A presentation on what Sector Led Improvement is in Public Health and some work in East of England

1. www.adph.org.uk
Sector Led Improvement in
Public Health
Principles and Practice
Prof Jim McManus
Vice President
Association of Directors of Public Health
Director of Public Health, Hertfordshire
County Council
Jim.mcmanus@hertfordshire.gov.uk

2. www.adph.org.uk
After 18 months
of Health
Foundation QI
funding… What’s
the difference
between Quality
Improvement
and Sector-Led
Improvement?

3. www.adph.org.uk

4. www.adph.org.uk
Source: www.phf.org

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Quality Improvement PH framework:
Quality in Public Health a Shared
Responsibility
Public Health System
Collective efforts of
everyone who delivers
the range of functions
and services that seek to
protect, promote and
improve health

6. www.adph.org.uk
Quality standards – What Good looks
like
Purpose of the WGLL Publications
• To support Sector Led Improvement
• To facilitate quality assurance within
the system, by supporting scrutiny
and audit
• To define what good system
leadership looks like, and to clarify
other roles and responsibilities
• To encourage system-wide cohesion
• To support the achievements and
ambitions of population health
outcomes within ICSs and STPs
• To encourage and support evidence
based design and commissioning
• To support workforce development
and highlight the need for a highly
skilled PH workforce

7. www.adph.org.uk
Towards a Public Health Ready
Reckoner for SLI/QI
Scrutiny
National
Exercises –
Suicide
Peer
Challenge
External
Peer to Peer
Learning
Sharing
Practice
Benchmarking
including
against self
assessments
Critical
Friend
Topic Days
Peer
Audit
Contract
Management
Assurance
and
Governance
QI Cycle
Self
Assessment
Intra

8. www.adph.org.uk
Peer I:
East of England ADPH Network
• 9 DsPH covering 12 Local Authorities
• ADPH Network Coordinator 0.4wte
• Meet
– Bimonthly telecalls
– Quarterly with PHE – PH system leadership forum
– Quarterly DPH face to face – SLI focus

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Peer II:
ADPH SLI Regional Audit Tool -
Impact
Level 1: Essential Level 2: Developing Level 3: Advanced Level 4: Transformational
Planning for
impact
Activities seem to be
designed
independently of the
expected impact
Planned activities loosely link
to the improvement and may
lead to improved outcomes
Clear how key activities link
to improvement and are
expected to lead to
improved outcomes
Network uses innovative methods
for planning activities and the
expected impact
Monitoring No regular monitoring
of activities’ outcomes
Only activities’ outcomes
monitored without reference
to impact
Consistent monitoring and
recording - activities’
outcomes and impact
Network uses innovative
measurement and monitoring of
impact over short, medium and
longer term
Improvement Maybe some
improvement from SLI
activities - not
consistently
documented
Some improvement
documented resulting from
SLI activities
Documented substantial
improvement from SLI
activities - clearly cascading
to LAs
Network is documenting
consistent improvement across
local and regional level over time
ADPH SLI Self audit tool – mostly ‘developing’ in 2018 and
aiming for ‘advanced’ in 2019

10. www.adph.org.uk
Peer II:
Self assessment & Peer reviews
• Peer to Peer Learning – LA teams
are visiting each other focussing on
learning from Peer Review
• PH team (DELPH) Self
Assessment priorities are being
shared to understand common
challenges
• External Challenge and Peer
Review – 4 peer reviews completed
recently with at least 1 more being
planned this year
• Raising awareness – regular SLI
agenda item on East of England
Chief Executives’ Forum
highlighting the impact of our SLI
activities
From reviews & self assessments –
emerging themes
• Communities and Place
• Place based Commissioning
• PH Workforce Strategy and Capacity
• Shared system vision, narrative and
ambitions
• Population Health
• Prevention: System and Scale

11. www.adph.org.uk
Peer III: Networks
• Networks – key way to bring
together complex system and
peer:peer support
• 11 EoE Health and Wellbeing
Networks have been evaluated
• Agreed move to strategy for
“Improvement Communities”
1. Alcohol and Drugs*
2. Children and Young People*
3. CVD Prevention
4. NHS Health Checks*
5. Healthy Places/ built environment
6. Knowledge & Intelligence Network
7. Obesity Prevention & Healthy Weight*
8. Physical Activity*
9. Population Health/ Healthcare PH
Network
10. STP/ICS Prevention Leads Group
11. Sexual Health*
12. Suicide Prevention*
13. Tobacco Control *
14. Worklessness, Health and Work*
15. Mental Health Trust Smoke Free*
16. Non-medical Prescriber*
17. PHE/Hepatitis C
18. TB Control Group
19. EoE Workforce Strategy

12. www.adph.org.uk
ADPH SLI Self - Audit Tool - Impact
Level 1:
Essential
Level 2: Developing Level 3: Advanced Level 4:
Transformational
Planning for
impact
Activities seem
to be designed
independently of
the expected
impact
Planned activities
loosely link to the
improvement and
may lead to improved
outcomes
Clear how key
activities link to
improvement and
are expected to lead
to improved
outcomes
Network uses innovative
methods for planning
activities and the
expected impact
Monitoring No regular
monitoring of
activities’
outcomes
Only activities’
outcomes monitored
without reference to
impact
Consistent
monitoring and
recording - activities’
outcomes and
impact
Network uses innovative
measurement and
monitoring of impact
over short, medium and
longer term
Improvement Maybe some
improvement
from SLI
activities - not
consistently
documented
Some improvement
documented resulting
from SLI activities
Documented
substantial
improvement from
SLI activities -
clearly cascading to
LAs
Network is documenting
consistent improvement
across local and regional
level over time

13. www.adph.org.uk
What is going well in EofE SLI?
• We know Public Health has an established basis of working to best
evidence, in partnership, sharing the learning as system leaders –
we have the right culture and know the importance of evidencing
impact!
• Our Network Priority Objective – Assessment:
– Rolling Programme of Self Assessment – using DELPH tool
(Yorks & Humber)
– Completed - 6 teams
– Underway – 1 team
– Planning stage – 2 teams
• External Challenge and Peer Review – 4 peer reviews completed
recently with at least 1 more being planned this year

14. www.adph.org.uk
What else is going well in our SLI?
• Peer to Peer Learning – LA teams are visiting each other
focussing on learning from Peer Review
• PH team (DELPH) Self Assessment priorities are being shared to
understand common challenges and 11 EoE Health and
Wellbeing Networks have been evaluated – both these will inform:
• EoE SLI Workshop on 24 May - extended EoE Network to look at
how our Networks can better demonstrate SLI impact
• Raising awareness – regular SLI agenda item on East of England
Chief Executives’ Forum highlighting the impact of our SLI activities

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What are the challenges?
• Demonstrating impact can be difficult and there are no ready
answers
• A lot about the way we are working together is demonstrating the
qualitative impact of Partnerships and Networks
• We are better than we give ourselves credit for as we often just call
it something different – is it about badging and branding?
• We should make sure we use the ADPH tools that have been
developed for us to keep us on track towards being advanced
transformational and not in an extended developing stage

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The Good news
• If you’re doing Quality Improvement you’re doing
SLI!
• Need to systematise
• Pick the right method for the right issue

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The Moves to clarify added value of
bringing both together
1.Client – who, what do they want?
2.Clarify – what is the dance?
3.Create – work up the doable
4.Change - what is to be done
5.Confirm – the what and the doing
6.Continue – keep doing it
7.Close – thanks for the dance, happy?
Read one review of this here
http://www.sweeneycomms.com/The-Seven-Cs-of-
Consulting-g.asp

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Thank you
• Sara.blackmore@southglos.gov.uk
• Jim.mcmanus@hertfordshire.gov.uk