People Centred Public Health: Community/Vol Agency Stakeholders Workshop

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A workshop for community and voluntary agencies on public health priorities for Hertfordshire and how we can build people centred public health together

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People Centred Public Health: Community/Vol Agency Stakeholders Workshop

  1. 1. www.hertsdirect.org People Centred Public Health Opportunities for Community Agencies in a Strategic Shift to Prevention Jim McManus Director of Public Health Sept 27th 2013
  2. 2. www.hertsdirect.org What we want to get to • Articulate what people centred public health means • Explain the context • Explain what agencies can do • Suggest some models
  3. 3. www.hertsdirect.org Healthier Herts: A Public Health Strategy for Hertfordshire Consultation Draft OUR PURPOSE to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence OUR VISION: A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well against Hertfordshire Priority 5: We understand what’s needed and we do what works Priority 6: We make public health everybody’s business and work together HOW WE WILL WORK TOGETHER (our strategic priorities: how we do it for our County) The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, H ealthier Lives Priority 2: Our Population Starts Life Healthy and Stays Healthy Priority 3: We narrow the gap in life expectancy and health between most and least healthy Priority 4: We protect our communities from harm (chemical, biolo gical, radiologic al and environmental) Building Blocks For the Public Health Family Strong Leadership Capable, Skilled People Co-production with citizens Effective Partnerships Evidence and Knowledge Driven Plan and Deliver for Localism Whole System Approaches Making better use of behavioural sciences at individual, interpersonal, community and service levels
  4. 4. www.hertsdirect.org 1. OUR CHALLENGES
  5. 5. www.hertsdirect.org Hertfordshire • 1.1m People in 37 Settlements • 10 Districts • 1 County Council • 2 NHS CCGs • 8 NHS Trusts • 1400+ vol orgs • Urban/Rural mix
  6. 6. www.hertsdirect.org Major Disease Shifts • 1st – Poverty, Living Conditions – Improvement in incomes, reduction in deaths • 2nd –Communicable Diseases – Now on average 6-11% of deaths in UK. Was 85% of deaths before 1900 • 3rd – Non-Communicable Diseases – Over 60% of deaths due to lifestyle and behaviour – Poorest fare worst (smoking, diabetes, heart disease)
  7. 7. www.hertsdirect.org
  8. 8. www.hertsdirect.org Learning the lessons from the National Audit Office 2010 not on course!
  9. 9. www.hertsdirect.org Interface of PH, health inequalities & social care • NHS gone from infectious disease focus in 1948 to LTCs, cancer and mental health in 21st century • 1 in every 7 GP appointments for LTCs* • 50% of adults with a mental health problem had a MH, behavioural or emotional problem before the age of 14 yrs • MH biggest spend of NHS than any other health condition • Social determinants AND quality and accessibility of health & social care • Old model of health and social care – deliver to, not with…co-production, co-creating health, shared decision-making … • Personal budgets… for social care (and health ??) • Shift from one size fits all
  10. 10. www.hertsdirect.org The Big Strategic Challenges for Hertfordshire Health Improvement Health Protection Service Quality Imms Vaccs TB HCAI Environment •Non Communicable Disease •Public Mental Health •Development •Ageing Health Care Quality Public Service Outcomes
  11. 11. www.hertsdirect.org 2. THE CONTEXT
  12. 12. www.hertsdirect.org Conceptualising wider determinants Smoking 10% Diet/Exercise 10% Alcohol use 5% Poor sexual health 5% Health Behaviours 30% Education 10% Employment 10% Income 10% Family/Social Support 5% Community Safety 5% Socioeconomic Factors 40% Access to care 10% Quality of care 10% Clinical Care 20% Environmental Quality 5% Built Environment 5% Built Environment 10% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective. Contributors to overall health outcomes
  13. 13. www.hertsdirect.org 40 years of science/policy on wider determinants • From Rose to Black to Marmot....
  14. 14. www.hertsdirect.org Systems thinking on wider determinants Getting everyone on the same systems page The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!) The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences) The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)
  15. 15. www.hertsdirect.org 3. WHERE WE WANT TO GET TO
  16. 16. www.hertsdirect.org People Centred Public Health • Every service understands and owns a public health role • We skill and motivate people to self-manage their health and wellbeing • We focus on the person and co-ordinate around them • Physical, Social, Psychological and Spiritual are all part of the dynamics of health • Mindset of staff,volunteers, carers and users
  17. 17. www.hertsdirect.org Healthier Herts: A Public Health Strategy for Hertfordshire OUR PURPOSE to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence OUR VISION: A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well against Hertfordshire Priority 5: We understand what’s needed and we do what works Priority 6: We make public health everybody’s business and work together HOW WE WILL WORK TOGETHER (our strategic priorities: how we do it for our County) The Public Health Outcomes Framework (the national PHOF will Help us measure Our success) WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION (our strategic priorities: what we achieve for our County) Priority 1: Our Populatio n lives Longer, H ealthier Lives Priority 2: Our Population Starts Life Healthy and Stays Healthy Priority 3: We narrow the gap in life expectancy and health between most and least healthy Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental) Building Blocks For the Public Health Family Strong Leadership Capable, Skille d People Co-production with citizens Effective Partnerships Evidence and Knowledge Driven Plan and Deliver for Localism Whole System Approaches Making better use of behavioural sciences at individual, interpersonal, community and service levels
  18. 18. www.hertsdirect.org The Opportunity for Herts • The conditions for everyone to be healthy • The conditions for the poorest and worst off to be healthier • Public services which put this at the core of their business • People thriving and prosperous • Healthy workforce, prosperous County
  19. 19. www.hertsdirect.org The Strategy Pyramid 1 HWBS Herts PHS Local Strategies
  20. 20. www.hertsdirect.org The Strategy Pyramid 2 Missio nVision: Where we want to get to Strategy: How we want to get to the vision Implementation Plans : What we need to do in each area of the business and for each topic Individual Plans: My personal objectives and must dos Mission: Why ? Where/What do we want to be? Why do we Exist ? How we want to get there? What we need to do! What I need to do! Values, what’s important to us ? {
  21. 21. www.hertsdirect.org A Lifecourse approach • Conception to death • Protective and vulnerability factors (e.g. obesogenic or energy balanced environment) • Healthy outcome in one age is cumulative impact of earlier ages • Poor outcome in one age may be risk factor for another (low birth weight and CVD) • Early investment, early prevention (lifetime mental ill health and under 13s) • Data, Evidence, Implementation key
  22. 22. www.hertsdirect.org Mission • Our mission is to work together to improve the health and wellbeing of the people of Hertfordshire, based on best practice and best evidence* • • *Best evidence means not just effectiveness but cost-effectiveness
  23. 23. www.hertsdirect.org Vision • Healthy, Happy Hertfordshire: Our vision is that everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives.
  24. 24. www.hertsdirect.org Timeframes of impact/yield Years 0 1 5 10 15 Planning Education Vitamin Supplements Air Pollution Decent Homes Jobs Primary Care 20 CVD Events Self Care Vitamin D and TB Rickets CVD Events Acute Bronchitis Admissions Respiratory Mental Health overcrowding educational attainment Life Expectancy Healthier space use Changing culture of activity Life ExpectancyMental Health
  25. 25. www.hertsdirect.org 4. WHAT WE NEED TO DO
  26. 26. www.hertsdirect.org What it means for public health • Design pathways around people • Whole life approach • Whole school approach to health • Whole place approach to health • Commission preventive services which join up with clinical services • Build protective factors
  27. 27. www.hertsdirect.org What it means for NHS Services, for example • Preventive services in every patient pathway • Preventive services in clinical services link up to community services (referral for leisure and behavioural interventions) • Making Every Contact Count • Commissioning for self-management in chronic disease
  28. 28. www.hertsdirect.org What it means for community agencies • Identify need and be part of needs assessment process • Co-design public health services with public health commissioners • Embed public health skills across your services • Build resilience in users and communities • Motivate people to self-manage • Become health promoting in all you do
  29. 29. www.hertsdirect.org Health Improvement Health Protection Commissioning priorities, Evidence, acti ng when evidence is silent, making it work, supporting implementation Ensuring we have the right frameworks in place Long term, medium term, short term impacts Let’s assume you run a day centre..... FALLS PREVENTION? Service Quality and Improvement
  30. 30. www.hertsdirect.org What Outcomes can I contribute to?
  31. 31. www.hertsdirect.org Values - Ottawa Charter, 1986 • Underpins strategic role of local government • "The goal of a healthy public policy is health promotion, i.e., to enable people to increase control over and improve their health. • It is also essential to – create supportive environments, – strengthen community action, – develop personal skills and – reorient health services. All of these are areas for elected member leadership
  32. 32. www.hertsdirect.org The public health mindset means working across different dimensions of time and responsibility •Think through what we can do short term •Start work on the medium term •Set the policy framework for the long term •Build this understanding among partners •Get started and realise •County, District, Parish, NHS, Business and Community Sector working together
  33. 33. www.hertsdirect.org HERTFORDSHIRE LOCAL PUBLIC HEALTH MODEL (For Place or for People Settings) Development of a local plan for each area and agency between partners with use of existing community networks 2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS Neighbourhood interventions for Diet, Physical Activity, Smoking, Alcohol, 3a. IMPROVE LOCAL NEIGHBOURHOOD QUALITY Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN NEIGHBOURS 4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES Immunisation, Screening, This may differ from area to area depending on issues 1. Complete a Basic health profile – identification of health issues salient for the neighbourhood or service user group by checking the basic basic profile from JSNA or other source 5. Skilling people for their own health– develop and deliver basic personal health skills training. (Physical and mental health) So…towards a model explicitly designed to be as easy as possible for non-health specialists can implement it 3b. IMPROVE SALIENT HEALTH OUTCOMES Address issues specific to your population e.g. Coping and resilience for carers
  34. 34. www.hertsdirect.org So • Does this make sense? • Is it doable? • What do you think can make it better? • How do we improve? • Where do we go from here? • What can you do? • What do we need to do to helpyou?

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