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28th January 2011 Joint Dph Workshop Leeds


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A presentation to a development session for DsPH on the public health transition

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28th January 2011 Joint Dph Workshop Leeds

  1. 1. The Joint Director of Public Health: Opportunities and challenges in a changing landscape Jim McManus Joint Director of Public Health, Birmingham City Council New Species or Oddity? A DPH in Local Government
  2. 2. Wendy thought the new multiple accountabilities for Directors of Public Health could get a bit fraught
  3. 3. 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 </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>
  4. 4. Health Improvement Health Protection Service Public Health 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. 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>
  6. 6. 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>
  7. 7. The Vision as I see it <ul><li>Public health at heart of strategic role for LA </li></ul><ul><li>JSNA - Commissioning </li></ul><ul><li>Opportunities for health improvement short, medium and long term </li></ul><ul><li>The big prize is not the 20% </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>
  8. 8. 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>
  9. 9. 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>
  10. 10. Financial Issues for Councils <ul><li>Go bust very quickly indeed (tarrif services?) </li></ul><ul><li>Create parish/town councils and function transfer </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>Ringfencing of public health budgets in this context will be seen as a mixed blessing </li></ul>
  11. 11. The Opportunities <ul><li>Public health delivering outcomes </li></ul><ul><li>A balanced public health function </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>
  12. 12. Our Burdens of Disease Primary Secondary Tertiary
  13. 13. 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
  14. 14. Domains of Public Health Health Improvement Health Protection Service Public Health Where does this go and when will it stop being entirely NHS focused? Diverse accountabilities What about the PH role in Commissioning?
  15. 15. So what is our 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>
  16. 16. 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>
  17. 17. 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>
  18. 18. Life Expectancy by Ward Still there whatever the back office system Don’t wait for change or direction…move now
  19. 19. 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>
  20. 20. 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>
  21. 21. The DPH – Focus for Action or Porcupine? Elected Members HWBB SoS / CMO / DH / A-Z LA CMT NPHS Staff Team ? GP Consortia PROVIDERS
  22. 22. 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>
  23. 23. 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>
  24. 24. 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>
  25. 25. 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>
  26. 26. Embrace the vision and the opportunities for Public Health <ul><li>From “independent” advocate </li></ul><ul><li>(was that ever really true) to </li></ul><ul><li>Officer working with members </li></ul><ul><li>and GPs </li></ul>
  27. 27. Thank you! A copy of a supporting paper “some thoughts on the DPH transition” is in your pack