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Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System Dr. Kate Ardern MBChB MSc FFPH Executive Director of Public.

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Presentation on theme: "Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System Dr. Kate Ardern MBChB MSc FFPH Executive Director of Public."— Presentation transcript:

1 Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System Dr. Kate Ardern MBChB MSc FFPH Executive Director of Public Health for the Borough of Wigan

2 Strategic Drivers: Marmot Review The Marmot Review Fair Society, Healthy Lives (DH, 2010) identifies 6 key policy areas to tackle Health Inequalities and the priority actions:  Give every child the best start in life  Enable all children, young people and adults to maximise their capabilities and have control over their lives  Create fair employment and good work for all  Ensure healthy standard of living for all  Create and develop healthy and sustainable places and communities  Strengthen the role and impact of ill health prevention

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4 Wigan partnership Health and Well- Being Priorities (6 Outcomes) Health and Well - Being Board Health and well-being services Local Authority & Partners NHS Social care (children and adults,Third sector Housing, transport, Big SocietyLeisure, Education, Partnerships, Economy, Social enterprises Primary & Community care Secondary & Tertiary care Specialist & National care General population Low level advice & support Support at home Institutional care Acute care People choosing less dependent more cost-effective options Increasing demand on services NHS “flat cash” funding £100 m gap in funding

5 To foster the best possible health and well being for every person in Wigan Help local people take responsibility for their health Target resources correctly Reach out across partnerships Harness local knowledge, skills and leadership People centred Respect contributions & perspectives Openness, honesty, integrity Ownership & accountability Best quality & innovation Co-production Increase autonomy & perception Improve accessibility of services to support independence Reduce deaths & disability due to CVD & cancer Reduce social exclusion Care closer to home Safeguarding, dignity & respect Raising and exceeding public expectations of health and well-being To invest in a balanced economy to focus on wellness determinants of health and high quality health and social care Stretching our ambition and performance to achieve world class public health Innovating and implementing best practice to achieve best performance against national standards Evidence, knowledge and skills Productivity and evaluation H&WBB BeliefsValuesOutcomes

6 People, Partnerships & Performance: Gestation from Input to Outcome Treat Health Inequalities Prevent Health inequalities Sustain & Maintain Reduction in HI

7 Life Life Expectancy at Birth

8 Demand Management System Redesign Stimulating the Market Optimising the role of the Voluntary and Independent sectors Commissioning of Health Improvement Services and Programmes Service re-design to fully incorporate preventative interventions Public Health capacity and capability building Locality working Optimising the role of the Voluntary and Independent sectors Develop the assets based approach to community empowerment Building social capital Developing co-production Public Health capacity and capability building – community health advocates Public Health Annual Report PH expert advice Assurance that commissioning plans incorporate best quality & governance practice Assurance that CQUIN schedules reflect local & national priorities for health improvement, health protection & reducing health inequalities Develop & implement a Joint Health & Well- being Strategy. Influencing the wider determinants of health Building the PH capacity of the wider workforce Health promoting settings Corporate social responsibility Social Impact Bonds Screening Programme co- ordination Environmental public health Communicable and Infectious Disease Control Immunisation and Vaccination Safeguarding PH resilience and response to incidents and disasters Research & Development Joint Strategic needs & Assets Assessment Evaluation of services and programmes Health Impact Assessment Health Equity Audits Integrating critically appraised evidence into programmes & services Health Surveillance and Assessment Health Profiling HEALTH AND WELL-BEING PROGRAMMES FOR CHANGE Unleashing the Talents of Local People System Reform Achieving Best Quality Health &Well- being Policy Health Protection Knowledge Management

9  How to achieve economies of scale for delivering a national public health and wellbeing system  Using pooled Information, intelligence and place based solutions to undertake new functions  Workforce capacity and capability and resource management to deliver high quality care  Leadership, partnership and vision to successfully deliver population healthcare and wellbeing

10 PH System Resilience Risks  Significant clarification needed about role, responsibilities and relationships in planning and responding to public health emergencies and public health input into Major Incident and Civil Contingency planning and response.  Significant concerns about the size and scope of the ring-fenced national public health budget and allocations to local authorities – especially in the light of the Nicholson challenge.  Current proposals for the division of commissioning responsibilities across Clinical Commissioning Groups, Local Authorities, Public Health England and the NHS Commissioning Board potentially works against a whole system approach to commissioning services.  Significant clarity needed about the specialist roles across the new system, the workforce transition and the importance of current and future professional training and professional regulation.  Failure to secure the future of public health specialists currently in training when there are few consultant posts currently being advertised.  Very low morale amongst PH staff who are experiencing significant PCT management cost reduction, freezing of key vacancies and considerable uncertainty about their future given that there is no guarantee of potential for future employment in Local Authorities – especially as many Local Authorities are making significant job cuts amongst their existing staff  Multi-disciplinary nature of public health risks being lost in the future if doctors, dentists and nurses do not see it as a career option.

11 Public health capacity to support the construction of JSNA and the preparation of local health and well being strategies and to support the Health and Wellbeing Boards. Public health capacity to support the oversight of CCG and NHS Commissioning board activities. Capacity to ensure local direction and determination of health protection capacity, particularly that associated with existing health protection units. Public Health leadership in informing care pathway development. Capacity to support the commissioning of local health improvement services. Capacity to discharge responsibility for lead commissioner responsibilities.

12 Leadership in GM: The Greater Manchester Strategy The Manchester Independent Economic Review History of collaborative working across GM A Health Commission which leads on GM wide health and well-being programmes A GM Strategy which stresses the role of health in growth and employment Combined Authority and Local Enterprise Partnership

13 Enablers and Evidence: The case for health collaboration at the GM level. The View from the Moon

14 Understanding the primacy of local working, and the emphasis on JSNA, integrated public sector working, democratic leadership and prioritisation That aggregation to exploit collaborative advantage should only happen from the perspective of local requirement Recognising the potential future role and responsibility of Directors of Public Health in their own local authorities & that in supporting the discharge of this function DPHs may wish to secure specialist skill and technical expertise not likely to be available in each local authority Demonstrating where GM DPH working collectively had already invested resource and capacity, where there was related collaborative activity currently hosted within the GM PCTs and where there were other GM structures providing economies of scale for discharge of regulatory function in Local Authorities. Proposing how to align some functionality to a description of public health function.

15  Community engagement needs to move beyond consultation into empowerment, which will involve the transfer of power and resources to communities themselves  Work towards integration of primary and community care services with statutory, voluntary and independent sector neighbourhood services, providing a more holistic user-centred focus.  Public health commissioning mechanisms to drive development of health improvement skills, resilience and leadership within local populations, making the concept of co-production of health between services and communities a reality  Making strengthening the core economy of neighbourhood and family the central task of all public services  Using the power of Public Health Commissioning, locally coordinated eg through H & WBBs, to explore new models of integrated delivery. For example, develop forms of community-oriented primary care appropriate to underserved communities with poor health outcomes  Bottom-up action plans to integrate services as part of the co-production approach with communities, can provide the cornerstones of emerging strategic approaches to Community-based Budgets.

16 Making Health Everyone’s Business: The Approach Community Development For Health Developing Public Health Leadership/ Culture change Commissioning levers Investment in health & wellbeing services Developing staff skills & confidence Staff Health & Wellbeing Maximising Health Gain

17  Established in May 2010 to reduce tobacco related health inequalities; to reduce smoking prevalence across the borough by developing and delivering a local Tobacco Control Strategy and Action Plan.  Locally, the issues include: a high prevalence of smokers, especially within the more deprived areas, illicit tobacco, and underage sales.  Specific work streams include: reducing the supply of illicit tobacco, promoting smoke-fee homes and play areas, reducing the number of young people that start smoking, and assisting every smoker to quit smoking, particularly from disadvantaged communities. The objectives are to strategically plan and commission effective, evidenced based interventions for tobacco control.  2 Cabinet members assist in Chairing the Alliance and there is clinical engagement on the Steering Group from the Cardiology Consultant at WWL, the PEC Chairman. Other partners are Public Trading Standards, Ashton, Leigh & Wigan Community Health Care, Wrightington, Wigan & Leigh NHS Foundation Trust, Environmental Health, Greater Manchester Police, Greater Manchester Fire & Rescue Service, Children & Young People’s Service’s, Adult Services, Wigan & Leigh Housing, HMRC, Community Engagement, Wigan & Leigh CVS, 5 Boroughs Partnership NHS Foundation Trust, Wigan Leisure & Culture Trust.

18 Wigan’s major local social housing provider, Wigan & Leigh Housing, has 23,000 properties across the most deprived areas of the borough. Smoking prevalence is high within the tenant population reaching a peak of at 47% on Marsh Green; an estate of around 3000 properties. Smoking was identified as a joint priority with Wigan & Leigh Housing (WALH) for a number of reasons: These included the cost of re-decoration after tenants who smoked had left but the major factor related to the payment of rent arrears. Staff noted the fact that, when negotiating a repayment plan with the tenants, the large amounts of spend which relating to smoking in their regular outgoings. In the initial stages key staff groups were trained to advise and signpost to smoking cessation services and support. The health Improvement Team maintained their contact with the staff and have continued to support with updates and resources. Wigan & Leigh Housing is working within the Alliance to promote the expansion of the work relating to smoking and debt. In May 2012, event being arranged by our local Council for Voluntary Service, to raise awareness of the issue and of the support and services that can offer help with both stopping smoking and debt management. This will be followed by the local housing conference, run by WALH, on the same theme. To ensure consistency and sustainability Public Health will utilise the ongoing MECC programme to train the debt advisors to advise and signpost re stopping smoking whilst the frontline staff working in other areas will be given training allowing them to signpost into debt and smoking support. Making Health Everyone’s Business

19  The Public Health Directorate leads on commissioning a comprehensive portfolio of services and programmes to promote healthy weight. Our flagship programme is the Lose Weight Feel Great care pathway for managing excess weight in adults that was launched in January  With services for overweight clients right through to bariatric surgery it has capacity to provide treatment for over 10,000 clients per annum across a range of services. It is one of the most comprehensive integrated pathways in the country and has significantly increased access to highly personalised advice and support services focused on achieving long term weight loss and maintenance.  In the first 20 months of the programme, approvals for bariatric surgery have been reduced by 73% saving the PCT over £ Over 13,500 people have called the access hub for help and advice and nearly 11,000 people have been referred into services.  Risk is the fragmentation of the commissioning budget may impact on this type of approach where currently the commissioning for all services related to obesity sits within Public Health.

20  This approach of developing the skills of frontline staff in basic behavioural change techniques specifically seeks to provide frontline staff with the skills, tools and confidence to embed prevention in their day-to-day work with clients.  Its based on the premise of making the most of the thousands of encounters that public sector, voluntary and community organisations have with people every week and using these contacts as opportunities to raise health issues and signpost people to appropriate support services.  Locally, Public Health is working with a wide range of organisations to develop staff skills and confidence in raising health issues and signposting people to appropriate support and advice. Organisations committed to this programme include: Ashton, Leigh & Wigan Community Healthcare NHS Trust; Wrightington, Wigan & Leigh NHS Trust; Wigan Leisure & Culture Trust; Wigan Council; 5 Boroughs NHS Trust; and Groundwork. Essential Public Health is a 2 hour training programme that is being used to provide staff with the practical skills and confidence to deliver ‘health chats’.

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22 Healthy Living Pharmacy Programme  The Healthy Living Pharmacy (HLP) concept was developed by NHS Portsmouth during 2009/10 to develop and demonstrate the quality and effectiveness of community pharmacy services, and to improve their contribution to health and wellbeing services overall.  In Wigan we have 70 community pharmacies, the majority of which are already providing excellent services such as stop smoking, sexual health advice and support for self care.  Pharmacies are a key resource for many borough residents from those who lead an active, working life to individuals suffering from long term conditions; and local pharmacies can be a more appropriate and readily accessible venue than a hospital or GP surgery.  Wigan became one of 20 HLP pathfinder areas in September The local Pharmaceutical Committee (LPC), Medicines Management Team and Public Health worked together to support 10 pharmacies on the programme with a target of between 6 and 8 achieving accreditation by March All 10 achieved the set criteria and have now been accredited.  The phase 1 programme has thus far proved so popular with the pharmacies that a further 28 have now signed up for phase 2. The training for counter staff started in June and will be completed on October 3rd. Moving forward the Health Improvement Team will continue to support the pharmacies to continue the progress and to actively undertake or support specific health improvement campaigns. We will have 38 of the 70 pharmacies achieving Healthy Living Pharmacy accreditation. This programme is ongoing in a number of areas but Wigan will have the highest number in England once the accreditation process is completed.

23 Community Health Champions  The advent of ‘Making Every Contact Count’ (MECC) as a work stream fitted in with the work already underway in the capacity building programme. Wigan puts as much emphasis is with non NHS front line staff and volunteers as on the work with NHS staff.  The changes in the way that housing benefits are paid will impact on the social housing providers and is expected to increase the numbers of tenants falling into arrears. We are using this as an opportunity to increase the work related to spending on tobacco and debt management to more teams within the housing sector and to expand beyond the borough’s main social housing provider. All the staff and volunteers who have undertaken our training have become part of our Workplace and Community Health Champion Network. A website has been developed which allows us to communicate updates and further opportunities along with continuing to recruit to the ranks of over 1130 champions.

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25  Complex health and well-being challenges  Influencing resource decisions across organisations  Developing trust across organisational boundaries  Harnessing health and well-being leadership skills across local people and all organisational sectors in the Borough.  For more info see


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