Jim McManus

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Jim McManus

• Joint Director of Public Health
• Birmingham City Council

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Prevent, Enable, Personalise, Realise some
tentative experience from BirminghamCOSLA
Annual Conference 2012
Delivering Success
Jim McManus Joint Director of Public
Health Birmingham City Council 16th February 2012
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Public Service Reform Big Tasks

1. Localism Act
2. Elected Mayors??? Errr...
3. NHS Reforms public health, clinical
   commissioning groups, NHS Commissioning Board,
   Health and Wellbeing Boards
4. Police and Crime Commissioners
5. Open Public Services White Paper
6. Spending Review
7. Social Care Funding

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Big Asks

• Do better with a lot less
• And by the way your population is still getting
  older, needier and growing
• And you will have a 25 increase in dementia
• And immigration will bring costly TB and CVD
• Oh, and youll have more folk with learning
  disabilities
• And they all have to have personal budgets

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The basic message complex relationships, big
tasks
Good outcome
Life circumstances
Behaviours
Bad outcome
The arrows include public services and access
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The basic message interventions big asks
Good Health
Life circumstances
Behaviours
Ill Health
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Birmingham ChangePrevent, Enable, Personalise,
Realise

• Major Change reducing buildings, reducing
  costs, outsourcing, mutuals
• New single contract (50,000 people)
• New operating model for children universal,
  targeted, special and complex

• New Operating Model for adult social care
  prevent, enable, personalise
• Benefits realisation
• Radical new ways of doing things

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New Ways of Working

• Not just rely upon commissioning
• Working with wide range of civil society
  partners
• Shared leadership of Health and Well-Being Board
• Support from HealthWatch
• Using new powers and new resources to create
  healthier communities

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The Big Ask What success looks like... 37million
People supported to manage LTC
Increased through community resources
Increased through joint interventions
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Why does service change matter?
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Life Expectancy against Core Cities

• 4th out of 8 Male
• 5th out of 8 female

Male Female
England 78.3 82.3
Sheffield 77.8 81.5
Leeds 77.7 82.0
Bristol 77.2 81.9
Birmingham 76.4 81.3
Newcastle 76.2 81.0
Nottingham 75.2 80.3
Liverpool 74.5 79.2
Manchester 74.0 79.1
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Life Expectancy by Ward
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(No Transcript)
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Gaps in school readiness at 3 and 5 years by
family income UK
Average percentile score
Waldfogel Washbrook 2008
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National Audit Office 2010not on course!
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And what has got us there? Barriers to reform

• Focus, or lack of it
• Starting with a promising intervention, then
  making sure it is doomed to fail by tinkering
  about
• Scientific Grounding and Understanding of Need
  (or lack thereof)
• Partnerships obsessed with structure and
  governance
• Poor integration of joint commissioning
• Cultures...Aaarrrghhh!!!!!
• Deficit We know more than you

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Not getting value of Intelligence in achieving
Better Outcomes...
What did we achieve?
Does anyone actually Really do all this?
Keeping on Track
Prioritisation
Best Buys/Best Dos
Need
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Writ across all Programmes

1. Telecare 14 million
2. Intelligence and Information Programme
3. Predicting need in social care
4. Data sharing with GPs
5. Diverting people from social care and hospital
6. Targeting young people to reduce risk
7. Worklessness
8. Decent Housing
9. Preventing Extremism
10. Enablement
11. Public Health Transition

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Critical Success Criteria Fire Service

• Falls Assessment
• Telecare Assessment
• JSNA and data sharing
• Population density of fire and need
• Sharing populations
• Well constructed outcomes based agreements

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Health and Care Our Burdens of Disease mean
Prevention is wrong way round
Tertiary
Primary
Secondary
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The Big Ask What success looks like... 37million
People supported to manage LTC
Increased through community resources
Increased through joint interventions
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Whole System plus focused action
The example of health inequalities
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The Conceptual Framework
Reduce health inequalities and improve health and
well-being for all.
Create an enabling society that maximises
individual and community potential.
Ensure social justice, health and sustainability
are at heart of policies.
Policy objectives
A. Give every child the best start in life.
C. Create fair employment and good work for all.
E. Create and develop healthy and sustainable
places and communities.
B. Enable all children, young people and adults
to maximise their capabilities and have control
over their lives.
D. Ensure healthy standard of living for all.
F. Strengthen the role and impact of ill health
prevention.
Policy mechanisms
Equality and health equity in all policies.
Effective evidence-based delivery systems.
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The Golden Thread
Need, Outcomes
Priorities, Interventions
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Health Inequalities What we know

• Edinburgh World Congress of Epidemiology 2011
• Non Communicable Diseases
• Impoverished understanding of behavioural
  sciences in some public health programmes
• Multiple Tracks. Public policy action in all of
  them

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Policy History...Zzzzz

• Black Report 1982 (UK)
• Ottawa Charter 1986 (World)
• Health of the Nation 1984 (England Wales)
• Our Healthier Nation 1998 (England Wales)
• Healthier Wales 2000 (Wales)
• Choosing Health 2005 (England)
• WHO Commission on Social Determinants 2009
• Marmot Review of Health Inequalities 2010

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2008
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2007
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The upshot of all this is that whatever framework
you use.....
Its the same problem!
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The Big Tasks

• Short term challenge of tertiary prevention
• Medium term problem of keeping the ill well
• Short term problem of stopping avoidable events
• Long term problem of changing determinants of
  health, health expectations, behaviour and culture

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The Big Tasks

• The Ask

• Who

• Short term challenge of tertiary prevention
• Medium term problem of keeping the ill well
• Short term problem of stopping avoidable events
• Long term problem of changing determinants of
  health, health expectations, behaviour and culture

• Social Care, NHS, Housing
• NHS, Social Care, Housing, Leisure
• NHS, Leisure
• Local government par excellence

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Birminghams use of Marmot

• Activities

• Framework

• 1. Adopt the Outcomes
• Starting well
• Developing well
• Living well
• Working well
• Ageing well
• 2. Add an outcome dying well
• 3.Cut our JSNA and Strategy across the Lifespan
• 4. Use as golden thread

• For Health Inequalities Action
• For JSNA
• For Health and Wellbeing Strategy
• For Integration
• As a lifecourse approach to human ecology

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Examples of Marmot in practice

• LGBT MENTAL HEALTH

• PREVENTION

• Lifecourse approach using Marmot
• Early development
• Mental health problems onset
• Tasks for each lifestage
• Community and Public Sector tasks
• Interdependencies

• Use of Marmot Framework across lifecourse
• Tasks for adult social care and older adult
  social care elucidated
• Incorporation into third sector contracts with
  third sector
• Preventive workstream

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Examples
Start Well Develop Well Age Well
Adults Communities High priority parents in touch with A C Transition Older Peoples offer from prevention to very high need
Homes Neighbourhoods Overcrowding and infant mortality Decent Homes Standard Access, Trips, Falls, Extreme Weather, Adaptability,
Development Back to work packages Digital inclusion Back to work packages for parents Digital Inclusion Volunteering and work packages Digital Inclusion
NHS Infant Mortality Conception Frail Elderly
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Demonstrated

• The role of public health sciences in public
  service can be significant
• The role of behavioural sciences in public
  service reform can be significant
• Public health disciplines can be applied across
  public service reform

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Thank You!

• Jim.mcmanus_at_birmingham.gov.uk