1. Wigan: Healthy Lives, Healthy People
Dr. Kate Ardern MBChB MSc FFPH
Executive Director of Public Health for the Borough of Wigan

2. Strategic Drivers: Marmot Review
The recent 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 2

3. 3

4. Wigan Health & Well-Being Board
Wigan is in the cohort of ‘early implementers’ – aim is to transform the health and social care system with the LA and PBC working together as mutually respecting partners
Local Authorities will take on the role of joining up the commissioning of local NHS services, social care and health improvement and will promote integration and partnership working
Multi sector stakeholder event held on 2 March 2011 to ‘start the journey’
Aim to have ‘shadow’ Board from April 2011
Organisational development support is needed to capture key learning

5. Health and Well - Being Board
Wigan partnership Health and Well- Being Priorities (6 Outcomes)
Health and well-being services
Local Authority & Partners
NHS
Social care (children and adults,Third sector Housing,
transport, Big Society Leisure, Education, Partnerships,
Economy, Social enterprises
Primary & Community care
Secondary & Tertiary care
Specialist & National care
Support
at home
General
population
Low level
advice
& support
Institutional
care
Acute
care
People choosing less dependent more cost-effective options
£100 m gap in funding
Increasing demand on services
NHS “flat cash” funding 5

6. Safeguarding, dignity & respect
Evidence, knowledge and skills
To invest in a balanced economy to focus on wellness determinants of health and high quality health and social care
Raising and exceeding public expectations of health and well-being
Safeguarding, dignity & respect
Respect contributions & perspectives
Increase autonomy & perception
Care closer to home
People centred
Harness local knowledge , skills and leadership
Co-production
Help local people take responsibility for their health
To foster the best possible health and well being for every person in Wigan
Beliefs
Values
Outcomes
Openness, honesty, integrity
H&WBB
Improve accessibility of services to support independence
Best quality & innovation
Target resources correctly
Stretching our ambition and performance to achieve world class public health
Reach out across partnerships
Innovating and implementing best practice to achieve best performance against national standards
Reduce social exclusion
Ownership & accountability
Reduce deaths & disability due to CVD & cancer
Productivity and evaluation 6

7. HEALTH AND WELL-BEING PROGRAMMES FOR CHANGE
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
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
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
Unleashing the Talents of Local People
System Reform
Achieving Best Quality
Health &Well-being Policy
Health Protection
Knowledge Management 7

8. HWBB Launch Event Feedback
Liked the 'Big Conversation' style of event - want a follow up and soon!
High participation on the day and positive - even though the current economic climate, public sector cuts are challenging. Talked openly about the 'tough stuff' and impacts.
Participants want public representation/input into H&WBB - beyond a 'token rep from HealthWatch'
A process for gathering public views needs to be formed that feeds into H&WBB and Commissioning priorities and that cuts across LA, PBC, Voluntary and Community Sectors
Want to know about level of scrutiny and how this will work - educational opportunities here
Creation of a Networked Board - want a diagram of where H&WBB sits
'Root and branch' review of existing groups, terms of reference and how they will fit with H&WBB
Communication plan needed for ongoing involvement of stakeholders and influencing of key H&WB priorities

9. DPH Leadership
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. 9

10. What I’m Responsible for in Wigan Borough
Improving health
Health inequality – life expectancy, teenage pregnancy
Underlying conditions - poverty, housing, transport, worklessness, education, aspirations & confidence
Lifestyles – obesity, tobacco, alcohol, physical activity, oral health, optimising management of long term conditions & screening.
Protecting health
“New” health problems - Pandemic Flu, climate change
“Old” health problems – TB, food poisoning, imm & vacc, sexual health
Securing high quality health & wellbeing (including preventative population health& social care)
integrated commissioning, plurality of providers
Integrated systems – e.g joint intelligence
Sustainable development /Corporate Employer
Public empowerment, patient focus
Quality and timeliness of diagnosis & care 10

11. Local Marmot Action Plan
A ‘conscience’ for the new Health & Well-Being Board
The 6 Marmot objectives provide the strategic framework
Joint Strategic Needs & Assets Assessment highlights the health inequalities
Priorities are being set in the context of an emerging policy agenda
Plan includes health and well-being challenges throughout life
- start well, develop well, live well, work well, age well
Engaging local businesses through Food Sector and Well at Work
Got cross sector commitment to understand and tackle causes of poor health locally

12. Heart of Wigan
CVD prevention partnership was established last year to raise the profile of CVD prevention work and specifically advocate for healthier policy and environments.
Over the last 6 months, Heart of Wigan commissioned a piece of work examining the potential impact of local public policy on CVD across the borough based on the national consensus from a range of leading experts on the potential health impact of policy modification and to secure local consensus amongst senior decision makers on how receptive local conditions are to change or introduce related policy.
The shortlist of 8 policies which had senior management support is now being taken out to community consultation to gather residents’ views.
Heart of Wigan is also developing a CVD commissioning framework to guide future local investment in the area, 12

13. Lifestyle Smoking in the Townships
26% of the adult population of Wigan borough are smokers compared with 24% in England overall.
The Health and Lifestyle Survey (2005/2006) suggests that younger residents are more likely to be current smokers than older residents and men are more likely to have smoked than women.
Wigan South Township has one of the highest average smoking estimates of any Wigan’s townships at 34.5% and is higher than both the England and Wigan borough average.
Estimates range from 26.4% to The majority of areas in Wigan South Township have estimates that are among the highest in the borough.
The area in the north of Wigan South Township has the highest smoking estimate of any area in Wigan borough.
Percentage of adults who smoke across Wigan Borough
with areas in Wigan South Township highlighted 13

14. Smoking (The Reality at RAEI)
Reception area at RAEI
Smoking litter found beneath
this sign below!!!
Smoking (The Reality at RAEI)
The gutters
Standing next to
the sign on the left was this guy on the right!!!
Visitors
Parents/Carers 14

15. Healthy Hospital Programme
This programme contributes towards the QIPP agenda by adding value in a hospital setting through focusing on the prevention of ill health. The programme adopts the framework set out by the World Health Organisations’ Healthy Hospitals initiative by actively supporting and encouraging the health and wellbeing of patients, staff and visitors to ensure that the organization adopts a health promoting culture as routine practice.
Good progress has been made in developing and delivering health improvement interventions around smoking, alcohol, healthy eating and breastfeeding as well as working towards improving staff health and wellbeing.
A robust smoking cessation brief intervention programme has been rolled out on a trust wide scale and smokers are now actively targeted in the Pre Op Assessment clinic.
An innovative training approach is currently being developed to ensure that every opportunity becomes a health improvement opportunity; this will ensure that staff receive the appropriate skills to initiate brief ‘health chats’ that will promote and protect health and wellbeing of patients & staff. 15

16. Smoke Free Wigan & Leigh
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. 16

17. Ashton, Leigh & Wigan’s Take 7 Steps Out Roadshow17

18. Lose Weight Feel Great
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 2009.
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. 18

19. Health and Work
The ‘What Makes Wigan Work’ Worklessness Strategy for the Borough has seen Wigan be one of the top performing Boroughs in Greater Manchester at supporting people back into work e.g. reduction in Mental Health IB claimants.
Achieved through the full allocation of Working Neighbourhoods Funds to the strategy and its implementation, strong partnerships, and responsive commissioning
Maximising opportunities within the private sector and building public health capacity within the workforce
Key business making huge strides in workplace health e.g. HJ Heinz ‘Full of Beans’ programme

20. Make Every Contact Count
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’. 20

21. RSPH Level 2 in Health Improvement
The Royal Society of Public Health (RSPH) level 2 award in Understanding Health Improvement is being utilised in a number of ways:
Train the trainer within local public sector, community and voluntary organisations to build local training capacity.
Training within local public sector, community and voluntary organisations to ensure that public health is better understood and health messages being given out are as consistent as possible. Current plans include train the trainer for teaching support staff in the level 2 programme so that it can be delivered to all 14+ pupils in the borough .Training for Greater Manchester Fire Service community staff and active fire fighters.
Wigan has a large number of amateur sports teams, particularly focused on Rugby League. The volunteers who run these clubs are being trained in RSPH so that holistic messages are given to young people rather than a sole focus on physical activity. This is supporting the borough’s Healthy Stadia programme and has led to Wigan having the first two amateur clubs in Europe to achieve Healthy Stadia status.
Supporting staff health & wellbeing - Administrative staff in Public Health and wider PCT have successfully completed the qualification and the qualification is starting to be delivered to staff in primary care settings. 21

22. Effective Leadership 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. 22