Welcome and scene setting Councillor Olwen Hamer, Chris Dawes and Professor Zafar Iqbal

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Welcome and scene setting Councillor Olwen
Hamer, Chris Dawes and Professor Zafar Iqbal
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STOKE 2012 - 2020
SUCCESSFUL WORKING CITY
Economy, Employment, Education, Housing, Security
Environment Council Partners
HEALTHY CITY
Health Promotion, Improvement Community
Development Council, Public Health, Care System
Communities
CARING CITY
Care System NHS, Social Services, Third Sector
The Individual
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Professor Zafar Iqbal

• Acting Director of Public Health

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Why Now ?

• Eye of an economic storm
• Health of most vulnerable and poorest
• Evaluation of pioneering programmes
• Assets and community empowerment
• A City Council with a PH outlook
• Mandate for Change
• Opportunity for Refresh and Renew

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Estimated impact on publics health and
well-being role of the local authorities
Source Canadian Institute for Advanced Research
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• Health-related behaviour is all about
  resolutions to give up the things you do not want
  to give up and to do the things you do not want
  to do. You cannot do that you cannot make the
  resolutions and stick to them, unless you are
  feeling on top of life.
• ( Richard Wilkinson giving evidence to the House
  of Commons Health Select Committee, 2008)

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• The Story So Far

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Infant mortality in SOT between 1973 and 2000
Office for National Statistics 2007
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Interventions

• Scale visible from space
• Intensity improve the poorest fastest
• Local needs local intelligence
• Ambitious - risks

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Cobridge Community Health Centre

• The new three storey community health centre will
  bring together three local GP practices with a
  combined patient list of 11,000.
• The building will also include a wide range of
  health services including
• District nursing, health visiting, school nursing
  
• Adult physiotherapy, podiatry, occupational
  therapy and speech therapy
• Integrated sexual health unit including
  Genito-urinary medicine (GUM), contraception and
  Chlamydia screening
• A pharmacy
• A chest clinic and other outpatient services
• Specialist out-patients clinics
• X-ray

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Impact

• 15,000 health checks
• 5,000 more young people accessing sexual health
• 5,000 lifestyle programme
• Record numbers of smoking quitters
• 5,000 diabetics better blood sugar control
• Ambition to have 1000 community health champions

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Percentage improvement in health indicators in SOT
NHS Stoke-on-Trent 2012
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2011 Health2011 Health Profile for SOT (1)
Profile for SOT (1)
Association of Public Health Observatories 2011
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Vision

• Inspirational and ambitious
• Galvanise/empower communities to raise
  aspirations
• Grounded in JSNA and evidence
• Shift treatment to early intervention to
  prevention
• Cover all influences place , communities and
  services
• Root causes Mandate For Change

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The greatest danger for most of us is not that
our aim is too high and we miss it, but that it
is too low and we reach it. Michelangelo
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Appreciative InquiryIntroduction and the
principles of the approach

• Trevor Hopkins
• Asset Based Consulting

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Good organisations know how to preserve the
core of what they do best. Preserving the right
thing is key. Letting go of other things is the
next step David Cooperrider
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Definition
Appreciate Valuing, recognising the best in
people or the world around us, affirming past and
present strengths, successes and
potentials Inquiry The act of exploration or
discovery or to ask questions and be open to
seeing new potentials and possibilities.
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Principles
Reflection remembering times when our culture,
values and identity made us proud. Affirmation -
inquiring into those strengths and how we can use
them to create the future Action practical
planning towards the future
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First some background

• Traditional approaches to development
• Identify problems and barriers to progress
• Maybe analyse why the problems exist
• Propose solutions
• Create an action plan
• Also assign fault or blame
• Focus attention on what is missing, and the gaps
• Can sap energy and motivation

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Characteristics

• Appreciative - AI looks for the positive core
  of the organisation and seeks to use it as a
  foundation for future growth
• Applicable - AI is grounded in stories of what
  has actually taken place in the past and is
  therefore essentially practical.
• Provocative - AI invites people to take some
  risks in the way they imagine the future and
  redesign their organisation to bring it about.
• Collaborative - AI is a form of collaborative
  inquiry. It always involves the whole system or a
  representative cross-section of the whole system.

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The Appreciative Approach

• Focuses on existing resources and capacity
• Identifies what is desirable
• Creates energy, interest and motivation

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The appreciative cycle
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DefinitionWhat would Stoke on Trent look like
if it was a healthy city by 2020?
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DiscoverAppreciative interviews

• Discussions in pairs

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Appreciative interviewing

• Can you tell a story of a time when you made a
  positive change to improve your own health and
  wellbeing?
• What do you believe is now the single most
  important thing that positively influences your
  own health and wellbeing?
• Now turning to your work can you tell a story
  of how you involved others as equal partners in
  bringing about real and sustainable change?
• Imagine your community, your friends, your
  family, your colleagues and the wider community
  in Stoke on Trent telling stories about how you
  have worked together as equal partners to achieve
  your dreams of a healthy community.
• What would these stories be?

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Sharing your stories
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VisionThe six Marmot Policy Objectives
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Delivering Together on the Social Determinants of
Health in Stoke on Trent Visioning event5th
March 2012

• Dr Mike Grady.
• Principal Adviser
• Institute of Health Equity
• UCL

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Review of the Social Determinants of Health and
the Health Divide in the WHO European Region
The CSDH closing the gap in a generation
The Marmot Review Fair Society Healthy Lives
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Male life expectancy at birth, local authorities
2008-10

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Female life expectancy at birth, local
authorities 2008-10

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Areas of action
Sustainable communities and places
Healthy Standard of Living
Early Years
Skills Development
Employment and Work
Prevention
Life course
Accumulation of positive and negative effects on
health and wellbeing
Prenatal
Pre-school
School
Training
Employment
Retirement
Family building
Life course stages
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Strategic Drivers. Fair Society Healthy Lives 6
key Policy Objectives

• Give every child the best start in life
• Enable all children, young people and adults to
  maximise their capabilities and have control over
  their lives
• Create fair employment and good work for all
• Ensure healthy standard of living for all
• Create and develop healthy and sustainable places
  and communities
• Strengthen the role and impact of ill health
  prevention

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Fair Society, Healthy Lives (Marmot Review)

• Health inequalities are not inevitable or
  immutable
• Health inequalities result from social
  inequalities - causes of the causes the
  social determinants
• Focusing solely on most disadvantaged will not be
  sufficient - need proportionate universalism
• Reducing health inequalities vital to economy -
  cost of inaction

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Local Government

• Complex, disparate and diverse systems of Local
  Government .
• Focus on needs of local population and place.
• Differing capacities to orchestrate action to
  address the social determinants of health.
• Whole System Leadership
• Increasing participation and empowering
  communities.

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Health,Wellbeing and resilience

• Evidence participation and improving life skills
  ameliorates impact of health inequalities through
  developing social support networks. (Bynner and
  Parsons 2006)
• Learning and skill development impact positively
  and fosters community action.
• I have learned ..I use my counselling skills
  with my family. I listen more and I know my
  daughter will say I am really proud of what you
  are doing ,Mum (Jane)
• Social networks create the conditions in which
  people thrive
• I would say that people in the group have more
  confidence. At one poInt they would have been sat
  at home doing nothing ,now they are out and are
  involved. Once you get there it s amazing to see
  how far you can go. (Joyce)

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Creating conditions in which individuals and
communities have control over their health and
lives and participate fully in society
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VisionWhat would things be like in Stoke if it
was a healthy city in 2020......?
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Break
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Vision and outcomes

• Trevor Hopkins

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Definitions

• Vision (Dream)
• Outcome
• Indicator
• Performance Measure

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Vision
Outlines what the organisation wants to be, or
how it wants the world in which it operates to
be (an "idealised" view of the world). It is a
long-term view and concentrates on the future. It
can be emotive and is a source of
inspiration. For example, a charity working
with the poor might have a vision which is "A
World without Poverty."
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Outcome
A condition of well-being for children, adults,
families or communities

• All babies born healthy
• All people enjoy good mental health
• All people live in safe communities
• All people enjoy a clean environment
• All people benefit from a prosperous economy

Positive, jargon-free statements of well-being in
plain language that people can understand A
condition of well-being for people in a
place......
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Indicator

• A measure which helps quantify the achievement of
  an outcome.

• 16 current smoking prevalence
• Incidences of self harm
• All age, all cause mortality rate
• Adults with learning disabilities in employment
• Rates of serious violent crime rate

How would we recognise these outcomes in
measurable terms if we tripped over them?
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Performance Measure

• A measure to evaluate how well a programme,
  agency or service system is working.

• Three questions
• How much did we do? (quantity)
• How well did we do it? (quality)
• Is anyone better off as a result? (quantity and
  quality of effect or customer/client outcomes)

Performance measures tell us how well service
providers are working as opposed to the impact on
whole populations
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From ends to means
Outcomes A condition of well-being for children,
adults, families or communities
Population Accountability
Ends
Indicators A measure which helps quantify the
achievement of an outcome
Performance Measures A measure to evaluate how
well a programme, agency or service system is
working
Performance Accountability
Means
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Priorities

• What is most important to us?

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Prioritisation

• Six coloured sticky dots each
• Move around the room
• Read what others have said
• If it helps, interact with other people
• Vote for your six most important outcomes
• If you feel particularly passionate or
  committed to one particular outcome you can sign
  up to this with your name and telephone
  number/email address

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What next?

• Vision, outcomes and priorities from this
  session to be presented at the Health
  Well-being Board for discussion and agreement
• A further workshop to be held (possibly in
  April/May) to take forward the Design and
  Delivery of the vision for health and
  well-being in Stoke by 2020.
• The vision, JSNA, annual report and strategic
  framework to be launched in June/July 2012

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Closing Comments

• Blank box for Trevor to insert bullets of the
  key points from todays session