Improving outcomes and reducing inequalities through integrating public health Dr Peter Marks Director of Public Health Leicestershire and Rutland

Presentation Why public health in local government? Where are we in Leicestershire? A vision of integrated public health Fit for Work – one example of partnership working in action Opportunities and challenges for Health and Wellbeing boards

The determinants of health

Health and Wellbeing What makes folk feel okay about life?

Why public health in councils? Influence on many of the determinants of health Democratic legitimacy and community leadership Contacts with people

“Public health is coming back to local government”

Transition in Leicestershire Shadow Health and Wellbeing Board established – chaired by county and district councillor – two district councillors as members – interim strategic priorities agreed – JSNA refresh underway Health Member Champions in each DC linked into H&WBB Two shadow CCGs DPH member of Corporate Management Team in LCC Two consultants provide link to CCGs Public health staff moved to County Hall, retaining desks with PCT Senior PH staff co-located in districts Virtual Public Health Team H&WBB linked into wider partnership approaches to strategic commissioning and “community budgets”

Health and Wellbeing Board (The Board) Staying Healthy Partnership (Virtual Management team) Virtual PH team

Public Health Team County Councils x2 County Sports Partnership District councils x7 CCGs x2CYPS Trading standards Devolved Public Health Team

Commissioning services Influencing organisations Private & Voluntary NHS Councils Service provision Lifestyle change Shifting the balance

Virtual PH team Need for relationships at all levels – Strategic – HWBB – Tactical – Staying healthy partnership – Operational – co-located team Ability to influence other organisations Empowering, devolved working, increasing trust with organisations Structures important but personal working relationships are also key

Leicestershire Fit For Work Original remit to ensure that people at risk of long-term sickness absence receive timely, co-ordinated back-to-work interventions focused on preventing them from losing their employment Move management of sickness absence from the medical model into vocational rehabilitation. Move vocational rehabilitation closer to mainstream primary care.

Commissioning Partnership

What FFW currently does Employer liaison Case co-ordination, to facilitate timely intervention Employment advice Wider social support such as debt or housing advice Learning and skills advice Conciliation to overcome escalated disputes between employees and employers

Outcomes April 2011-August 2011 Return to work58% Stayed at work19% Still off sick11% Unemployed7% Disengage from return to work plan5% Absentees return to work77% Presentees stay at work88% Totals Specific

Mediation/Negotiation38% Help with new employment23% Personal support17% Musculoskeletal15% Mental health 7% ‘Main intervention’ that made a difference April 2011-August 2011 Questionnaire responses from 67 cases based on client questionnaire completed after case closed

FFW-the future Continuing to improve the management of sickness absence ……but now also through joint working with employers, local authority and NHS: -Increasing focus on improving the health and wellbeing of all working age people -Championing health promotion in the workplace

Health and Wellbeing Boards Opportunities Strong partnership working at strategic level Shared understanding of JSNA Shared vision in Joint Health and Wellbeing Strategy Bringing together political leaders, officers and HealthWatch Democratic legitimacy Challenges Only part of the picture – needs partnership at all levels Not all the relevant partners will be around the table – needs wider engagement Effective partnership is not just about structures Ensuring those with the greatest needs are heard How will HWBBs hold partners to account?