Transcript Document

Growth and Reform
The Public’s Health in
Greater Manchester
Lesley Jones
Director of Public Health for Bury Council
The Public’s Health - Greater Manchester
Opportunities
• Directors of Public Health want to use the opportunities
presented by transition to work together and rethink improving
the public’s health, to focus on the outcomes most important to
Greater Manchester
• New opportunities for system change, building on longstanding
tradition of collaborative working in Greater Manchester
• Establish a credible Sector-Led Improvement approach to secure
improved Public Health outcomes.
• Review of GM public health activities post transition - alignment
with Greater Manchester Strategy and Public Service Reform
(PSR)
• Leadership of the Public Health system by Directors of Public
Health with Public Health England.
• Recognition that commissioning responsibilities sit across the
health system – so partnerships are key.
Public Health Commissioning from 1st April 2013
National
Sub-national/
regional
Local
1. NHS Commissioning Board10
Commissioning: specialist NHS services, including some mental health and acute care
within managed networks; screening; child public health for under-fives, including the
Healthy Child Programme and health visitors (until 2015 when this responsibility will
move to local authorities); immunisation, core pharmacy and primary ophthalmic
services; and antenatal and newborn screening aspects of maternity services. Some of
these functions may be commissioned sub-nationally.
Public Health
England Greater Manchester Centre
Responsible for national public health campaigns and health
protection nationally and locally and will host specialist expertise
such as dental public health.
Local area teams of the NHS
Commissioning Board
Commissioning primary care, including the GP contract. This includes mental health
within the GP contract.
Greater Manchester Directors of Public
Health Group/ Association of CCGs
May work together to increase the effectiveness of commissioning of public health and
health services for key groups over a larger geographical area, such as looked-after
children and disabled children.
Clinical commissioning groups
Commissioning local child and adolescent mental healthcare (CAMHs), physical
healthcare and maternity services. CCGs will commission urgent and emergency care.
Local authorities
Commissioning child public health services, including the Healthy Child Programme for
five to 18 year-olds, school nurses and the majority of other public health services,
including: dental public health; tobacco, alcohol and drugs; public mental health;
accidental injury prevention; and sexual health services. Local authorities will take over
commissioning child public health for under-fives, including the Healthy Child
Programme and health visitors, from 2015 onwards.
Schools
Commissioning public health initiatives, such as mental wellbeing, key elements relating
to special educational needs, and other school initiatives that local authorities do not
commission.
Police and crime
Commissioning drugs, alcohol and youth justice services.
Public Service Reform – Greater Manchester
Opportunities
Public Service Reform
Sector-Led
Improvement
Strategic
Framework
for the
Public’s
Health
Improved outcomes
GM knowledge used
to change policy and
influence:
Government
PHE
Dept. for Work and
Pensions
Dept. of Health
Better use of resources
Protecting the
Public’s Health
System change
Growth and Reform
Public Health
•Ambition is sustainable economic growth,
• Work for Health
• New Early Years model – Public Health
nursing / health visitors/ Family Nurse
Partnership
• Risk stratification
- older people at risk of entering
residential care
- Individuals falling out of work due to
ill health
• Direct support to Working Well (WPL)
• GM IGMA Chapter and Mental Health
and Wellbeing Baseline Data
• Developing community assets and
individual resilience
• Strategic Framework for the Public’s
Health
• Risk and reward – conversations with
PHE & Treasury on FNP
where all residents contribute to and
benefit from sustained prosperity. This is
set out in the GMS and our Growth and
Reform Plan.
•GM PSR Programme is central to the
delivery of this vision. Generating growth
and jobs will not be sufficient to close the
gap between tax and public spending.
•Increasing independence and enabling
people and their families to take advantage
of economic growth across the wider city
region.
•The Autumn Statement has re-affirmed
GM ambition: Multi-year budgets, Growth
and Reform Deals. Propositions about
sharing risk and reward, and new models of
accountability
PATHFINDERS
UPSCALING EVIDENCEBASED INTERVENTION
INNOVATION
PROTECTING THE
PUBLIC’S HEALTH
Public Service Reform - Work for Health
• A programme to enable system change within health services to
integrate work as part of a treatment plan
• Piloted in 3 pathfinder sites: Stanley Road in Oldham, Farnworth
in Bolton and Worsley Mesnes in Wigan
• Insight into the factors that influence health professionals and
individuals attitudes about working with a health condition
• Social marketing activity - conversation between health
professionals and communities around work and health
Public Service Reform - Alcohol recovery
from employment
• Individuals with alcohol dependency have difficulty sustaining
employment
• Innovative use of technology / text messaging to maintain
support and prevent relapse
• Data sharing protocol with the Working Well programme to
allow monitoring of referrals including substance misuse
treatment starts, waiting times and treatment outcomes
Public Service Reform - Greater Manchester
Alcohol Strategy
•
Alcohol identified as key issue through Troubled Families PSR
workstream
•
Councils now have considerable power to influence decisions made
on alcohol licensing, but the process can be difficult and resource
intensive
•
Evidence suggests that limiting availability through times of sale and
outlet density can have a positive impact on levels of harm
particularly violence and disorder
•
Public Health England is working with partners across GM to produce
a toolkit to support councils in being more active in their action on
alcohol control through licensing, through improved intelligence,
promoting a more consistent approach that leads to better
enforcement
The Public's Health - A Greater Manchester
Strategic Framework
• GM ambitions to keep
people in good health and
reduce the impact of health
conditions on their ability to
fully participate in creating
economic and social
wellbeing
• 60% of early deaths can be
prevented by thinking
beyond traditional
healthcare activities?
Source: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health
Aff(Millwood) 2002;21(2):78-93 cited We Can Do Better — Improving the Health of the American People Steven A. Schroeder, M.D.
The Public's Health - A Greater Manchester
Strategic Framework
• Strategic approach working across all sectors.
• The public’s health is the responsibility of all agencies and
not solely the remit of one.
• Changing everyday practice to embed actions across the
public sector needed to sustain and improve the public’s
health.
Priority areas identified for action
1.Children and young people
2.Environment
3.Work, skills and income
4.Primary care
5.Mental wellbeing
6.Resilience – community and individual
The Public's Health - A Greater Manchester
Strategic Framework
• Areas of activity where potential to minimise risks to health
and secure health improvement is the greatest for each
priority area.
• Identification of areas where the scale of change requires
reprioritising of current resources or changes to the way
that services are commissioned.
• Demonstrate how lower cost early intervention activities are
a serious alternative to expensive, sometimes ineffective
later interventions and how this will reduce current and
future cost pressures.
Work, Skills and Income
Greater Manchester Intelligence
Local and National Policy Context
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Greater Manchester Collaboration Opportunities
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IGMA Public Health Chapter (Productive and Active Residents)
HIA Welfare Reform Bill (DWP)
WPL Analysis and CBA
Fit For Work Evaluation (University of Liverpool)
Work for Health Insight – GPs and Allied Health Professionals
Fuel Poverty Geographic Mapping
Public Sector Reform, Troubled Families, Work and Skills, Complex Dependency
GM Fuel Poverty Strategic Framework
GM Work for Health (including Workplace Ageing Strategy and Recovery for Employment projects)
JRF Longitudinal Study of Low Pay No Pay Cohort
Childhood Poverty Reduction Strategies (various national documents on in work progression)
GM Poverty Commission
Financial Exclusion, Health and Employment (Glasgow City Council, Insight Collective and the Scottish
Government)
Evaluation of CAB Provision in Primary Care (University of Sheffield CESR)
Welfare Reform Bill/ Universal Credit – various impact assessments (i.e. Young Foundation Bedroom Tax
mapping 2012)
This should set out the contribution of the PHS to tackling worklessness and unemployment, with clear links
to the GMS.
Actions in this area should focus around keeping people in work, stopping people falling out of work and
helping them get back into work. The principle of “Good Work “ needs to be embedded in practices in this
area.
The PHS should help facilitate better engagement between health providers and work programme
providers.
Further work is required to promote better understanding of the link between unemployment and health
conditions type of job and recognition that the type of work that some people can do is affected by their
health.
High Level Outcomes
What we will seek to
achieve by working
together and how we will
measure success
Strategic Priorities
The high level changes
required at Greater
Manchester level to achieve
the outcomes
Collaborative Actions
A small number of actions
that (a) Have evidence on
impact on the strategic
outcomes (b) can be
delivered at scale
Next steps for the Public’s Health
• Publication of the Greater Manchester Strategic Framework
for the Public’s Health – November 2014
• Transition of 0-5 years Public Health services – October 2015
• Development of Greater Manchester Alcohol Strategy
• Ongoing review of alignment with Greater Manchester
Strategy and PSR