Transcript Slide 1
Jim McManus
Joint Director of Public Health
Birmingham City Council
Delivering Success:
Prevent, Enable, Personalise, Realise
some tentative experience from Birmingham
COSLA Annual Conference 2012
Jim McManus
Joint Director of Public Health
Birmingham City Council
16th February 2012
Public Service Reform
– Big Tasks
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6.
7.
Localism Act
Elected Mayors??? Errr...
NHS Reforms – public health, clinical commissioning groups, NHS
Commissioning Board, Health and Wellbeing Boards
Police and Crime Commissioners
Open Public Services White Paper
Spending Review
Social Care Funding
Big Asks
• Do better with a lot less
• And by the way your population is still getting older, needier and
growing
• And you will have a 25% increase in dementia
• And immigration will bring costly TB and CVD
• Oh, and you’ll have more folk with learning disabilities
• And they all have to have personal budgets
The basic message –
complex relationships, big tasks
Good outcome
Life circumstances
Behaviours
Bad outcome
The arrows include public services and access
The basic message
– interventions = big asks
Good Health
Life circumstances
Behaviours
Ill Health
Birmingham Change
Prevent, Enable, Personalise, Realise
• Major Change – reducing
buildings, reducing costs,
outsourcing, mutuals
• New single contract (50,000
people)
• New operating model for
children – universal, targeted,
special and complex
• New Operating Model for adult
social care – prevent, enable,
personalise
• Benefits realisation
• Radical new ways of doing
things
New Ways of Working
• Not just rely upon commissioning
• Working with wide range of civil society partners
• Shared leadership of Health and Well-Being Board
• Support from HealthWatch
• Using new powers and new resources to create healthier communities
The Big Ask: What success looks like...
£37million
Self management
People supported to
manage LTC
Range of targeted/
Flexible Services
Support to service
user /Citizens
Increased
Improved flexibility
Prediction
and
Prevention
Increased through
community
resources
Number of
those receiving
preventive services
Increased
Customer
Satisfaction
Increased through
joint interventions
Supported to stay
in their Home
Why does service change
matter?
Life Expectancy against
Core Cities
4th out of 8 Male
5th out of 8 female
Male
Female
England
78.3
82.3
Sheffield
77.8
81.5
Leeds
77.7
82.0
Bristol
77.2
81.9
Birmingham
76.4
81.3
Newcastle
76.2
81.0
Nottingham
75.2
80.3
Liverpool
74.5
79.2
Manchester
74.0
79.1
Life Expectancy by Ward
Average percentile score
Gaps in school readiness
at 3 and 5 years by family income: UK
Waldfogel & Washbrook 2008
National Audit Office 2010
not on course!
And what has got us there?
Barriers to reform
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Focus, or lack of it
Starting with a promising intervention, then making sure it is doomed to
fail by tinkering about
Scientific Grounding and Understanding of Need (or lack thereof)
Partnerships – obsessed with structure and governance
Poor integration of joint commissioning
Cultures...Aaarrrghhh!!!!!
Deficit – We know more than you
Not getting value of
Intelligence in achieving Better Outcomes...
What did we
achieve?
Does anyone actually
Really do all this?
Keeping on Track
Prioritisation
Best Buys/Best
Dos
Need
Writ across all Programmes
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2.
3.
4.
5.
6.
7.
8.
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10.
11.
Telecare £14 million
Intelligence and Information Programme
Predicting need in social care
Data sharing with GPs
Diverting people from social care and hospital
Targeting young people to reduce risk
Worklessness
Decent Housing
Preventing Extremism
Enablement
Public Health Transition
Critical Success Criteria –
Fire Service
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Falls Assessment
Telecare Assessment
JSNA and data sharing
Population density of fire and need
Sharing populations
Well constructed outcomes based agreements
Health and Care: Our Burdens
of Disease mean Prevention is wrong way
round
Primary
Secondary
Tertiary
The Big Ask: What success looks like...
£37million
Self management
People supported to
manage LTC
Range of targeted/
Flexible Services
Support to service
user /Citizens
Increased
Improved flexibility
Prediction
and
Prevention
Increased through
community
resources
Number of
those receiving
preventive services
Increased
Customer
Satisfaction
Increased through
joint interventions
Supported to stay
in their Home
Whole System plus focused
action
The example of health inequalities
The Conceptual Framework
Reduce health inequalities and improve health and well-being for all.
Create an enabling society that
maximises individual and community
potential.
Ensure social justice, health and
sustainability are at heart of policies.
Policy objectives
A.
Give every child the
best start in life.
C.
Create fair employment
and good work for all.
B.
Enable all children,
young people and
adults to maximise their
capabilities and have
control over their lives.
E.
Create and develop
healthy and sustainable
places and
communities.
D.
Ensure healthy
standard of living for
all.
Policy mechanisms
Equality and health equity in all policies.
Effective evidence-based delivery systems.
F.
Strengthen the role and
impact of ill health
prevention.
The Golden Thread
Need, Outcomes
Marmot
JSNA
Priorities, Interventions
Strategy
Commissioning
Health Inequalities :
What we know
• Edinburgh World Congress of Epidemiology 2011
• Non Communicable Diseases
• Impoverished understanding of behavioural sciences in some public
health programmes
• Multiple Tracks. Public policy action in all of them
Policy History...Zzzzz
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Black Report 1982 (UK)
Ottawa Charter 1986 (World)
Health of the Nation 1984 (England & Wales)
Our Healthier Nation 1998 (England & Wales)
Healthier Wales 2000 (Wales)
Choosing Health 2005 (England)
WHO Commission on Social Determinants 2009
Marmot Review of Health Inequalities 2010
2008
2007
The upshot of all this is that whatever
framework you use.....
It’s the same problem!
The Big Tasks
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Short term challenge of tertiary prevention
Medium term problem of keeping the ill well
Short term problem of stopping avoidable events
Long term problem of changing determinants of health, health
expectations, behaviour and culture
The Big Tasks
The Ask
Who
• Short term challenge of tertiary
prevention
• Medium term problem of
keeping the ill well
• Short term problem of stopping
avoidable events
• Long term problem of changing
determinants of health, health
expectations, behaviour and
culture
• Social Care, NHS, Housing
• NHS, Social Care, Housing,
Leisure
• NHS, Leisure
• Local government par
excellence
Birmingham’s use of Marmot
Activities
Framework
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1. Adopt the Outcomes
• Starting well
• Developing well
• Living well
• Working well
• Ageing well
2. Add an outcome “dying well”
3.Cut our JSNA and Strategy
across the Lifespan
4. Use as “golden thread”
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For Health Inequalities Action
For JSNA
For Health and Wellbeing
Strategy
For Integration
As a lifecourse approach to
human ecology
Examples of Marmot in practice
LGBT MENTAL HEALTH
PREVENTION
• Lifecourse approach using
Marmot
• Early development
• Mental health problems onset
• Tasks for each lifestage
• Community and Public Sector
tasks
• Interdependencies
• Use of Marmot Framework
across lifecourse
• Tasks for adult social care
and older adult social care
elucidated
• Incorporation into third sector
contracts with third sector
• Preventive workstream
Examples
Start Well
Develop Well
Age Well
Adults &
Communities
High priority parents in
touch with A & C
Transition
Older Peoples’ offer
from prevention to very
high need
Homes &
Neighbourhoods
Overcrowding and infant
mortality
Decent Homes Standard
Access, Trips, Falls,
Extreme Weather,
Adaptability,
Development
Back to work packages
Digital inclusion
Back to work packages
for parents
Digital Inclusion
Volunteering and work
packages
Digital Inclusion
NHS
Infant Mortality
Conception
Frail Elderly
Demonstrated
• The role of public health sciences in public service can
be significant
• The role of behavioural sciences in public service reform
can be significant
• Public health disciplines can be applied across public
service reform
Thank You!
[email protected]