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28th February 2011 Capita Conference Mc Manus

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Presentation on local government capabilities in public health

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28th February 2011 Capita Conference Mc Manus

  1. 1. A New Approach to Public Health Monday 28 th February 2011 Jim McManus Joint Director of Public Health, Birmingham City Council The Local Authority as Strategic Driver on Health and Wellbeing Boards
  2. 2. Issues <ul><li>Strategic Practical and statutory issues for getting public health into local government – role of DPH </li></ul><ul><li>Understanding local authorities as strategic health partner </li></ul><ul><li>Taking forward joint working with HWBB </li></ul><ul><li>New governance focus for public health </li></ul><ul><li>How will boards be monitored for compliance and be accountable </li></ul>
  3. 3. Networks not Deficits <ul><li>Much wider than the DPH although the DPH role is important </li></ul><ul><li>AND </li></ul><ul><li>The DPH is not bringing health into local government for the first time. Understanding the Polity and politics of this will be crucial </li></ul>
  4. 4. Domains of Public Health Health Improvement Health Protection Service Quality and Improvement Commissioning priorities, Evidence, making it work, supporting implementation Ensuring we have the right frameworks in place Long term, medium term, short term, matrix
  5. 5. Local Government Public Health <ul><li>IS </li></ul><ul><li>A portfolio of activities </li></ul><ul><li>part of a Matrix </li></ul><ul><li>About doing our Core Business in a Healthy Way as well as these new functions </li></ul><ul><li>About complex and strategic working </li></ul><ul><li>About partnership </li></ul><ul><li>About People, and Places, and Exposures </li></ul><ul><li>IS NOT </li></ul><ul><li>A replacement for the NHS or good primary care </li></ul><ul><li>Going to improve life expectancy tomorrow </li></ul><ul><li>Lacking in Evidence </li></ul><ul><li>Lacking in Implementation </li></ul><ul><li>Always Short Term </li></ul><ul><li>About shifting all energy from NHS to Local Authority services </li></ul>
  6. 6. The Vision as I see it <ul><li>Public health at heart of strategic role for LA </li></ul><ul><li>JSNA – Outcomes, Commissioning and system wide </li></ul><ul><li>Opportunities for health improvement short, medium and long term </li></ul><ul><li>The big prize is not the 20% ringfenced budget </li></ul><ul><li>In the LA, but not focused solely on the LA </li></ul><ul><li>Get this right for primary care </li></ul><ul><li>Take to heart the NAO criticisms </li></ul>
  7. 7. 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 need a lot of preparation </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><ul><li>Identify other outcomes too </li></ul>
  8. 8. So what does it mean? <ul><li>The Core Business </li></ul><ul><li>Doing the core business of the Local Authority in a way which </li></ul><ul><ul><li>improves the health of the population </li></ul></ul><ul><ul><li>Reduces inequalities in health caused or acted on by social determinants </li></ul></ul><ul><li>The Ringfenced Budget </li></ul><ul><li>Opportunities but need to be seen in the context of the core business </li></ul><ul><li>The DPH is “MORETHAN” the 20% of the 4% </li></ul><ul><li>The DPH is not EVERYTHING in LA terms though </li></ul>
  9. 9. Transition <ul><li>Models </li></ul><ul><li>Directorate </li></ul><ul><li>Corporate </li></ul><ul><li>Commissioned </li></ul><ul><li>Outsourced </li></ul><ul><li>Matrix </li></ul><ul><li>Issues </li></ul><ul><li>Balance between corporate role and PH core role </li></ul><ul><li>Person-organisation fit </li></ul><ul><li>The Outcomes frameworks do NOT align </li></ul>
  10. 10. The Accountability Challenge for the DPH <ul><li>Either everyone wants you or you wonder which Lion will bite you first… </li></ul><ul><li>At least some of that is down to the System, and some of it is down to the DPH </li></ul><ul><li>Which type of DPH will you be – control, enable, make, share or buy? </li></ul>
  11. 11. You might have got it wrong if… Elected Members HWBB SoS / CMO / DH / A-Z LA CMT NPHS Staff Team ? GP Consortia PROVIDERS DPH
  12. 12. Vision, but what about outcomes? Health minded and health-seeking people Both workers and citizens (Self care, and self management reduces reliance on services) Adapted with thanks from Newcastle Model SHARED OUTCOMES JSNA Shared Data Sets Commissioning Priorities H & WB Strategy High Quality Strategy SHARED OUTCOMES Governance, Leadership and Organisation High Quality Partnership Structure HWBB Others Citizen Engagement & Co-Production Delivery Areas Provide Integrated Services Deliver shared outcomes Citizen Engagement & Co-Production
  13. 13. Issues for us to work out <ul><li>System </li></ul><ul><li>Clarity of governance </li></ul><ul><li>Boundaries </li></ul><ul><li>Deliverables </li></ul><ul><li>Outcomes Framework </li></ul><ul><li>Early Wins with HWBB </li></ul><ul><li>Systems Working, Matrix Working </li></ul><ul><li>Pressure Valves </li></ul><ul><li>Complexity </li></ul><ul><li>Person </li></ul><ul><li>Capacity v DASS/DCS </li></ul><ul><li>Partnership Oriented </li></ul><ul><li>Strengths </li></ul><ul><li>Support </li></ul><ul><li>Boundaries </li></ul><ul><li>Working with elected members </li></ul><ul><li>Working with GPs </li></ul><ul><li>Resilience </li></ul><ul><li>The myth of independence </li></ul><ul><li>Political Restriction </li></ul>An OD Programme for the Organisation and the DPH
  14. 14. Some Golden Rules <ul><li>Position – Council Plan, Directorate Plans, HI Plan </li></ul><ul><li>A good time to refresh outcomes, strategies and delivery – keep momentum and morale </li></ul><ul><li>Phased Positions </li></ul><ul><li>Formation/Learning/Preparation </li></ul><ul><ul><li>Members </li></ul></ul><ul><ul><li>GPs </li></ul></ul><ul><ul><li>DsPH </li></ul></ul><ul><ul><li>LA Directors </li></ul></ul><ul><ul><li>PH Staff </li></ul></ul>
  15. 15. Birmingham Policy Framework <ul><li>Council’s Big Three includes Behaviour Change by Services AND Citizens </li></ul><ul><li>The Council Plan – Be Healthy </li></ul><ul><li>The Prevention Framework and Prevention Strategy for Birmingham </li></ul><ul><li>The Public Health Strategy 2011 </li></ul><ul><li>Transition Programme but day job </li></ul>
  16. 16. Models for new services <ul><li>Provide </li></ul><ul><li>Outsource </li></ul><ul><li>Commission </li></ul><ul><li>Matrix </li></ul><ul><li>Network </li></ul><ul><li>Mixed Economy </li></ul><ul><li>Stimulate Social Enterprise </li></ul>
  17. 17. Some Must dos <ul><li>Ensure a robust JSNA </li></ul><ul><li>Ensure HWBB have outcomes </li></ul><ul><li>Support effective commissioning at GP consortium and LA level </li></ul><ul><li>Monitor outcomes </li></ul><ul><li>Control big risks – Health protection, contraception </li></ul>
  18. 18. Context <ul><li>Birmingham’s support for the White Paper </li></ul><ul><li>Desire to do things differently </li></ul><ul><li>View of members and GPs that public health isn’t working optimally </li></ul><ul><li>PH refreshing and reshaping its vision </li></ul>
  19. 19. Some History <ul><li>Public Health Acts 1836 and 36 subsequently </li></ul><ul><li>Public Health into NHS in 1974 </li></ul><ul><li>LA Public Health Movement since </li></ul><ul><li>Environmental Health </li></ul><ul><li>Promotion of Health 1984 Act </li></ul><ul><li>Range of Public Health Functions endured in LA: </li></ul><ul><ul><li>Communicable disease </li></ul></ul><ul><ul><li>Social care </li></ul></ul><ul><ul><li>Housing </li></ul></ul><ul><ul><li>Waste disposal, sewage, waste collection </li></ul></ul><ul><li>Marmott ! </li></ul>
  20. 20. The Opportunities <ul><li>System wide outcomes </li></ul><ul><li>Wider networks and systems approaches </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>
  21. 21. Our Burdens of Disease Primary Secondary Tertiary Role for corporate and roles for core here
  22. 22. The Challenge <ul><li>We are doing tertiary prevention first because of where we are epidemiologically </li></ul><ul><li>Understand which levers pull short, medium and long term </li></ul>Short Term – primary care EXPOSURES LIFESTYLE Medium to Long Term – LA and other players EXPOSURES. PLACES. LIVES Time
  23. 23. So what is the Birmingham approach since 2008/9? <ul><li>Policy Commitment </li></ul><ul><ul><li>The Council Plan </li></ul></ul><ul><li>An assessment of work and priorities across the council </li></ul><ul><li>Each service area playing its part </li></ul><ul><li>Corporate areas playing their part </li></ul><ul><li>Scrutiny of Delivery </li></ul>
  24. 24. Each Service Area Playing its Part <ul><li>Regulatory services – workplace health and also nutrition through food outlets serving food to people in low paid/deprived areas (the healthy food sales awards)and work on young people and tobacco/alcohol </li></ul><ul><li>Housing and Health </li></ul><ul><li>Adult Social Care and Health including our strong work on prevention and integration between health and social care </li></ul><ul><li>Childrens’ JSNA and helping to reshape commissioning and the work they are doing on emotional development </li></ul><ul><li>Worklessness and health, work just starting </li></ul><ul><li>The Core Strategy including clear commitments on health </li></ul>
  25. 25. Corporate Area Playing its Part <ul><li>Shaping the Place to reduce risk and exposure </li></ul><ul><ul><li>Protective Factors (Good Housing, Good Education, Good Economy, Decent Public Realm) </li></ul></ul><ul><ul><li>Vulnerability Factors </li></ul></ul><ul><li>Be Healthy as a Key Priority (for our CORE business) </li></ul><ul><li>Health of our staff as a key part of a corporate strategy for our human resources </li></ul>
  26. 26. Birmingham Approach to the White Paper <ul><li>Shadow HWBB </li></ul><ul><li>GP Engagement </li></ul><ul><li>Public Health Strategy </li></ul><ul><li>Transitional Programmes </li></ul><ul><li>Shared Leadership across City </li></ul><ul><li>develop HWBB </li></ul><ul><li>Public Engagement </li></ul><ul><li>Member and GP shared learning </li></ul><ul><li>Prediction & Prevention </li></ul><ul><ul><li>Falls prevention in social care </li></ul></ul><ul><ul><li>Telecare </li></ul></ul>
  27. 27. Some approaches to a Board Loose, Strategic, Agree Priorities Task Group Other Agency or Partnership (CDRP) What is more important for the Board? Governance or Agreement?
  28. 28. Outcomes and monitoring them Health minded and health-seeking people Both workers and citizens (Self care, and self management reduces reliance on services) Adapted with thanks from Newcastle Model SHARED OUTCOMES JSNA Shared Data Sets Commissioning Priorities H & WB Strategy High Quality Strategy SHARED OUTCOMES Governance, Leadership and Organisation High Quality Partnership Structure HWBB Others Citizen Engagement & Co-Production Delivery Areas Provide Integrated Services Deliver shared outcomes Citizen Engagement & Co-Production
  29. 29. Transition Streams
  30. 30. Thank you! A copy of a supporting paper “some thoughts on the DPH transition” should be in your pack [email_address] Or [email_address] Email – a lesson in joint working???

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