This presentation is an overview for elected members of successes and challenges for public health in hertfordshire

1. www.hertsdirect.org
Public Health
Successes and Challenges
Teresa Heritage, Executive Member
Public Health, Localism and Libraries
Jim McManus
Director of Public Health

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What we do
• Public health approaches can be thought of as
“public good” – better working of the system had a
wider impact on people
– Better coverage of immunisation gives immunity
benefit to whole population
– better control
– Better control of screening reduces significant
cost and death to NHS
• Almost all of what PH does has an element of public
good and system/population good rather than an
individual offer
• We think there is an opportunity here to bring
this approach to bear on local authority
commissioning

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Some of what PH does in numbers
from last year
• 4,000 people in drug and alcohol treatment
• 60,000 contacts with sexual health services
• 20,000 women accessing contraception
• 35,000 school nursing appointments
• 27,000 NHS health checks
• 32,000 people + went on a health walk
• 6,700 hours of public health advice to NHS
commissioners
• 5,200 hours of advice to HCC commissioners

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SLI
• This “population good” approach is reflected in
the LGA/ADPH approach to Sector Led
Improvement (next slide)

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What good looks like
Improving the Public’s Health is integral to the work of public services in
this place
Safe Informed Embedded Empowered
Criterion:
The core services
and functions and
well delivered and
effective
Criterion:
The system
understands why the
Population’s health is
important
Criterion:
Public Health skills
and tools are in use
and being embedded
across the system
Criterion:
The wider workforce
are actively
contributing to a
public health agenda
• Services in place
• Contracts
• Clinical Governance and
quality
• Access
• Monitoring
• Best Value
Safe
• Process for regular
review of services
against need and
evidence
• System understands
that a sick population is
a costly population
• Articulate prevention
across primary,
secondary and tertiary
prevention
• Benefits to system of a
PH approach is
understood – pathways,
outcomes, cost savings
• Barriers to growth are
understood
• The narrative of why
Public Health is
important is understood
• You could stop
anyone in the
organisation and ask
why public health is
important to their job
• There is a prevention
strategy across
services with clear
aims
• Workforce health
programmes in place
• There is a
commissioning cycle
and PH concepts and
tools are a core part
of this
• People in the system
think about inequality
and equity in the work
they do
• The Principles of
• Need,
• Equity,
• Evidence,
• Evaluation,
• Impact and
• Change
• are embedded within
the skill set of officers
Transactional Transformational
© Copyright, ADPH, 2015
Evidence of leadership for public health being built from officers to members, at all levels

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Some work we’ve done
• Look at our successes
• Articulate what we think is the PH role in system
leadership alongside the role of others
• Articulate what we want from others in the
system

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14/15 Successes
1. Health Weight Strategy
2. District Offer getting districts
providing work alongside NHS and
CC services
3. Health Checks at run rate
4. Workplace Offer – employers value
our work
5. Do Something Different helps
people cope with long term
conditions
6. Health Protection Work recognised
as good
7. Infection prevention in care homes
reducing hospital admissions
8. 40% of adults in structured drug and
alcohol treatment successfully
complete (up from 35% last year)
acquisitive crime due to addiction
down
9. Good rate of getting people through
drug/alcohol services successfully
1. Redesign sexual health service –
new service started 1st April
2. Collaborative working with teenage
pregnancy team, and integrated
health improvement strategy.
3. Strong contract management of
school nurse contract led to
improvements
4. Beezee bodies weight management
for children/families working closely
with childrens services and used
with thriving families too
5. Pastoral leads model in schools on
mental health
6. Partnership working on young
peoples health
7. CAMHS Review

8. www.hertsdirect.org
14/15 Successes 2
1. MoU with CCGs
2. User pathways being developed
(stroke ESD and others in place)
3. PH indicators in some quality
contracts between CCGs and NHS
Providers
4. Integration work on Health and Social
Care – prevention, self management
and multimorbidity
5. Advice to commissioners in HCC
ranging from tree health to mental
health
6. Input on Dementia Strategy and
prevention strategy for HCS
7. Advice on community navigators roll
out
8. Pharmacy medication review
9. Tartan Rug on health challenges
being used by commissioners
10. Adverse Childhood Experience study
1. Year on year decreases in adult
smoking prevalence
2. Met HWB ambitions for adult
prevalence of smoking
3. Engagement with partners on health
and place agenda
4. Programme management
methodology embedded
5. Central repository of work
6. Forward planning for committee
process
7. Facilitating evidence-based practice
in districts
8. Matrix working in intelligence
9. Closer working with CCGs

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Challenges and Opportunities
(some of those identified by scrutiny)
• Intelligence and Information – making the JSNA
and joined up intelligence really drive
commissioning
• Influence NHS Commissioning to ensure
reduction in cost impact on social care
• Better use of pharmacies across the county with
minor ailments
• Better mental health system

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Some suggested core priorities for PH
1. JSNA to further develop to deliver what commissioners
need
2. Squeezing further value from the commissioned
services (cost value, outcome value, join up with
pathways)
3. Influencing for value and evidence across the system
4. Helping where evidence is silent on how you
evaluate/measure/determine what good investment is
5. Young People
6. Supporting MH Commissioners
7. Prevention of avoidable illness and cost
8. Supporting health and social care integration through
PH approaches

11. www.hertsdirect.org
Our Ambitions
• Prevention of avoidable expensive illness and disability
in NHS and social care
• A population mindset across all commissioners
– What population (where are we?)
– What issue/need (Where do we want to be?)
– What outcomes do we want (How do we get there?)
– What interventions do we buy (What gets us there?)
– How do we know it’s working (are we there yet?)

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Some challenges
• Austerity climate, we need to do more joined up
together
• Govt announces consultation on 7% cuts to
public health budgets - we all need to input to
the consultation
• Joining up preventive action to save public
money and keep people better longer
• Preventable disease still going up
• Significant avoidable cost in NHS, lower
productivity despite growth in finance

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Premature death in Hertfordshire
• The causes of premature mortality can be
grouped into four main conditions which account
for around 80% of premature deaths. These are:
• cancer
• heart disease and stroke
• lung disease
• liver disease