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Greater Manchester Health Inequalities Review

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Title: Greater Manchester Health Inequalities Review


1
Greater Manchester Health Inequalities Review
  • March 2006

2
Why did we set out to do this review?
  • Greater Manchester has one of the lowest life
    expectancies in the country. Despite progress in
    recent years Greater Manchester is not projected
    to achieve the 2010 life expectancy target.
  • Poor health and inequalities results in increased
    costs, lower economic output as part of the cycle
    of multiple deprivation.
  • Partnership working is increasingly critical to
    effective public services

3
Structure of the review
  • Phase 1 interviews and documentary review to
    establish the main issues facing Greater
    Manchester
  • Phase 2 a workshop approach to explore possible
    solutions to issues arising from Phase 1
  • Phase 3 developing and agreeing action plans

4
Purpose of today
  • To share with you our initial findings and get
    your views
  • Agree a process to share the findings more widely
  • To agree a broad outline for Phase 2 workshops
  • To share a new tool for looking at NHS spend
  • Agree ongoing ERG requirements

5
Audit Approach Phase 1
  • 110 interviews with 41 organisations across GM
  • Review of key documents/papers and good practice
    initiatives from those organisations as well as a
    number of networks and cross-GM alliances
  • Consultation with some voluntary sector groups

6
Findings Key topic areas
  • Strategic fit
  • Partnership and Accountability
  • Information and Intelligence
  • Workforce
  • Performance Monitoring
  • Diversity
  • and
  • Finding Good practice

7
The overall picture
  • Collaboration - moving in the right direction
  • Greater Manchester knows what the health
    inequalities issues are
  • BUT
  • There is no health vision for Greater Manchester
    and a lack of champions
  • Concerted, radical action is required to make a
    difference and reduce the health inequalities gap

8
  • Strategic Fit

9
GM has a number of collaborative structures to
support the implementation of Health Inequalities
action and develop policy
  • AGMA
  • AGMPCTs
  • Health Leadership Group
  • Alliances and taskforces
  • Networks e.g. Mental Health
  • Greater Manchester Forum
  • Acute Chief Executives Forum

10
GM knows what its health issues are and
undertakes significant information analysis
  • All organisations were able to tell us what the
    health inequalities issues are in their area
  • There is growing and in some cases sophisticated
    understanding of health inequalities in local
    areas

11
GM has intent to address the issues facing the
population
  • Most organisations demonstrated intent to engage
    in the HI agenda
  • The move towards collaboration is critical to
    success and is an excellent foundation for the
    future
  • The use of NRF, engagement in LAAs and the health
    partnerships are driving some new initiatives.

12
But there is no clear leadership of the Health
Inequalities agenda
  • There is no overall leadership for addressing
    health inequalities across Greater Manchester
  • Local strategic partnerships provide a focus but
    this is not necessarily aligned with health
    partners agendas.
  • Inconsistent engagement in local partnerships and
    this is exacerbated in Mental Health where
    providers work with a number of different
    district partnerships.
  • Leadership of the health inequalities agenda is
    often via the Director of Public Health.

13
And
  • Often acute service change is driven by new build
    and clinical services but without an explicit
    expectation that change will lead to improved
    health
  • The potential for the corporate citizen approach
    is not well understood or embedded
  • The public health delivery framework is a good
    move forward but does not include local
    government.
  • There are different approaches to health
    inequalities issues

14
GM does not put the mental health of its
population as a priority.
  • Concentration on physical health and secondary
    care
  • Lack of information about mental health
  • Mental health organisations have particular
    difficulties in engaging with LSPs
  • Pockets of excellence exists showing good
    outcomes

15
Constant reconfiguration prevents progress
  • A characteristic of the more successful
    partnerships appears to be stability
  • Reconfiguration in the NHS in particular is
    damaging the potential for more successful joint
    developments
  • Creates difficulties for some partners in
    engaging fully with the NHS on joint agendas

16
  • Partnership and Accountability

17
There is some excellent partnership working
  • Some partnerships show success in taking action
  • These partnerships engage their acute trust
    colleagues
  • Some DPHs have excellent relations across all
    sectors regardless of whether there is joint
    funding
  • This creates a climate where action can be taken
  • Smoke Free Manchester is one such example

18
But
  • Partnerships take different approaches to Health
    Inequalities
  • Some local partnerships are focusing on wider
    determinants such as skills, employment, housing
    and crime
  • Others focus on the agenda defined by Choosing
    Health
  • Action arising from partnerships varies
  • Not all partners are engaged
  • Not engaging a wider range of partners fully will
    prevent meaningful dialogue

19
The impact of non-executives and members makes a
difference
  • This appears to be a key characteristic in
    excellence
  • Robust challenge of board decisions is evident
  • Support provided by those who represent their
    local communities is influential in getting a
    mandate for action

20
But this impact could be greater..
  • Health and overview scrutiny committees need
    better skills to challenge effectively
  • Strengthen the role of scrutiny and challenge
    through HOS committees and support of NEDs in
    ensuring robust challenge.

21
Clear variance in spend between organisations
  • Variance in spend between PCTs is not well
    understood
  • Great deal of management time exerted on planning
    for and spending relatively small amounts of money

22
Lack of engagement with the voluntary sector
  • Inconsistent involvement of the voluntary sector
  • There is insufficient voice for the hard to
    reach groups
  • Meaningful management support of the voluntary
    sector will add greater insight into practical
    solutions and ensure quality provision to target
    groups

23
  • Information and Intelligence

24
The information is available
  • GMAS GIS, PHO portal, Tactical Information
    System, Stats and Maps
  • There are data analysts positioned across GM
  • A great deal of analysis happens

25
Intelligent use of information?
  • Minimal use of information provided by the Public
    Health Observatory
  • Limited use of TIS is made by DPHs and
    organisations
  • The GMAS GIS has potential for highlighting hot
    spots
  • Data skills and capacity is unco-ordinated and
    often not accessible
  • Information is not effectively used to identify
    targeted actions or inform commissioning
  • Action plans are oriented towards monitoring and
    data collection
  • Lack of common agreement about where the data
    gaps lie

26
GM not confident in applying HI evidence to
commissioning decisions
  • Lack of evidence that concerted action is being
    taken
  • Needs to have a clear vision of what has to
    change to make a difference and commission
    accordingly
  • Excessive analysis may prevent decisive action

27
Making the most of research and research funds
  • Do research funds inform changes locally?
  • Research establishments not tied into the local
    health inequalities agenda
  • Teaching, secondary and tertiary centres have a
    wealth of untapped information
  • 5 star research facilities in mental health yet
    little local impact
  • The public health practice unit proposal is
    emerging but must be widely available to all
    organisations

28
  • Workforce

29
Workforce planning is beginning
  • Strategic arrangements are in place to ensure a
    range of skills available to senior public health
    staff
  • Some good analysis of the current workforce
    available in direct public health provision
  • No evidence of workforce implications of
    addressing health inequalities in local
    government

30
Has GM got the workforce capacity to address
health inequalities?
  • Little evidence that the potential of existing
    staff to address health inequalities in all
    organisations is being harnessed
  • Management time is spent on gaining small numbers
    of extra staff
  • With management support for small service
    providers in the voluntary sector an untapped
    resource can be enhanced

31
Impact and role of Directors of Public Health
  • Embracing joint appointments has resulted in real
    engagement
  • DPHs have too wide a range of responsibilities to
    be able to provide suitable and sufficient advice
    and guidance
  • The collective role of Directors of Public Health
    to all sectors is unclear
  • The role and focus of the PH network is unclear
    to many organisations

32
  • Performance Monitoring

33
There are some good examples of performance
monitoring
  • Some organisations and partnerships have
    sophisticated monitoring systems
  • Nationally prescribed targets are generally well
    monitored
  • Local Area Agreements has strengthened some
    performance monitoring

34
Performance is not monitored on a GM wide basis
  • No readily owned GM wide performance measures
  • No readily available comparative information
    between partnerships
  • Many partnerships struggle to agree common
    priorities and set appropriate targets.
  • Focus still on individual organisational targets.

35
  • Diversity

36
Diversity is managed by exception
  • Where there is a high ethnic minority population
    - diversity is high on the agenda
  • Where there is a low ethnic minority population -
    in some cases therefore more diverse, diversity
    is not on the agenda
  • GM appears to identify diverse communities as
    problematic
  • needing special treatment rather than dealing
    with the barriers to access

37
Diversity
  • Some clear indications of the impact that diverse
    populations are having on the provision of
    services
  • These are not widely shared
  • information from acute trusts about take up by
    diverse communities
  • Inequality of access
  • examples of late presentation which are not
    informing commissioning

38
  • Sharing of good practice
  • Its your problem when your neighbours wall is on
    fire

39
Good practice
  • There is a wealth of notable practice across
    Greater Manchester
  • Good practice across the board including joint
    working, learning disability, ethnic minorities,
    use of information, public health reports,
    corporate citizen, member engagement, teenage
    counselling
  • Significant time and effort is invested in
    getting new initiatives off the ground

40
But
  • Need to think outside the box
  • Tertiary centre has designed hard hitting posters
    on prevention but why arent these up in
    secondary schools
  • Some organisations do not know their neighbour
    has a solution
  • An example of a PCT struggling to engage a
    particular group but a neighbouring authority had
    this addressed
  • A PCT understands what corporate citizen means
    and can demonstrate real actions but a neighbour
    doesnt know where to start
  • Acute trust has insight into real inequity of
    access but there is no obvious forum to share
    this and the wider lessons
  • Acute trust wants to get involved but never
    approached or asked

41
Summary of what needs to happen
  • Develop a health inequalities vision for Greater
    Manchester
  • Clarify the role of DPHs and the focus of the
    Public Health network
  • Ensure health and overview scrutiny committees
    develop their skills to challenge more
    effectively
  • Improve the use and co-ordination of information
  • Ensure that existing groups of staff are utilised
    in addressing health inequalities
  • Develop pan-GM performance measures that support
    regular monitoring, comparison and evaluation.
  • Engage more widely to understand the barriers to
    access facing the population of more diverse
    groups
  • Develop arrangements to share good practice as a
    matter of course across GM

42
Food for thought
  • The following slides give an insight into the
    high level data available to all organisations
    and the insights it can provide.
  • They are intended to raise questions at this
    stage.

43
NHS spend in Greater Manchester total spend for
the population
44
Admissions by PCT across GM
45
Endocrine, nutritional and metabolic admissions
(not diabetes)
46
Cancer and tumour admissions
47
Circulation problemsis the excess spend around
28m?
48
Respiratory admissions
49
Dental admissions compared with a fluoridated SHA
area
50
Phase 2 Creating the environment for change
51
Visioning
  • A workshop to explore what needs to happen to
    create a vision for Greater Manchester
  • To identify key players and stakeholders
  • To understand what existing structures and
    organisations could help
  • Representation from across sectors

52
How to make scrutiny and Non-Executive
Director/Member challenge a greater strength?
  • New non-executives to the NHS in coming months
  • Strengthening Board/cabinet/executive challenge
  • Councillors encouraged into health scrutiny
  • Making health scrutiny more effective

53
Resource allocation
  • Overall cost Is the spend of the right amount
    in the right areas and are variances understood
    and justifiable?
  • Explore outliers in spend by programme budget
    categories
  • Explore the effects of ill-health in GM on NHS
    spend in particular
  • Can this type of use of data inform GM wide
    performance monitoring?
  • Is something similar possible for LG funds?

54
Information and intelligence
  • What systems are available and what has to happen
    to information systems to support joint
    performance monitoring?
  • How to get ownership of collective information
    systems??
  • What support do public health and data analysts
    require and how to access their skills and
    capacity better?
  • What public health/health inequalities
    information does commissioning need to inform
    decisions?
  • How does HEA inform commissioning?
  • What insights can secondary and local government
    providers give to increase understanding and
    inform the right commissioning for GM?

55
Application of research and intelligence
  • How does the research capacity available in GM
    get locally applied?
  • What role would a public health practice unit
    play across all sectors?
  • What engagement needs to happen to secure
    research funds? Influence university research?

56
What role can the Directors of Public Health play
to have best effect in supporting the HI agenda
for Greater Manchester across all sectors?
  • Strategic? Enabling? Operational?
  • What do local government and primary care
    commissioners need from these roles?
  • What resource needs to be dedicated to a
    commissioning function?

57
Mental health where does this really sit in the
priorities of Greater Manchester?
  • What has to happen to engage all partners in
    addressing the real inequalities that exist for
    the people of Greater Manchester in their mental
    health? And consequently their physical health
    and the health of those around them?

58
How can the existing workforce be galvanised into
the Health Inequalities agenda?
  • For example
  • Explore the role and use of the health visiting
    resource
  • Delivering a school health service
  • Engaging local authority staff
  • Making health improvement everyones business

59
Would a Greater Manchester good practice database
help? Who could own and facilitate this?
  • Web-based? Excel based?
  • What organisations have the skills to do this?
  • What categories might be best to focus on?
  • Will organisations contribute to populating this?

60
(No Transcript)
61
Some other options to support those tasked with
leading the Health Inequalities agenda ?
  • Corporate Citizen?
  • Engaging with the voluntary sector?
  • Facilitated self-assessment workshops with
    individual health partnerships?
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