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Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System

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Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System Dr. Kate Ardern MBChB MSc FFPH Executive Director of Public Health for the ... – PowerPoint PPT presentation

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Title: Healthy Lives Healthy People: Opportunities and Challenges for the New Public Health System


1
Healthy Lives Healthy People Opportunities and
Challenges for the New Public Health System
  • Dr. Kate Ardern MBChB MSc FFPH
  • Executive Director of Public Health for the
    Borough of Wigan

2
  • Strategic Drivers Marmot Review
  • The Marmot Review Fair Society, Healthy Lives
    (DH, 2010) identifies 6 key policy areas to
    tackle Health Inequalities and the priority
    actions 
  • 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

3
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4
Health and Well - Being Board
Wigan partnership Health and Well- Being
Priorities (6 Outcomes)
Health and well-being services
Local Authority Partners
NHS
Local people, Social care (children and
adults), Third sector, Housing, transport,
Leisure, Education, Partnerships, Economy,
Social enterprises
Primary Community care
Secondary Tertiary care
Specialist National care
Support at home
Institutional care
Acute care
General population
Low level advice support
People choosing less dependent more
cost-effective options
100 m gap in funding
Increasing demand on services
NHS flat cash funding
5
Evidence, knowledge and skills
To invest in a balanced economy to focus on
wellness determinants of health and high
quality health and social care
Raising and exceeding public expectations of
health and well-being
Safeguarding, dignity respect
Respect contributions perspectives
Care closer to home
Increase autonomy perception
People centred
Co-production
Harness local knowledge , skills and leadership
Help local people take responsibility for their
health
To foster the best possible health and well being
for every person in Wigan
Beliefs
Values
Outcomes
Openness, honesty, integrity
HWBB
Best quality innovation
Improve accessibility of services to support
independence
Target resources correctly
Reach out across partnerships
Stretching our ambition and performance to
achieve world class public health
Innovating and implementing best practice to
achieve best performance against national
standards
Reduce social exclusion
Ownership accountability
Reduce deaths disability due to CVD cancer
Productivity and evaluation
6
People, Partnerships Performance Gestation
from Input to Outcome
Treat Health Inequalities
Prevent Health inequalities
Sustain Maintain Reduction in HI
2005
2010
2015
2020
7
Life Expectancy at Birth
8
What Should a Local Public Health and Wellbeing
System Look Like?
  • How to achieve economies of scale for delivering
    a national public health and wellbeing system
  • Using pooled Information, intelligence and place
    based solutions to undertake new functions
  • Workforce capacity and capability and resource
    management to deliver high quality care  
  • Leadership, partnership and vision to
    successfully deliver population healthcare and
    wellbeing

9
DPH Leadership
  • Community engagement needs to move beyond
    consultation into empowerment, which will involve
    the transfer of power and resources to
    communities themselves
  • Work towards integration of primary and community
    care services with statutory, voluntary and
    independent sector neighbourhood services,
    providing a more holistic user-centred focus.
  • Public health commissioning mechanisms to drive
    development of health improvement skills,
    resilience and leadership within local
    populations, making the concept of co-production
    of health between services and communities a
    reality
  • Making strengthening the core economy of
    neighbourhood and family the central task of all
    public services
  • Using the power of Public Health Commissioning,
    locally coordinated eg through H WBBs, to
    explore new models of integrated delivery. For
    example, develop forms of community-oriented
    primary care appropriate to underserved
    communities with poor health outcomes
  • Bottom-up action plans to integrate services as
    part of the co-production approach with
    communities, can provide the cornerstones of
    emerging strategic approaches to Community-based
    Budgets.

10
Public Health Priorities in Wigan Borough
  • Improving Health
  • Health inequality life expectancy (significant
    overall improvement for both men and women but a
    significant 7 to 9 year internal inequalities gap
    across the Borough), teenage pregnancy(
    significant improvement currently at its lowest
    rate)
  • Underlying conditions - poverty, housing,
    transport, worklessness, education, aspirations
    confidence
  • Lifestyles obesity, tobacco, alcohol, physical
    activity, oral health, optimising management of
    long term conditions.
  • Protecting Health
  • New health problems - Pandemic Flu, climate
    change, healthcare acquired infections
  • Old health problems TB, food poisoning,
    sexual health,
  • Securing Population Health
  • Integrated systems e.g. health and social care
    commissioning, joint intelligence
  • Developing community resilience and health
    literacy
  • Public empowerment, patient focus
  • Quality and timeliness of prevention, diagnosis
    care

11
Making Health Everyones Business The Approach
12
Smoke Free Wigan Leigh
  • Established in May 2010 to reduce tobacco related
    health inequalities to reduce smoking prevalence
    across the borough by developing and delivering a
    local Tobacco Control Strategy and Action Plan.
  • Locally, the issues include a high prevalence of
    smokers, especially within the more deprived
    areas, illicit tobacco, and underage sales.
  • Specific work streams include reducing the
    supply of illicit tobacco, promoting smoke-fee
    homes and play areas, reducing the number of
    young people that start smoking, and assisting
    every smoker to quit smoking, particularly from
    disadvantaged communities. The objectives are to
    strategically plan and commission effective,
    evidenced based interventions for tobacco
    control.
  • 2 Cabinet members assist in Chairing the Alliance
    and there is clinical engagement on the Steering
    Group from the Cardiology Consultant at WWL , the
    PEC Chairman. Other partners are Public Trading
    Standards , Ashton, Leigh Wigan Community
    Health Care, Wrightington, Wigan Leigh NHS
    Foundation Trust, Environmental Health, Greater
    Manchester Police, Greater Manchester Fire
    Rescue Service, Children Young Peoples
    Services, Adult Services , Wigan Leigh
    Housing, HMRC, Community Engagement, Wigan
    Leigh CVS, 5 Boroughs Partnership NHS Foundation
    Trust, Wigan Leisure Culture Trust.

13
Wigans major local social housing provider,
Wigan Leigh Housing, has 23,000 properties
across the most deprived areas of the borough.
Smoking prevalence is high within the tenant
population reaching a peak of at 47 on Marsh
Green an estate of around 3000 properties.
Making Health Everyones Business
Smoking was identified as a joint priority with
Wigan Leigh Housing (WALH) for a number of
reasons These included the cost of re-decoration
after tenants who smoked had left but the major
factor related to the payment of rent arrears.
Staff noted the fact that, when negotiating a
repayment plan with the tenants, the large
amounts of spend which relating to smoking in
their regular outgoings. In the initial stages
key staff groups were trained to advise and
signpost to smoking cessation services and
support. The health Improvement Team maintained
their contact with the staff and have continued
to support with updates and resources. Wigan
Leigh Housing is working within the Alliance to
promote the expansion of the work relating to
smoking and debt. In May 2012, event being
arranged by our local Council for Voluntary
Service, to raise awareness of the issue and of
the support and services that can offer help with
both stopping smoking and debt management. This
will be followed by the local housing conference,
run by WALH, on the same theme. To ensure
consistency and sustainability Public Health will
utilise the ongoing MECC programme to train the
debt advisors to advise and signpost re stopping
smoking whilst the frontline staff working in
other areas will be given training allowing them
to signpost into debt and smoking support.
14
Lose Weight Feel Great
  • The Public Health Directorate leads on
    commissioning a comprehensive portfolio of
    services and programmes to promote healthy
    weight. Our flagship programme is the Lose Weight
    Feel Great care pathway for managing excess
    weight in adults that was launched in January
    2009.
  • With services for overweight clients right
    through to bariatric surgery it has capacity to
    provide treatment for over 10,000 clients per
    annum across a range of services. It is one of
    the most comprehensive integrated pathways in the
    country and has significantly increased access to
    highly personalised advice and support services
    focused on achieving long term weight loss and
    maintenance.
  • In the first 20 months of the programme,
    approvals for bariatric surgery have been reduced
    by 73 saving over 440000. Over 13,500 people
    have called the access hub for help and advice
    and nearly 11,000 people have been referred into
    services.
  • Risk is the fragmentation of the commissioning
    budget may impact on this type of approach where
    currently the commissioning for all services
    related to obesity sits within Public Health.

15
Make Every Contact Count
  • This approach of developing the skills of
    frontline staff in basic behavioural change
    techniques specifically seeks to provide
    frontline staff with the skills, tools and
    confidence to embed prevention in their
    day-to-day work with clients.
  • Its based on the premise of making the most of
    the thousands of encounters that public sector,
    voluntary and community organisations have with
    people every week and using these contacts as
    opportunities to raise health issues and signpost
    people to appropriate support services.
  • Locally, Public Health is working with a wide
    range of organisations to develop staff skills
    and confidence in raising health issues and
    signposting people to appropriate support and
    advice. Organisations committed to this
    programme include Ashton, Leigh Wigan
    Community Healthcare NHS Trust Wrightington,
    Wigan Leigh NHS Trust Wigan Leisure Culture
    Trust Wigan Council 5 Boroughs NHS Trust and
    Groundwork. Essential Public Health is a 2 hour
    training programme that is being used to provide
    staff with the practical skills and confidence to
    deliver health chats.

16
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17
Healthy Living Pharmacy Programme
  • The Healthy Living Pharmacy (HLP) concept was
    developed by NHS Portsmouth during 2009/10 to
    develop and demonstrate the quality and
    effectiveness of community pharmacy services, and
    to improve their contribution to health and
    wellbeing services overall.
  • In Wigan we have 70 community pharmacies, the
    majority of which are already providing excellent
    services such as stop smoking, sexual health
    advice and support for self care.
  • Pharmacies are a key resource for many borough
    residents from those who lead an active, working
    life to individuals suffering from long term
    conditions and local pharmacies can be a more
    appropriate and readily accessible venue than a
    hospital or GP surgery.
  • Wigan became one of 20 HLP pathfinder areas in
    September 2011. The local Pharmaceutical
    Committee (LPC), Medicines Management Team and
    Public Health worked together to support 10
    pharmacies on the programme with a target of
    between 6 and 8 achieving accreditation by March
    2012. All 10 achieved the set criteria and have
    now been accredited.
  • The phase 1 programme has thus far proved so
    popular with the pharmacies that a further 28
    have now signed up for phase 2. The training for
    counter staff started in June and will be
    completed on October 3rd. Moving forward the
    Health Improvement Team will continue to support
    the pharmacies to continue the progress and to
    actively undertake or support specific health
    improvement campaigns. We will have 38 of the 70
    pharmacies achieving Healthy Living Pharmacy
    accreditation. This programme is ongoing in a
    number of areas but Wigan will have the highest
    number in England once the accreditation process
    is completed.

18
Community Health Champions
  • The advent of Making Every Contact Count (MECC)
    as a work stream fitted in with the work already
    underway in the capacity building programme.
    Wigan puts as much emphasis is with non NHS front
    line staff and volunteers as on the work with NHS
    staff.
  • The changes in the way that housing benefits are
    paid will impact on the social housing providers
    and is expected to increase the numbers of
    tenants falling into arrears. We are using this
    as an opportunity to increase the work related to
    spending on tobacco and debt management to more
    teams within the housing sector and to expand
    beyond the boroughs main social housing
    provider.

All the staff and volunteers who have undertaken
our training have become part of our Workplace
and Community Health Champion Network. A website
has been developed which allows us to communicate
updates and further opportunities along with
continuing to recruit to the ranks of over 1130
champions. www.alwhealthchamps.nhs.uk.
19
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20
Effective Leadership
  • Complex health and well-being challenges
  • Influencing resource decisions across
    organisations
  • Developing trust across organisational boundaries
  • Harnessing health and well-being leadership
    skills across local people and all organisational
    sectors in the Borough.
  • For more info see www.phwigan.com
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