Co-Producing Healthier Outcomes


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An assets approach to health builds on the strengths of individuals and local communities and views them as co‐producers of health and wellbeing. This session describes how assets and co‐production approaches are already building healthier communities and explores how this will change the way we tackle the big health challenges for Scotland.

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  • We have talked about the need to understand our audience and see things as they do not as we do = John Reid when health secretary said he could understand why a single mum would smoke – understood that the ten minutes she gets outside away form the kids is her only break – only chance she gets in the day for time for herself. How can we replace that benefit she gets from a cigarette break?
  • Hierarchical model with sometimes token invovlement
  • Much of the evidence available to policy makers to inform decisions about the most effective approaches to promoting health and to tackling health inequities is based on a deficit model and this has, inevitably, produced policies and practices which disempowered the populations and communities which are supposed to benefit from them. An assets approach to health and development embraces a positive notion of health creation and in doing so encourages the full participation of local communities in the health development process. E.g. community based interventions have huge impact -10% reduction in cost of LTC (using self care/expert pt etc ) could save NHS £6.9 billion/year that is £20.7 billion by 2014 ( ref Human Factor)
  • Chest Heart and stroke Self management Champions -pilot in Perth proposal to work along side Health professionals Question how do we balance Self Managementnt/ Health input/Community involvement/ Self Management toolkit Sandra Gourlay Cancer be friending voluntary
  • Glasgow cited at top and bottom of life expectancy - 28 years All other countries in between. Tayside 23 years. CLICK Aspiration - remove, not just reduce but remove.
  • Co-Producing Healthier Outcomes

    1. 1. Co – producing healthier outcomes
    2. 2. COMMUNITIES IN CONTROL Paul Ballard Deputy Director of Public Health Honorary Senior Lecturer Dundee University Medical School
    3. 5. Customer understanding <ul><li>We don ’ t see things as they are; we see them as we are </li></ul>(Anais Nin)
    4. 6. Medical Nemesis <ul><li>The health care system “expropriates the power of the individual to heal himself and to shape his or her environment” (Ivan Illich Medical Nemesis 1975). </li></ul>
    5. 8. What isn’t co-production? Consultation Informing people Co-designing services Representation on service boards and panels Evaluating services User led organisations Personal budgets Volunteering
    6. 9. What is co-production? <ul><li>“ Co-production means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.” ( nef 2008) </li></ul>
    7. 10. Communities in Control <ul><li>The challenge is to work with communities, not to find out what they want and then provide it, but to enable them to take control and provide their own solutions. This is called co-production. </li></ul>
    8. 11. Elements of co-production <ul><li>Building on people’s existing capabilities </li></ul><ul><li>Recognising people as assets </li></ul><ul><li>Reciprocity and mutuality </li></ul><ul><li>Peer support networks </li></ul><ul><li>Blurring distinctions between people and professionals </li></ul><ul><li>Facilitating rather than delivering </li></ul>
    9. 12. Asset Approach <ul><li>“ A health asset is any factor or resource which </li></ul><ul><li>enhances the ability of individuals, communities and populations to maintain and sustain health and well-being. These assets can operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses.” </li></ul>
    10. 13. Changing roles: current service delivery model <ul><li>Planners specify what the services will look like, procure them and then monitor the services using targets </li></ul><ul><li>Practitioners assess need, ration resources and deliver services to passive recipients </li></ul><ul><li>Users and communities are defined by what they lack and receive care based on how needy they are perceived to be </li></ul>
    11. 14. Changing roles: co-production model <ul><li>Planners, Practitioners, Users/Communities </li></ul><ul><li>All three have a role in assessing needs, mapping assets, agreeing outcome targets, planning allocation of resources, designing and delivering services, monitoring and evaluating impact </li></ul><ul><li>Professional and experiential knowledge are valued and combined, everyone’s capacity is developed. </li></ul><ul><li>Minimises waste by developing solutions with users </li></ul><ul><li>Can often reduce costs by focusing on person-led community- involved services, relieving pressure on expensive specialist services </li></ul>
    12. 15. Co-production in action <ul><li>Time banking </li></ul><ul><li>Family Nurse Partnership </li></ul><ul><li>Healthy Communities Collaborative </li></ul><ul><li>SHINE </li></ul><ul><li>Keyring </li></ul><mc type=&quot;items&quot; fid=&quot;LgAAAABcv+Fc8jqdSaD2tCvchQ9OAQDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAAAB&quot;><itm><id>RgAAAABcv+Fc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeRbAAAJ</id><t>IPM.Note</t><urlid>RgAAAABcv%2bFc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeRbAAAJ</urlid></itm><itm><id>RgAAAABcv+Fc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeRDAAAX</id><t>REPORT.IPM.Note.NDR</t><urlid>RgAAAABcv%2bFc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeRDAAAX</urlid></itm><itm><id>RgAAAABcv+Fc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeREAAAX</id><t>REPORT.IPM.Note.NDR</t><urlid>RgAAAABcv%2bFc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeREAAAX</urlid></itm><itm><id>RgAAAABcv+Fc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeROAAAJ</id><t>IPM.Note</t><urlid>RgAAAABcv%2bFc8jqdSaD2tCvchQ9OBwDCWDJzUFSOTbXRY0mGdBr3ACakSkjvAADCWDJzUFSOTbXRY0mGdBr3AHhuPeROAAAJ</urlid></itm></mc>
    13. 16. HEALTH EQUITY STRATEGY Paul Ballard Deputy Director of Public Health Honorary Senior Lecturer Dundee University Medical School
    14. 17. <ul><li>“ achieving health equity within a generation is achievable </li></ul><ul><li>- it’s the right thing to do </li></ul><ul><li>- now is the right time to do it” </li></ul>
    15. 19. Key Elements of the Health Equity Strategy <ul><li>Contributing to Health Equity within a generation </li></ul><ul><li>Utilise co-production and assets based approach </li></ul><ul><li>Focus energy and resources on early years </li></ul><ul><li>Focus greater effort on behavioural change </li></ul><ul><li>Agree with partners measures of progress and outcomes </li></ul><ul><li>Build co-ordinated health intelligence </li></ul>
    16. 20. The Design Process <ul><li>Early 2009 – Creation of multi-agency Steering Group and Board </li></ul><ul><li>April – June 2009 – Ongoing engagement with communities </li></ul><ul><li>September 2009 – Endorsed by Health Board </li></ul><ul><li>October 2009 – January 2010 – Period of formal consultation </li></ul><ul><li>March 2010 – Endorsed by Health Board </li></ul><ul><li>April – July 2010 – Implementation Plan constructed including template for CHPs/CPPs </li></ul><ul><li>August 2010 – Health Board endorsed Implementation (Optimisation) Plan </li></ul>
    17. 21. Key areas for implementation <ul><li>CHP/CPP action plans </li></ul><ul><li>Segmenting data/population health data zones </li></ul><ul><li>Organisational development plan for NHS Tayside </li></ul><ul><li>Early years </li></ul><ul><li>Acute service perspective </li></ul>
    18. 22. Measures <ul><li>Life Expectancy (at birth) </li></ul><ul><li>Premature Mortality (those aged under 75 years) </li></ul><ul><li>Mortality (15-44) </li></ul><ul><li>Mortality by cause of death </li></ul><ul><li>Infant Mortality </li></ul><ul><li>Admissions by diagnosis (CHD, Cancer, CVD, COPD, Alcohol) </li></ul><ul><li>Multiple Emergency Admissions </li></ul><ul><li>Diabetes Type II Prevalence </li></ul><ul><li>Teenage Conception </li></ul><ul><li>STIs – Chlamydia </li></ul><ul><li>BBV – Hep ‘C’ </li></ul><ul><li>Obesity </li></ul><ul><li>Screening (bowel, cervical and breast) </li></ul><ul><li>Community Resilience/Social Capital </li></ul><ul><li>Co-Production (Indicators to be developed) </li></ul>
    19. 23. Remember <ul><li>People are the heart of the solution, not the problem. </li></ul>
    20. 24. Introduction to SHINE project Dr Margaret Hannah Deputy Director of Public Health NHS Fife
    21. 25. SUB HEADING
    22. 26. Micro market for highly tailored care packages for frail, elderly Personalised, humanistic care Timely, preventative support Micro-enterprises Fits with wider reshaping care agenda Family empowerment Co-production with communities Technology with a human face
    23. 27. WORKING WITH COMMUNITIES IN FIFE Heather Murray Senior Policy Officer Fife Council
    24. 30. <ul><li>Deck access flats </li></ul><ul><li>Dampness and disrepair </li></ul><ul><li>Poor environment </li></ul><ul><li>Low confidence and aspiration </li></ul>
    25. 32. ECONOMIC REALITIES OF CO-PRODUCTION Gerry Power National Lead - Co-production and Community Capacity Joint Improvement Team Scottish Government
    26. 33. ‘ ... co-production is essentially about the delivery of public services being shared between the service provider and the recipient ... co- production is nothing new ... what makes ... (it) ... topical in the current financial crisis is the expectation that effective user and community involvement may help to improve outputs, service quality and outcomes and reduce costs ...’ Barker, Adrian., 2010, Co-production of Local Public Services. Local Authorities and Research Councils’ Initiative. Available from < > (accessed 31 March 2011)
    27. 34. Governance International THE CO-PRODUCTION STAR TOOLKIT
    28. 35. 1.Target it. maps what co-production is already taking place, the benefits its having and how this can be built on. 2.Focus it. identifies the activities where there are likely to be big savings and/or service quality improvements in areas which are organisational priorities . 3.Incentivise it. who wants to work with you in co-producing your services including service users and potential service users to find out.
    29. 36. 4.Market it. encouraging behaviour change by people who use services, other citizens and by provider staff, citizens, frontline staff and managers. 5.Grow it. focuses on scaling up the co-production activities that work, including spreading good practice to other services and other organisations
    30. 37. Gerry Power ( National Lead - Co-production and Community Capacity Reshaping Care for Older People Programme Joint Improvement Team Scottish Government Area 2ES St Andrew's House Regent Road Edinburgh EH1 3DG 0131 244 2374