Title: Councils at the Heart of Health Reforms Ian Gray CIEH, Chris Shaw Sheffield City Council
1 Councils at the Heart of Health Reforms Ian
Gray CIEH, Chris ShawSheffield City Council
Sandra Whiles Blaby District Council
2Today's Menu
- A bit about
- the challenges
- the reforms
- our potential
- the outcomes frameworks
- our offer
- ladders of intervention
- group work
3A Few Challenges
- Health inequalities people, places and power
- An ageing population
- Families with complex needs
- Youth unemployment
- System changes
- Limited resources
4What's Going On?
- Reform
- To improve or change for the better
- To give up a bad habit
- Re-form
- To form anew
5The New Health System
- Health and Wellbeing Board
- Public health improvement, protection, care
- Joint Strategic Needs Assessment (JSNA) (with
CCGs) - Joint commissioning
- Local Healthwatch
- Health Protection Agency
- National Treatment Agency
- Regional PH teams
- PH Observatories
- Cancer registries
Public Health (PH) England
Local Government
NHS Commissioning Board
Clinical Commissioning Groups (CCGs)
- Primary care
- GPs, Dentists, Pharmacists, Optometrists
- Specialised commissioning
- Prison health
- Immunisation
- Public Health 0-5yrs
Most commissioning of healthcare services locally
6A Moment in Time?
- Central strategic leadership to give a context
for local action - Locally led - councillors and GPs
- A new vision for Public Health wellness
should be central to all we do - Outcomes frameworks to energise and motivate
- Dedicated resources for Public Health to promote
a strategic approach to prevention
7A Few Things to Keep us Busy?
- Setting up new structures quickly which engage,
influence and deliver - Big challenges with limited solutions or
resources - Learning new skills
- Professional worries
- Building new relationships
- Establishing a sustainable performing culture
8Special Relationships Structures
- Health Wellbeing Board
- Clinical Commissioning Groups
- Local authority Health Champions
- Local Health Well Being Forums
- Local Councils and the Community
- Local Health watch
- Businesses
- Third sector
9Health and Wellbeing?
- What makes folk feel okay about life?
- (salutogenesis )
- Not being ill and feeling okay about life?
10Environmental Health
Waste
Planning
Sport and Leisure
Housing
and all the contacts the council has with the
public
11What Will be Different in the Future?
- Do we?
- Give Pooh Bear a tablet
- Take him into hospital to bandage his head
- Fit a stair lift
- Install telecare equipment to support Pooh Bear's
independence - Change our policies to increase the number of
accessible homes
12Are You a Chadwick or a Snow or Doesn't it Matter?
13A Leicestershire Approach
- A wider strategic approach to deliver better
outcomes in our place around issue and place - Visible leadership around culture and healthy
challenge - Pragmatic doing - not waiting for permission
- Risk management
14Leicestershire's Partnership Structures
Simplified!
15What Levers Can We Use?
- Make the JSNAs and HWBB strategies useful
- Integrated commissioning
- Use the outcomes frameworks as a performance
management tool - Evidence of what works
- Shared commitment to make the difference
- Reputation
16The Outcome Frameworks
- Public Health
- The NHS
- Adult Social care
- What about children?
17Public Health Outcomes' Framework
- To improve the nations health and wellbeing and
improve the health of the poorest fast - Outcome 1 Increased healthy life expectancy
- Outcome 2 Reduced differences in life
expectancy and healthy life expectancy between
communities
18Public Health Outcomes Framework
- Improving the wider determinants of health
- Health improvement
- Health protection
- Healthcare public health and preventing premature
mortality
19NHS Outcome Framework
- Preventing people from dying prematurely
- Enhancing quality of life for people with
long-term conditions - Helping people to recover from episodes of ill
health or following injury - Ensuring that people have a positive experience
of care - Treating and caring for people in a safe
environment and protecting them from avoidable
harm
20Adult Social Care Outcome Framework
- Enhancing quality of life for people with care
and support needs - Delaying and reducing the need for care and
support - Ensuring that people have a positive experience
of care and support - Domain 4 Safeguarding adults whose circumstances
make them vulnerable and protecting from
avoidable harm
21Every Child Matters
- Be healthy
- Stay safe
- Enjoy and achieve
- Make a positive contribution
- Achieve economic well-being
22Public Health, Environmental Health-So What?
- Chris Shaw
- Director of Health Improvement
- Sheffield City Council
23We Get It , So What?
24Learning from History
- PH in local government was led by medical men for
much of 19th and 20th centuries - People working for them, engineers, inspectors of
nuisances, HVs - MoH, powerful influences on the work undertaken
- MoH constrained - what council was willing to pay
for and what it believed would be effective - Webster - MoHs did not act collectively esp on
poverty - Up to 1974 responsible for sanitation,
prevention, housing, waste, health services for
women and children, school health, etc - Since 1974, attention dwindled, some arguing why
should we do it, its the NHS job?
25Local Government The Public Health Service
An individuals life circumstances contribute more
to health improvement than health care services
25 Health Care System
50 Social Economic Environment
Local government is best placed to change life
circumstances and improve health
15 Genes
10 Physical Environment
26Double Vision?
- Faculty of Public Health, CIEH spot the
difference -
- Leading, inspiring and delivering a safer,
cleaner and healthier world. - The worlds population achieves and maintains
its fullest potential for health and wellbeing
27Wave Theory
- Public health has delivered in waves over the
decades from the classic water and sanitation
of 1800s, to scientific advances into 1950, the
post war welfare developments (including the NHS)
and risk factor and lifestyle issues from 1960 to
now - This combination of reforms and a change in the
health concerns of the generation present a
massive opportunity for redefining a relationship
which has always existed but changed with
progress in other fields - Afternow Phil Hanlon Glasgow University
28The EHO View of the World
29 LA Services to PH Solutions
30What Are You Selling?
activity DPH Comments
Current regulatory That would happen anyway
Current Campaigns Show me the evidence of impact
Community focussed activity How is that better than ours?
New investment What should I stop doing?
31Observations
- CCGs have too much to do, you will do well to
engage them or GPs, you have too much to do too. - Everyone wants a place on Health and Wellbeing
Boards - DPHs are not inclined to change their
commissioning plans - Members will be on your side.
- PH practitioners do not know as much as you about
communities. - PH evidence isnt all its cracked up to be.
- EH will have to rethink its role and
relationships if it is to be involved, Institute
can help. - Think health concerns long term conditions,
mental health, older people - Think Political concerns- Inequality, vulnerable
communities, strategic priorities
32Ideas
- Health and safety- local accident data, Lofstedt,
different intervention, - Food what are the PH threats? Food strategy,
salt, transfats, - Combine Protection with Improvement
- Housing- vulnerable communities, private rented ,
fuel poverty , Cat 1 hazards - Wellbeing resilience opportunity?
33We get it, so what next ?
34(No Transcript)
35Ladder of Interventions
36So What Do We Have to Offer?