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Ten minutes on system leadership and public health for elected members

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This is a slideshow for a ten minute talk on system leadership challenges in health and social care, aimed at elected members as part of a "system challenges" workshop

Published in: Health & Medicine
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Ten minutes on system leadership and public health for elected members

  1. 1. www.hertsdirect.org Ten Minutes... on system leadership and public health Workshop for elected members Jim McManus Director of Public Health Jim.mcmanus@hertfordshire.gov.uk
  2. 2. www.hertsdirect.org Some of what we do for Hertfordshire • 142 workstreams ranging from health protection to health improvement • 40 staff on commissioning and technical/specialist side • £52m budget reducing to £46m • 35,000 hours of school nursing a year • 8000 hours of health visiting a week • 60,000 people using sexual health services • 15,000 children weight measured every year • 96% of children get hearing and eye screening • Immunising children and young people
  3. 3. www.hertsdirect.org Protection • Medical examiners for new death certification • Infectious Disease Outbreaks • Assurance on vaccs, imms, screening • Advice – contaminants and environment • Statutory consultee • Mentally disordered offenders • Child Death Overview Panel
  4. 4. www.hertsdirect.org But • This is not the whole story • What would we do if someone else commissioned all this? • How do we make use of core PH services to impact on the rest of the system? • How do we use core PH Skills to impact on the rest of the system? – Equity, service redesign, • What is the role of each bit of the system on Public Health?
  5. 5. www.hertsdirect.org The 3 Domains of Public Health Health Improvement Health Protection Service Quality This area much underutilised by commissioner across the system
  6. 6. www.hertsdirect.org We have built a culture where being healthy is not the default option for many Only acting as a system will turn it round And it will take phases of work across time, and work at different levels If focusing on individuals really worked that well, why are we still in this mess?
  7. 7. www.hertsdirect.org The History, and the Future..waves of Public Health Adapted from Davies et al, 2014 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62341-7/abstract Infectious Diseases Lifestyle Diseases Culturally Reinforced Diseases
  8. 8. www.hertsdirect.org Big Ticket Issues • Systematic approach to prevention • Systematic approach to health inequalities • Systematic approach to making systems better at keeping people at optimum wellness • Cultural and social norms reinforcing that • Making health the default and easy option
  9. 9. www.hertsdirect.org Can elected members think system in all they do on health? If not, we won’t reverse the wave of avoidable disability and disease 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.
  10. 10. www.hertsdirect.org Ambitions • Protect and promote the health of the population • Look across the system and get the system to improve health • Think Systems • Think 4 Es – Economy – Effectiveness – Efficiency – EQUITY
  11. 11. www.hertsdirect.org The System in England National Leadership Evidence, Local centres ,health protection Imunisation and screening Dental PH JSNA, Evidence, Advice esp CCGs Commissions pile of stuff (eg school nurses) Sits on HWBB Vital to public health: communicable disease Food safety, range of EH Services Counties and Unitaries Unitaries and Districts Counties and Unitaries Trading Standards (esp tobacco control and public safety)
  12. 12. www.hertsdirect.org A man called Wanless • Worksheet in front of you we will be using later
  13. 13. www.hertsdirect.org We cannot afford to be where we are anymore. All the primary prevention in the world will not be the answer..need 2ndary and 3ary too. Especially system improvement
  14. 14. www.hertsdirect.org System Leadership when the system is in crisis – need to speak in one voice not four Authoritative (the law, policy) Formal (what policy wonks and thought leaders say) “Prevention core to future of NHS” “How will we get there, what’s happening, big buzz word....” Professed (what we say we do) Operant (what we actually do) “We believe in prevention and co- production” “Here’s our plan. 97% of money stays where it is We’ll take comments by tomorrow.” The Four Voices of Commissioning and Policy
  15. 15. www.hertsdirect.org The voice we need • The system despite valiant efforts from many needs to be re thought. We have short term, medium term and long term challenges. • Let’s agree what they are and then agree how we get there • Elected members need to push this discussion right across the system
  16. 16. www.hertsdirect.org The avoidable spend areas in the health system, with poor health/quality of life Crisis pathways And repeat Admissions, dual diagnoses People with long term mental ill health Whose physical health deteriorates due to Sub-optimal management Prescribing practice where IAPT or CBT could resolve issues Volume of spend Severity of condition Existing curve
  17. 17. www.hertsdirect.org Key actions to reduce spend curve Clinical + Lifestyle + Behavioural Recovery focused care Channel shift: Greater use of online and community groups; less prescribing Optimum physical health (eg quitting smoking reduces cost to MH services) Volume of spend Severity Existing curve The Achievable
  18. 18. www.hertsdirect.org That evidence question again...when the desire for evidence is an attempt to ward off more work.... The question 1. What evidence have you got? 2. What ROI have you got? 3. Have you done a Health Impact Assessment? 4. What specific evidence have you got? What they mean 1. What have you read that I haven’t? (AoMRC report) 2. That’ll fox you... 3. We never have, I’d love to know what one looks like 4. Ok, you’ve done your homework but I’m still resistant...
  19. 19. www.hertsdirect.org Building a public health mindset. What population? What issue/need? (Needs Assessment) What outcomes do we want? (Strategy) What interventions fit best? (Prioritising, Planning)How do we know it’s working? (Evaluation) Where are we? Intelligence, JSNA Where do we want to be? How do we get there? Are we there yet?

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