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Health & Wellbeing

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Health & Wellbeing - bringing together the pieces

Health & Wellbeing - bringing together the pieces

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  • Primary Prevention -- To engage in actions that prevent the initial occurrence of disorders or diseases by focusing on risk factors or environmental conditions that can result in the diseases or disorders Secondary Prevention - Early detection including to stop or slow down existing disease and its effects through action on contributing factors Tertiary Prevention - To reduce the occurrence of relapses/progression for someone living with a chronic disease or disorder while sustaining or improving quality of life Harm Reduction - Actions to decrease the adverse health, social and economic consequences of engaging in risky behaviours without requiring abstinence (e.g. smoking, drugs) Source : Jackson, S. (2005). Overview of Current Health Promotion Approaches - presentation to Canadian Health Network , Regional Workshops September 2005, and Prevention Workshop November 2005. Centre for Health Promotion, University of Toronto. Toronto Ontario
  • What do you want to prevent? Who is the target audience? Possible Phase 1 – audit and Phase 2 – creation of a framework for the assets approach Can include commissioned and delivered services.
  • The inverted triangle of action – taken from the Audit Commission 2009, ADASS / LG Association 2003 Red circle = potential scope Green = potential scope for community assets
  • This is another project which CPC have delivered and creation of a bespoke framework so that you can incorporate such assets can be included into any package of work.
  • The red areas represent the sustainable areas which can be repeated in future with the sustainable tools.
  • Stress that these are not actual figures


  • 1. Health & Wellbeing ...bringing together the pieces
  • 2. Context
    • Different systems / terminology
    • Shrinking budgets and drive for efficiency
    • Changes to public health and the NHS
    • Future introduction of Health and Wellbeing boards
    • Service offerings have tended to grow organically over time
  • 3. Bringing together the pieces.... Determinants of health Disease Adult Social Care Independent Living NHS Third Sector
  • 4. A shared understanding.... Condition Specific Support & Treatment (Assessed Services) Assessment of Need Individual’s Life Course Point of crisis / intervention PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION Non Assessed Services Condition management Characterised by absence of an issue or condition, but there may be a risk associated with genetics, lifestyle or environment Characterised by an issue or condition but this is managed to prevent deterioration (movement into the next stage) Universal Prevention Targeted Prevention Specialist Prevention / Short-term Intervention Specialist Care Health & Social Care Wider Partners Community Assets Spectrum of provision Audit of Health & Wellbeing Provision Joint Strategic Needs Assessment Asset Based Working
  • 5. Finding a more unified approach....
  • 6. Scope (1) Health & Social Care Single Organisation Wider Partners Local Strategic Partnership Community Assets
  • 7. Scope (2) – The inverted triangle of action Level of need General population need Low to moderate needs Substantial needs Complex needs Strategic focus Types of activity Citizenship Neighbourhood & community Info & service access Volunteering opportunities Age proofing services Community development Enabling community self help Community safety initiatives Decent homes Active ageing initiatives Befriending Shopping, gardening, repairs Intermediate care Enablement services Carer support Integrated care teams End of life care Post-discharge support Pathways out of hospital or residential care Lifestyle Practical support Enablement & early intervention Long term care in the community Institutional avoidance Timely discharge
  • 8. Recognising community assets…. Source: ‘A Glass Half Full: how an asset approach can improve community health & wellbeing’ http://www.idea.gov.uk/idk/core/page.do?pageId=18364393
  • 9. Methodology
  • 10. Sample outputs Total amount of funding Funding source Amount % Primary Prevention Amount (%) Targeted Prevention Amount (%) Adult Services £ 12,000,000 40% 0% 100% NHS £ 900,000 5% 86% 14% Housing £ 10,000,000 35% 59% 41% Corporate Services £ 1,900,500 10% 67% 33% CVS £ 1,900,500 10% 0% 0%   Value Schemes   Amount % Count % Supporting People £ 8,367,601 32% 122 62% Adults (Mainstream) £ 939,202 4% 33 9% Drugs £ 995,404 4% 9 4% Carers Grant £ 243,682 1% 7 3% NHS £ 1,353,220 5% 12 6% AIDS Grant £ 34,767 0% 6 2% Self Funders £ 154,340 1% 2 1% Area Based Grant £ 23,351 0% 1 0% Learning Disabilities Development Fund £ 47,700 0% 6 2%
  • 11. Sample outputs Type of services provided through funding (Primary vs. Targeted) Age Primary Targeted Emergency Alarm £ 0 £ 1,195,000 Home Improvement / Handyperson £ 4,940,000 £ 2,500,000 Information & Advice £ 2,245,000 £ 750,000 Support Network £ 14,000 £ 415,000 Luncheon Club £ 0 £ 55,000 Drop In £ 0 £ 258,000 Befriending £ 0 £ 144,000 Volunteering Opportunities £ 366,000 £ 0 Age Group Spend Focus of targeted spend (%) 2009 estimates non-specific £ 22,000,000     18-25 £ 1,500,000 41% 12% 25-39 £ 450,000 12% 26% 80+ £ 2,100,000 59% 5%
  • 12. Benefits....
    • Detailed understanding of:
        • What this funding is spent upon
        • The target recipients of this investment
        • Purpose of the provision
    • Ensure that provision is in the correct places
    • Identify duplication in provision and opportunities for better co-ordination, thus identifying efficiencies
    • Alignment to policies such as ‘Total Place’ and the ‘Big Society’
    • Promotes partnership working
    • First steps towards the integration of Public Health into Local Authorities
  • 13. Need Cost Resource shift Complexity Thickening the preventative waist.....
  • 14. Our experience.... Bolton Council and NHS Bolton required an independent review of current health and wellbeing provision to assist with strategic planning. CPC conducted this baseline audit of prevention based services across social care, health, housing, corporate services and the CVS. This audit provided an outcome framework against which services can be mapped so that spending can be aligned to local issues and contribution to strategic objectives can be traced. CPC also identified opportunities for better co-ordination and will ultimately inform the future targeted wellbeing and prevention strategies. In order to maximise the impact of prevention based services it was important to understand who currently benefits from them. CPC developed a framework within which the preventative services of both health and social care could be jointly examined. As a result of this work we identified overlaps and gaps of service provision so that future redesign of services can be undertaken and the process could be continually updated in a sustainable fashion. CPC were commissioned by NHS North West and the Department of Health to develop a ‘whole-system’ framework for the adoption / integration of a community asset approach within health, social care and related systems, enabling organisations to effectively plan and commission services in order to achieve the best possible outcomes for the people in their area. This work will also support commissioners and providers to redesign services, with other stakeholders including communities, in order that local assets (community and organisational) are pooled to enable the futures desired by all stakeholders to develop. Portsmouth City Council appointed CPC to undertake an in-depth independent review of the City Council’s Health Improvement and Development Service (HIDS), in order to inform future service development and investment decisions. The review provided the Council with a clear view of HIDS central co-ordination and leadership role for prevention, early intervention and health promotion across health and social care. CPC also provided a robust validation of the performance and contribution to wider agendas relating to determinants of health. The operational efficiencies of having health promotion and social care teams working together provide vital learning for other areas and place HIDS in a leading role.
  • 15. Brett Nelson Associate Director CPC 0161 830 2139 / 07827 804156 [email_address]