What does public health do - for new elected members
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This document summarizes a presentation about public health in Hertfordshire. It outlines some of the major public health challenges in the county, including health inequalities and non-communicable diseases. It discusses how public health responsibilities have shifted to local governments and the new opportunities this presents. It emphasizes taking a lifecourse approach to health from conception to death and using proportionate universalism. The presentation discusses building partnerships across organizations to address the social and economic determinants of health.
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What does public health do - for new elected members
- 1. www.hertsdirect.org Jim McManus Director of Public Health Public Health Building a culture, delivering change Elected Member
- 2. www.hertsdirect.org This presentation • What does public health do? • What does it look like in Hertfordshire? • What are key public health concepts? • What early thinking is happening?
- 6. www.hertsdirect.org Big Public Health challenges in Hertfordshire • Health Inequalities – least affluent die 7 years earlier than most affluent • Avoidable non-communicable disease – Tobacco, alcohol, inactivity, obesity, poor diet • Obesity in children • Mental health • Healthy ageing • Sexual Health including late HIV diagnosis • Drug and alcohol use • Health problems accumulating across the lifecourse
- 7. www.hertsdirect.org Four key points to remember while the new systems embed • Unique role of local authorities able to work on 80% of determinants of health • The importance of a lifecourse approach • The new strategic role of local government • Proportionate Universalism….Eh???
- 8. www.hertsdirect.org The Domains of Public Health Health Improvement Health Protection Service Quality Then & Now Sanitation Housing Now Environment Then & Now Smoking Heart Disease Now Care which keeps People healthy and independent
- 9. www.hertsdirect.org From 1st April 2013: Public Health in Local Government • Local Authorities responsible for most of the public health worker formerly in the NHS • Some bits have gone to Public Health England, some to NHS England (Immunisation, Screening, Health Visitors)
- 10. www.hertsdirect.org The New World 1 • DPH recruited and team in Local Govt (early – Sept 2012) with duties across the system • District Councils still retain their 1984 Act duties • HCC appoints portfolio holder for Public Health & Localism (other LA’s looking very closely!) • Financial austerity climate • Skills gaps and skills needs • Creating a whole new system, where some of the guidance doesn’t work • Public Health England
- 11. www.hertsdirect.org The New World 2 – the law and the Herts structure • Director of Public Health – Commissions mandated services – Commissions other services – Statutory duty to advise NHS CCGs – Duty to assure on health protection – Range of other stuff
- 12. www.hertsdirect.org Health protection Information & Intelligence Commissioning Strategy, Partnerships
- 13. www.hertsdirect.org What do we do? • School nurses • Sexual health • Chlamydia • Tobacco • Drugs and alcohol • Health checks • Obesity • Weight management • Contraception • Health promotion • Infection control • Child weight measurement • Advising NHS on priorities, funding, commissioning • Individual Funding Requests • Prior approval • Health protection • Information and intelligence • Evidence for interventions • Suicide and self harm 2014 – new medical examiner system 2015 – health visitors
- 14. www.hertsdirect.org Organisation • Senior team of consultants and registered specialists in public health • Programmes team – tobacco control, obesity, alcohol etc • Provider team – smoking cessation and chlamydia screening • HBS host the health promotion logistics team • Falls Team – now passed to Ambulance Service
- 15. www.hertsdirect.org New World 3 – the opportunity for the system • Strong political leadership on public health • Strong robust officer cohort across County and Districts with skills and knowledge appropriate to them • Strong relationship with NHS colleagues • Strong voluntary and community sector • Distributed Leadership
- 16. www.hertsdirect.org New World 4 -The Opportunity for Herts People • 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
- 18. www.hertsdirect.org The Public Health Family 2013 Environmental Health & Regulatory Services NHS Police, Community Safety Third Sector and Community Bodies Public Health England Specialist Public Health Agencies with Major Public Health Roles HCC Public Health County Council including Fire District Councils
- 19. www.hertsdirect.org Contributors to overall health outcomes and why elected councillors are important leaders 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.
- 20. www.hertsdirect.org A Hertfordshire Approach • Lifecourse Heath: conception to death – Lifestyle and preventable disease • Adopt the best evidence • Proportionate Universalism • Work across all tiers of local government • Strong Member Leadership with strong officer expertise
- 23. www.hertsdirect.org 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
- 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. www.hertsdirect.org The Game Plan..making sense of all this • 2013-14 – Get established, get contracts ready, internal systems and culture right – Get our strategy together
- 26. www.hertsdirect.org The public health mindset in local government 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
- 27. www.hertsdirect.org New Hertfordshire Mechanisms • Health and Wellbeing Board – still bedding in • Public Health & Localism Panel – a major opportunity • The Public Health Board –Officer sub Board of Health and Wellbeing Board and Joint Herts CEOs Forum • The Public Health Partnerships Fund...funding from the Director of Public Health for district councils to work with local communities on health issues • WILL BE WORKING ON SKILLS
- 28. www.hertsdirect.org Some things to look out for in the next 9 months • For Members – A Leaders’ and CEOs Summit on Public Health – A conference on public health specifically for elected members across all tiers • For Officers – A toolkit and common approach to public health – Skills development – A conference For everyone: the Herts Public Health Conference 2013
Editor's Notes
- And when thinking about the direction of the County Council over the coming years, we identified key priorities that we know will resonate with you as being important for your towns and parishes Opportunity to “Thrive”, “Prosper”, “Live save and healthily”, and “Take Part” And as we give our residents these opportunities, how can we as public services organisations enable our residents to make the most of them?
- You might think that as a county council with a budget of £937 million, we have nothing to worry about. However, this slide shows all of the many essential services that we need to provide For example, we spend £446 million just on the department that looks after (among others) older people, people with a physical disability, learning disability and mental health problems – essential services for many of our residents. We know that as parish and town councils, you will be just as passionate as us about ensuring that your area has these services delivered We are all in the situation where we need to make sure that our residents get the services that they need, even though our budgets are being dramatically decreased. And we are all being increasingly faced with the dilemma of how to reduce our spending while making the minimal impact on our most vulnerable residents. That’s why we went out of our way to ensure that 85% of the £180m savings were made by service redesign and internal efficiencies.
- As we are all aware, the financial climate has changed significantly for the country over the past couple of years. And we – County and Town/Parish Councils - have been especially affected, with every year seeing more budget cuts for local government. For example, HCC have had to reduce our spending by £180m over 4 years – a significant proportion of our budget The challenges and pressures are set to continue and it’s going to get tougher. However, this doesn’t detract from the fact that we still have a job to do in Hertfordshire – we still need to provide services for Hertfordshire residents – something we know that you are also passionate about. For example, this illustration shows just some of the services that Hertfordshire residents depend upon us to deliver.
- We have an opportunity - 1st April brought a major change in how we do Public Health in England, and this is still bedding in. Local Authorities are now responsible for most of the public health work formerly in the NHS. Given as we sar, that about 80% of the causes of ill-health are not about what the NHS does, we should welcome this opportunity and make the best of it. This means Public Health should be everybody’s business, there is something every member, every officer and every council can do We also know that the new public health model was built on a Unitary model of local government, so in Hertfordshire we will need to work hard to make sure District and Parish Councils are partners with us and I’ll come onto this
- Finally, another area of localism which you will hear increasingly more about is Public Health. The County Council has recently taken over responsibility for public health, and as local government bodies, there is a lot that we can do to make a difference to the health of our residents.
- Most disease that people suffer is avoidable. This slide shows that of all the things which influence our health and illness, only about 20% - the bits in purple – are down to medical care. The rest are about behaviours, education, income and the world we live in – things that we as public sector groups can influence. This is really important because it shows there is a role for parish/town, district and County councils in improving health. Encouraging people to be good neighbours, for example, and getting people to live, work, socialise and volunteer together are all important for good mental resilience and health. Healthy lifestyles are key to longer lives which have less ill-health and disability Making sure our children grow up confident and well adjusted will prevent up to 50% of common mental health problems in their later life Easier said than done, I know, but the evidence is there for us to work together on.
- We are mapping out a Hertfordshire Approach to Public Health which underlines the fact that public health is everybody’s business, and there are several elements to this: A lifecourse approach to health. Basically this means we need to make sure every child has the best start and that we keep people healthy throughout life. The seeds of ill-health in older age are set in working age and childhood. We want everyone to be as healthy as possible. That means we think about people across life, not topics. Preventable disease like heart disease accounts for over half of premature deaths in Hertfordshire. Good diet, physical activity, not smoking and not drinking too much are crucial in avoiding cancer, stroke and heart disease. We have a problem with Obesity we need to deal with and that requires us to work across all ages and across the whole system. We could all join forces for a lifestyle offer across the County. Elected Members are important, our leadership is going to be key to getting a new approach to public health working We need to look at what we can do through our general power of competence, so those of you going to the NALC/LGA free event on this in London in July need to ask what we can do on public health using this power Working across a range of agencies and all tiers of local government will be important, so I’ll come onto this now
- To help us understand that Public Health is everybody’s business we are going to do several things over the next few months: I intend to bring together elected members to look at our role, learn together and agree some ways of working. The first thing I will do is bring together Leaders and CEOs across District and County as part of developing our Countywide approach. After that there will be a conference for members in ALL tiers of local government in Hertfordshire, specifically on public health. The specialist public workforce will also be working to support officers across local government, the NHS, commercial and voluntary/community sectors. An officer public health Board has been set up for partners to work together on a joint framework which leaves flexibility for local priorities We will have a toolkit for councils to use an “everybody’s business” approach to public health in Hertfordshire We will make sure that we look at how we can use the public health contracts for things like Health Checks to link with lifestyle offers and work done locally, and reflect local as well as Countywide priorities We will make sure we do some work on skills and knowledge development including masterclasses for partners on public health and we will run again this year the Herts Public Health Conference for statutory, private and voluntary agencies to come together