26th May Bchwp Networking Event


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Third sector learning session on NHS Reforms, Public Health reforms and getting ready for new world

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  • I am going to talk about our experience of trying to address issues as they arose In most emergencies issues arise you do not plan for In this flu pandemic, we had neither a slow rising tide nor a flash flood experience but a mix of different issues in different parts of the country and the city I think what comes out of this is the need to seek to predict what systems of the City’s life will be most affected given what we now know, and then seek to make those resilient My guesses are most cities will see schools, nurseries and social care very affected In delivering this I am focusing on Local Authority services because this is a local authority seminar. I will, inevitably, do injustice to NHS family colleagues because of this. Setting up out of hours flu centres, for example, was a valuable experience for us. And the work of BADGER in developing clinical good practice in assessment and response is just one important piece of work from Birmingham I won;’t be able to do justice to. I will also inecvitably underestimate the role of the Birmingham Resilience Team and the multi-agency Birmingham Resilience Group. These have been hugely important and positive experiences.
  • 26th May Bchwp Networking Event

    1. 1. BCHWP Networking Event 26 th May 2011 Jim McManus Joint Director of Public Health Public Health Futures: Challenges and Opportunities
    3. 3. Key health issues <ul><li>Health inequalities </li></ul><ul><li>Need to rebalance hospital and community led care </li></ul><ul><li>Self Care </li></ul><ul><li>Infant mortality </li></ul><ul><li>Lifestyle issues as the basis for </li></ul><ul><ul><li>six biggest killers – smoking , obesity, alcohol, physical activity, alcohol misuse, drug misuse </li></ul></ul><ul><ul><li>Heaviest burden of long term conditions </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Life expectancy – heart disease, cancer, COPD </li></ul></ul><ul><li>Against backdrop of Changes to commissioning, Big Society and Localism </li></ul>
    4. 4. Life Expectancy at birth of persons by train station across the West Midlands
    5. 5. A New Public Health System <ul><li>Public Health England - new national Public Health Service, directly accountable to Secretary of State for Health </li></ul><ul><li>Return of Public Health leadership to Local Government </li></ul><ul><li>Dedicated resources for Public Health at local and national levels </li></ul><ul><li>Focus on outcomes and evidence based practice supported by a strong information & intelligence system </li></ul><ul><li>Maintaining a strong relationship with the NHS, social care and civil society – Health & Wellbeing Boards </li></ul><ul><li>Set out in the Health and Social Care Bill published January 2011. </li></ul>
    6. 6. A New Public Health System – Local Leadership for Public Health <ul><li>Directors of Public Health - Proposed role </li></ul><ul><ul><li>Jointly appointed by Local Authority/PHE & employed by LA, with accountability to members and through them to the public </li></ul></ul><ul><ul><li>Principal adviser on health to LA, members & officers on the full range of LA functions that impact on health </li></ul></ul><ul><ul><li>Joint lead - Joint Strategic Needs Assessment & Joint Health & Wellbeing Strategy, with Ds of Adult & of Child Services </li></ul></ul><ul><ul><li>Play a key role in the proposed new Local Authority functions to promote integrated working </li></ul></ul><ul><ul><li>Advocate for the public’s health in the community </li></ul></ul><ul><ul><li>Produce an authoritative independent Annual Report on health of local population </li></ul></ul>
    7. 7. <ul><li>Statutory health and wellbeing boards in every upper-tier local authority – established in April 2013 – with a minimum membership, including elected representatives, DPH, DASS,DCS, GP consortia, local HealthWatch etc… </li></ul><ul><li>Duty to promote integrated working between NHS and local government, including services that impact on wider health determinants (e.g. housing or education). </li></ul><ul><li>Duties on GP Consortia and local authorities to prepare the joint strategic needs assessment – but through the health and wellbeing board. </li></ul><ul><li>New joint health and wellbeing strategy , prepared by the health and wellbeing board and based on the needs identified in the JSNA , with requirement to consider the use of health act flexibilities (such as pooled budgets) and all local public sector spend in developing the strategy. </li></ul><ul><li>NHS and local authority commissioners required to have regard to the JSNA and joint health and wellbeing strategy when developing commissioning plans </li></ul><ul><li>Local authorities to determine how best to discharge scrutiny powers </li></ul>A New Public Health System – Local Leadership for Public Health
    8. 8. Public Health Funding & Commissioning Local communities Department of Health including Public Health England NHS Commissioning Board Local Authorities GP Consortia Providers Key Route for funding Route for accountability
    9. 9. PH Funding and Commissioning <ul><li>Allocations and the Health Premium </li></ul><ul><li>Allocations: From April 2013 </li></ul><ul><li>PHE will allocate ring-fenced budgets, weighted for inequalities, to upper-tier and unitary authorities </li></ul><ul><li>Shadow allocations to LAs in 2012/13 (to help plan) </li></ul><ul><li>Independent advice to DH on how the allocations are made. </li></ul><ul><li>Health premium </li></ul><ul><li>LAs will get an incentive payment, or ‘health premium’ built on the baseline allocation </li></ul><ul><li>Based on progress on health improvement & reducing health inequalities (Public Health Outcomes Framework). </li></ul><ul><li>The premium will be simple and driven by a formula developed with key partners incl. LG representatives, PH experts and academics. </li></ul>
    10. 10. PH Funding and Commissioning <ul><li>Accountabilities </li></ul><ul><li>Secretary of State: </li></ul><ul><ul><li>Allocation of resources to health and social care </li></ul></ul><ul><ul><li>Strategy, and legislative and policy framework </li></ul></ul><ul><ul><li>Progress against national outcomes </li></ul></ul><ul><li>PHE: Accountable to the Secretary of State </li></ul><ul><li>Local government </li></ul><ul><ul><li>Accountable to PHE for public health grant according to conditions </li></ul></ul><ul><ul><li>Accountable to local populations for outcomes </li></ul></ul><ul><ul><li>HWBBs charged with assessing and agreeing local priorities </li></ul></ul><ul><li>Data (from PHE) - performance against outcomes, including: </li></ul><ul><ul><li>Comparison by local area </li></ul></ul><ul><ul><li>Incentivisation of improvements </li></ul></ul><ul><ul><li>Tracking national progress towards health improvement </li></ul></ul>
    11. 11. Public Health Outcomes Framework: VISION <ul><li>Domain 1 - Health Protection and Resilience: Protecting the population’s health from major emergencies and remain resilient to harm </li></ul><ul><li>Domain 2 - Tackling the wider determinants of health: Tackling factors which affect health and wellbeing and health inequalities </li></ul><ul><li>Domain 3 - Health Improvement: Helping people to live healthy lifestyles, make healthy choices and reduce health inequalities </li></ul><ul><li>Domain 4 - Prevention of ill health: Reducing the number of people living with preventable ill health and reduce health inequalities </li></ul><ul><li>Domain 5 - Healthy life expectancy and preventable mortality: Preventing people from dying prematurely and reduce health inequalities </li></ul><ul><li>Consultation question: </li></ul><ul><li>Do you agree with the overall framework and domains? </li></ul>To improve and protect the nation’s health and to improve the health of the poorest, fastest
    12. 12. Public Health Outcomes Framework – ALIGNMENT WITH NHS AND ASC Adult Social Care Public Health NHS Adult Social Care and Public Health: Maintaining good health and wellbeing. Preventing avoidable ill health or injury, including through reablement or intermediate care services and early intervention. Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeat emergency admissions. Supporting carers and involving in care planning. ASC, NHS and Public Health: The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches. NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants. Awareness and early detection of major conditions <ul><li>Consultation question: </li></ul><ul><ul><li>Is this the right approach to alignment across the NHS, Adult Social Care and Public Health frameworks? </li></ul></ul>
    13. 13. Summary timetable Summary timetable (subject to Parliamentary approval of legislation) Date <ul><li>Consultation on: </li></ul><ul><li>specific questions set out in the White Paper; </li></ul><ul><li>the public health outcomes framework; and </li></ul><ul><li>the funding and commissioning of public health. </li></ul>Dec 2010–March 2011 Set up a shadow-form Public Health England within the Department of Health Start to set up working arrangements with local authorities, including the matching of PCT Directors of Public Health to local authority areas During 2011 Develop the public health professional workforce strategy Autumn 2011 Public Health England will take on full responsibilities, including the functions of the HPA and the NTA. Publish shadow public health ring-fenced allocations to local authorities April 2012 Grant ring-fenced allocations to local authorities April 2013
    14. 14. Overall Transition <ul><li>Accountability for delivery in 2011/12 will continue to rest with SHAs and PCTs. </li></ul><ul><li>In addition, SHAs will be responsible for the overall transition process in their regions during 2011/12 with co-ordination and leadership for public health from DH. </li></ul><ul><li>As part of this, Regional Directors of Public Health (RDsPH) will lead the transition for the public health system at the regional and local level. </li></ul>
    15. 15. Key Issues wider than Public Health <ul><li>Issues </li></ul><ul><li>Changed NHS </li></ul><ul><li>Smaller local government </li></ul><ul><li>Comprehensive Spending Review </li></ul><ul><li>The Localism agenda </li></ul><ul><li>Big Society </li></ul><ul><li>JSNA </li></ul><ul><li>Stakeholders </li></ul><ul><li>DsPH </li></ul><ul><li>GP Consortia/Federations </li></ul><ul><li>Local Govt </li></ul><ul><li>Health & Wellbeing Boards </li></ul><ul><li>Scrutiny </li></ul><ul><li>HealthWatch </li></ul><ul><li>Public Health England </li></ul><ul><li>NHS Commissioning Board </li></ul>
    16. 16. What should the Third Sector do? <ul><li>Work out what it can really offer the NHS and Local Government </li></ul><ul><li>Identify outcomes and how to evidence them </li></ul><ul><li>Work with NHS and Local Government to prepare </li></ul><ul><li>Work with GP Consortia in a structured way when they are ready </li></ul>
    18. 19. Building a “Whole Council Approach” through Domains of Public Health Health Improvement Health Protection Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation Ensuring we have the right frameworks in place Long term, medium term, short term impacts FALLS PREVENTION Service Quality and Improvement
    19. 20. Timeframes of impact/yield Years 0 1 5 10 15 Planning Frameworks and Core Strategies Education Vitamin Supplements Decent Homes Air Pollution Primary Care Air Pollution Decent Homes Reducing Worklessness Primary Care
    20. 21. 3. THE VCS PREPARING FOR THE NEW WORLD Contributions, Stakeholders and Influencing Processes
    21. 22. Choices <ul><li>Prevention </li></ul><ul><li>Care </li></ul><ul><li>Enablement </li></ul><ul><li>All of them? </li></ul><ul><li>Outcomes </li></ul><ul><li>Benefits </li></ul>
    22. 23. What Outcomes can I contribute to?
    23. 24. Which Stakeholders Influence Money DsPH HWBB GP Consortia LA PHE NHSCB Scrutiny Healthwatch?
    24. 25. Learning the lessons from the National Audit Office 2010 not on course!
    25. 26. Smart Moves <ul><li>Understand the trends and embed them into how you work </li></ul><ul><li>Show you understand how local government works </li></ul><ul><li>Get to know your GP Commissioning Consortium/a </li></ul><ul><li>Get to know lead elected members </li></ul><ul><li>Understand their agendas </li></ul><ul><li>Address them explicitly – what do health trainers do for them? </li></ul><ul><li>Early discussion at Health and Wellbeing Board </li></ul><ul><li>Don’t waste time meeting the world and its dog </li></ul>
    26. 27. 3. Case Study Behaviour Change in Local Government
    27. 28. Life Expectancy by Ward
    28. 29. The drivers for behaviour change <ul><li>Personalisation </li></ul><ul><li>The White Paper – new strategic role for local government </li></ul><ul><li>Other White Papers </li></ul><ul><ul><li>Children, Public Health, </li></ul></ul><ul><li>The drive to integration </li></ul><ul><li>The Local Government Act 2002 </li></ul><ul><li>The Financial Crisis </li></ul><ul><li>Business Transformation </li></ul><ul><li>Behaviour Change as an economic imperative </li></ul><ul><li>Funding Adult Social Care </li></ul><ul><li>Community cohesion – immigration and TB as examples </li></ul>
    29. 30. <ul><li>Understanding these as drivers and intervening variables </li></ul><ul><li>Transit or Escalator – move to less deprived areas </li></ul><ul><li>Isolate – move to equally or more deprived areas </li></ul>Birmingham by Cadbury Neighbourhood Classifications
    30. 31. The new public health duties <ul><li>Coming into Las where…. </li></ul><ul><li>Money has been removed and services cut. Whole landscape changed </li></ul><ul><li>There’s a ring-fenced budget and everybody wants some of it </li></ul><ul><li>Public health is not a known or necessarily trusted quantity (just how joint is your joint DPH?) </li></ul><ul><li>Implications </li></ul><ul><li>DsPH in the real world please. Address what value you bring </li></ul><ul><li>Identify value and priorities with clear business case linked to core authority priorities </li></ul><ul><li>Identify what you can add to LA core agenda and what outcomes </li></ul>
    31. 32. Financial Options for Councils <ul><li>Go bust very quickly indeed </li></ul><ul><li>Create parish/town councils and shove stuff on them </li></ul><ul><li>Cut, cut, cut – deny people services – 33% less? </li></ul><ul><li>Change your model – targeted services for those with greatest need, preventive and universal for others </li></ul><ul><ul><li>Spread risk and co-produce/outsource </li></ul></ul><ul><li>CAN HEALTH TRAINERS BE AGILE ENOUGH FOR THIS CHALLENGE? </li></ul>
    32. 33. Birmingham <ul><li>Prediction & Prevention </li></ul><ul><ul><li>Falls prevention in social care </li></ul></ul><ul><ul><li>Telecare </li></ul></ul><ul><li>Pro - Environmental Behaviour </li></ul><ul><li>Pro-Social Behaviour </li></ul><ul><li>Obesity in 29 highest priority schools </li></ul><ul><li>Staff Sickness </li></ul><ul><li>Staff Productivity (Smoking Cessation) </li></ul><ul><li>Industrial Disease & Accident Prevention </li></ul>
    33. 34. The Opportunities <ul><li>Public health delivering outcomes </li></ul><ul><li>Joined up Outcomes </li></ul><ul><li>A balanced public health function </li></ul><ul><li>Interface between GPs and Social care to save both sides of the system money </li></ul><ul><li>Behavioural solutions to thorny and expensive problems </li></ul>
    34. 35. Smart Moves <ul><li>Understand the trends and embed them into how you work </li></ul><ul><li>Show you understand how local government works </li></ul><ul><li>Get to know your GP Commissioning Consortium/a </li></ul><ul><li>Get to know lead elected members </li></ul><ul><li>Understand their agendas </li></ul><ul><li>Address them explicitly – what do health trainers do for them? </li></ul><ul><li>Early discussion at Health and Wellbeing Board </li></ul><ul><li>Don’t waste time meeting the world and its dog </li></ul>
    35. 36. What does a business case for behaviour change look like? <ul><li>What are you offering? </li></ul><ul><li>Why should local government care? </li></ul><ul><ul><li>Strategically </li></ul></ul><ul><ul><li>Financially </li></ul></ul><ul><ul><li>Priorities and outcomes </li></ul></ul><ul><li>Show an understanding of the trends this service needs to address </li></ul><ul><ul><li>personalisation, eg </li></ul></ul><ul><li>How can you address these? </li></ul><ul><ul><li>Be specific </li></ul></ul><ul><ul><li>Be SMART </li></ul></ul><ul><li>Identify return on investment in value terms </li></ul><ul><ul><li>Costed investment, </li></ul></ul><ul><ul><li>costed benefit </li></ul></ul><ul><li>Argue for a relationship type which sits well with that council </li></ul>
    36. 37. Thank you! Jim.mcmanus@birmingham.gov.uk