This is a presentation for an elected member development day on what Public Health does for Hertfordshire

1. www.hertfordshire.gov.ukwww.hertfordshire.gov.uk
What does Public Health do for
Hertfordshire?
Member Development Day
8th November 2019

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• What Public Health does for Hertfordshire and
why
• Core Programmes
• The Bigger agenda
– Prevention
– Population Health
– Districts
Covering

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• Run Programmes mandated by the Secretary of State as part of his
duty to provide an NHS
• Help the council discharge its duties
• Significant assurance and behind the scenes scientific and other
work
• Run the Prevention programme for HCC Transformation
• 142 workstreams with over 60 partners
• District Programmes
• Commission some services for NHS
• Lead the Population Health Management programme for STP
• Lead the Self Management Programme for NHS
• Co-ordinate Social Prescribing
• Flu planning and co-ordination
What do we do for you?

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• Public Health Acts 1834 onwards
• Local Government Acts 2011
• Health and Care Act 2012
• The County Council has a legal duty to improve
and protect the health of its population
• The NHS has a legal duty to reduce inequalities
Why?

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• One of the things about Public Health is that it’s a small
service. Less than 60 People. It’s bigger than
community protection but smaller than Adult Care.
• But I think our reach is wide. And I’d like to tell you
about what we do for the organisation. And I think what
the service does divides into three broad chunks:
– The key services we deliver
– The behind the scenes stuff we do which you may
never know about but which touch your lives
– Sharing the knowledge and skills we have

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• Almost everything we do except is commissioned out. Half of it sits with the NHS
and half with the Voluntary Sector. What Public Health commission for us counts as
part of meeting the Secretary of State’s mandate to deliver a National Health Service
free at the point of delivery.
• 70,000 people use our sexual health services
• Every under 5 child gets health checks – 35,000 hours of health visiting a year
• Our school nurses check the sight and hearing of 90% of our children
• Our drug and alcohol service sees over 2,000 people a year with very complex
problems
Key Services we Deliver

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• We have one of the lowest rates of smoking in pregnancy in England
• Healthwalks, social prescriptions, and more are funded by us. 35,000 people went
on a healthwalk last year
• An average of two national public health awards for every year they’ve been in the
council
• Working with district and borough partners and the voluntary sector
• And that’s just some of what we do
Key Services we Deliver

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• A lot of what public health does you may not
see, but you’d notice if we didn’t do it.
• Local Health Resilience Partnership
• We have been working with all ten districts and
the county on getting health into the planning
system.
• Similarly, we’ve been working on sustainable
transport and air quality policies with districts
and internally
Stuff we do which nobody sees

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• Health Protection
• Someone suggests we have a cluster of
cancers in children in an area. It’s the public
health team that do the analysis to determine
whether a full scale investigation is needed.
• If Grenfell happened here, we would need an
army of trained psychological responders.
Public health are leading that with NHS and non
NHS staff
Stuff we do which nobody sees

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• Did you know we have a duty to advise and
support the NHS in commissioning its services?
Two full time staff work on this and in addition
many of our analytical products support the
NHS in decision making
• But we also do that inside the Council and
across.
Added Value

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• Public Health support, matched funding or
evidence and testimonial letters have helped
bring in over £2.5M in external funding for
projects across Hertfordshire
• We fund a joint analyst with community safety
who delivered the serious violence needs
assessment
Added Value

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• Partnership with University of Hertfordshire on
Public Health getting their expertise into our
populations. Learning from their great strengths
• a joint partnership between the London School
of Economics social care research team, public
health and adult care, to help us work more
preventively.
Added Value

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• behavioural science team which has a balance
of skills beyond just one field, and we have over
40 champions trained to use behavioural
sciences across the council
• evaluation service which delivers evaluations to
childrens, adults and other departments across
the council on key services
• We produced an evaluation toolkit which helps
the voluntary sector prove their impact to
funders
Added Value

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What makes us healthy?

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Public Health
Political
and Regulatory
Environmental
Social and Interpersonal
Individual – Biological and Psychological
Conceives of different
layers of action for
public health problems
from individual to social,
environmental and
regulatory. Ranges
from
Clinical to population
focus

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Waves of Public Health
Waves of scientific models (Biomedical to Sociological)?
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62341-
7/fulltext

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Health
Improvement
Health
Protection Service
Quality and
Improvement
Commissioning
priorities, Evidence,
making it work with
and for people
supporting
implementation
How do we get it right with
and for people
Long term, medium term,
short term, matrix
Prevention, Enablement,
meaning, access,
Thinking about what we do
Methodologi
cal
Imagination

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Public Health across the Lifecourse•CommissionedbytheLocalAuthority
Preconception
• Sexual &
reproductive
health services
including
contraception
• Vitamins
• Social
prescribing
• Stop smoking
• Physical activity
• Perinatal mental
health
0-5 Years
• Support from
Health Visiting
• Vitamins
• Breastfeeding
help
• Oral health
promotion
• Stop smoking
• Physical Activity
• Perinatal mental
health
School Years
• Eye checks
• Hearing checks
• School Nursing
• Administering
vaccines
• Mental health
• Weight
management
• Child
measurement
• Oral health
promotion
• Stop smoking
• Physical activity
Working Age
Adults
• Weight
management
• Health Checks
• Public mental
health
• Sexual health
• HIV prevention
• Social
prescribing
• Workplace
health
• Stop smoking
• Physical activity
Old Age
• Social
prescribing
• Weight
management
• Health Checks
• Public mental
health
• Sexual health
• HIV prevention
• Stop smoking
• Physical activity
NHS
Immunisations across the lifecourse commissioned by NHS England but delivered by school nurses in school
Thingsyou
mayneversee
Statutory advice and guidance to NHS commissioners on service design and commissioning
Quality checks on screening and immunisations
Health Protection and Emergency Planning
Pathways for care services developed by Public Health
Suicide prevention work

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Health in Hertfordshire
• Overall, Hertfordshire
generally has better
health outcomes
compared with the rest of
the country as a whole.
• This reflects the fact that
Hertfordshire is a more
prosperous area than
average – health
outcomes are closely
linked with levels of
deprivation.

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It’s all relative…
• So when looking at variations (or inequalities) in health outcomes across England,
we get a positive picture of health in Hertfordshire…
• …but when we compare health outcomes in Hertfordshire with those in areas that
have similar levels of deprivation, we start to see opportunities for improvement.

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Looking closer
• Simply looking at figures for
Hertfordshire as whole, however,
masks the variations in health
outcomes which are present within
the county itself.
• A health statistic which looks better
than average at a county level, can
present a much more varied picture
of outcomes when shown at district
level.

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• An enabler of Transformation
• Not just about health
Prevention Across HCC

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Cross-cutting Prevention Themes
• Better use of data and evidence
• Reduce Demand, Do things better
• Health
• Physical activity
• Employment
• Review of how HCC (all directorates) work with key
partners
• Joined up approach to how we engage the voluntary
sector
• Better use of technology
• Behaviour change

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Behavioural Science Support Unit
A holistic offer for directorates to support behavioural
science approaches to be embedded in HCC core
programmes and services including:
•Access to expertise
•Training in key behavioural science approaches
•Behavioural analysis
•Innovative, behaviourally informed interventions
•Access to key tools and resources
•Robust evaluation

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The STP – Population Health Management
Public health vs population health

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The Triple Aim of PHM
Better care
for
Individuals
Better
health for
Populations
Lower Cost

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Using PHM to shift the balance
These are the broad
opportunities that we
can capitalise on
through our PHM
approach which will
directly support the
aspirations of HWE
STP
28
Status quo Moving forwards

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In short – we apply PH Skills and
Knowledge to change our system

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thank you