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
  Borough of Wigan

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• 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

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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
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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
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People, Partnerships Performance Gestation
from Input to Outcome
Treat Health Inequalities
Prevent Health inequalities
Sustain Maintain Reduction in HI
2005
2010
2015
2020
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Life Expectancy at Birth
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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

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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.

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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

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Making Health Everyones Business The Approach
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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.

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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.
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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.

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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.

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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.

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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.
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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