Transcript Document

Learning from the past……
looking to the future
The Director of Public Health’s Annual Report 2013
Wendy Meredith
Background to report
• 1972 Public Health moves from
Council into the NHS
• 2012 Health and Social Care Act
• Comparison of then and now
• Future working
Looking Back…1972
“The outlook for people born in
the last 20 years and who will
experience this affluence for the
whole of their lives must be a
cause of great concern
unless it is balanced by advances
in medicine allowing earlier
detection and treatment of this
condition [CVD]”
“It is extremely
disappointing
that a potentially
preventable
condition could
appear in such
numbers in the
community”.
“Many teachers whilst
prepared to give simple
factual health education
talks, have felt anxious
about dealing with more
personal topics in the
field of sex education,
relationships and the
abuse of drugs”.
New technology in the
form of an Answerphone
service was established
in April 1972 to increase
clinic attendances. Dr.
Ross reflected that
having received 21,800
calls this was “fulfilling a
much needed service in
the town”.
“These two nurses visit patients on
discharge from hospital giving them
full support in an effort to decrease
the possibility of the elderly person
having to be readmitted to hospital
and also to give them the
confidence to continue to live in the
community”.
Demographics and Health Need
• Bolton Population 276,800
• 24.2% increase in births between
2002 and 2012
• 15% of population over 65 years
Demographics and Health Need
continued…….
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Coronary Heart Disease
Stroke
Respiratory disease
Lung (& other) cancer
Obesity & associated conditions
Alcohol
Mental Health
Recommendations
• Ensure JSNA develops as a vital resource to support
health and social care and wider public service reform
• Engage with local commissioners to identify how
Boltons Health Matters can be improved to better meet
their needs
• Enhance and develop the Children and Young People’s
element of the JSNA
• Develop a systematic approach to gathering,
interpretation and presentation of data
• Undertake needs and asset assessments which focus
holistically on cohorts of people.
Integrated Health and Wellbeing
Services
• Significant advances in preventative healthcare
in the last 40 years
• Demand for services continues to outstrip
available resources
• Positive outcomes and good patient experience
depend upon services working together
• A life course approach to commissioning and
developing services to ensure prevention is
embedded in the practice of all
Recommendations
• Ensure the effective delivery of the Early Years model, prepare for
the implementation of the new model for Health Visiting and the
Council’s new commissioning responsibilities
• Re-design the Healthy Child Programme for school age children
focusing on the most vulnerable groups
• Further strengthen and expand the provision of services to improve
mental health and wellbeing and ensure that key cohorts in the
population get the service they need.
• Further develop opportunities within primary care to help people stay
well by systematically addressing individuals’ health and social care
needs.
• Further develop and implement the Bolton Integrated Health and
Social Care model to expand and improve multi-disciplinary care
across the borough
Health Protection
• Deaths from infectious diseases have
reduced dramatically since 1972
• Increased vaccination and development of
robust screening programmes
• STIs remain a challenge, emergence of
HIV and importance of early diagnosis
• Good hand hygiene remains a simple but
effective tool in controlling the spread of
infection
Recommendations
• Improve engagement with communities to increase vaccination
uptake rates
• Target work to increase flu vaccination uptake in pregnant women
and front line health and social care staff and increase
pneumococcal immunisation uptake, especially in women.
• Increase activity to ensure that those communities most at risk of
developing TB have improved ,work needs to continue to reduce the
stigma associated with the disease and to better enable individuals
who have tuberculosis to successfully complete treatment.
• Continue to focus on sexual health improvement, good sex and
relationships education and improved access to sexual health
services
• Increase awareness of infection prevention and control
interventions
Health Improvement
• Health behaviours influenced by more than
knowledge
• Affluent more likely to adopt healthier behaviours
• Action at population, community and individual
level to enhance outcomes
• Use of social media and new technologies
• Shift to the concept of “wellbeing”
• Health as “everybody’s business”
Recommendations
• Explore further the potential of social media in supporting
the achievement of health improvement outcomes (whilst
being aware that not everyone has digital access).
• Evaluate and learn from pilot programmes and initiatives
such as Farnworth Healthy Weight in order to ensure
best use of limited resources.
• Continue to identify and improve health outcomes for
vulnerable groups including Black and Minority Ethnic
and new and emerging communities.
• Continue to target and develop actions to improve the
quality of private sector housing particularly the private
rented sector.
Moving Forward
• Ensuring delivery of our statutory duties
• Assurance in respect of the health protection of Bolton’s
population
• Improving life chances for children: Early Years new delivery
model
• Linking health and education: commissioning 5-19 children’s
health and wellbeing service
• Tackling long term conditions: further develop early
recognition and swift referral
• Integrating health and social care: Staying Well
• Developing an Asset based approach to community
development
• Developing use of new technologies and social media to
improve health
…. and finally
“Much has changed in the last 40 years
since Dr Ross’s day. The NHS has
experienced many reorganisations.
The transfer of public health responsibilities
back to where they belong in local
government offers the greatest opportunity
to improve the health of Bolton people in the
next 40 years – public health has come
home”
Wendy Meredith, Director of Public Health’s Annual Report 2013
Driving the partnership –
Tackling health Equalities
Vision Steering Group
September 2014
Health Inequalities – Key Issues
• People living in the poorest neighbourhoods in
England will on average die seven years earlier
than people living in the richest neighbourhoods
and spend more of their lives with disability
• It is estimated that the annual cost of health
inequalities is between £36 billion to £40 billion
through lost taxes, welfare payments and costs
to the NHS
• Action on health inequalities requires action
across all the social determinants of health,
including education, occupation, income, home
and community
The Data – Comparison of Bolton
with the rest of England
• Life expectancy in Bolton is 1.7 years less than the
rest of England
• Bolton has the widest “internal” inequality gap of our
peers (between most and least deprived
neighbourhoods)
• 12.1 years for men
• 9.2 years for women
Wider determinants of health
Health Inequalities are preventable –
National recommendations (Marmot)
1. Give every child the best start in life
2. Enable all children, young people and adults to
maximise their capabilities and have control over
their lives
3. Create fair employment and good work for all
4. Ensure healthy standard of living for all
5. Create and develop healthy and sustainable
places and communities
6. Strengthen the role and impact of ill-health
prevention.
Our current strategy in Bolton
The Health & Wellbeing Strategy
• A life course strategy from starting well to end
of life
• Progress and priorities:
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Keeping children healthy (Early Years PSR pilot work;
Developing Well Sub Group of the Children’s trust)
Healthy adults at work (Borough Skills agenda and
Working Well pilot)
Community support for our older people (Health &
Social Care integration)
• Key partnership contributions: housing; Skills and
anti-poverty strategy
Discussion - What more can we do?
• What more we can the voluntary and
community sector across the spectrum of
health determinants?
• Specifically:
– Creating fair employment and good work?
– Ensuring healthy standard of living for all?
– Creating and developing healthy and
sustainable places and communities?
• How do we take this forward?