Public Health SystemLocal Public Health ArrangementsOutcomes and Indicators ProposedPopulation Health in Greater ManchesterGM Public Health Network - Priorities and Actions