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17th October 2011Social Services Research Group Seminar
Jim McManusJoint Director of Public Health
Challenges and Opportunities:A Public Health Perspective
The Context
• Local Government– Sector Led Improvement– Strategic Role (health, public health,
HWBB)– Big Society, Localism, Open Public
Services
• Public Health and NHS
• Opportunities and Freedoms?
The Challenge for Sector LedImprovement
• Helping LAs make optimal decisions – did Public Health ever help the NHS do that?
• Distributed nature of evidence based practice in Local Govt
• Evidence and its role in the political decision making process
• Critiques of the problems with evidence based practice
Synopsis – The Issues
Questions
• Where does Public Health fit in the new Sector-Led Improvement Agenda?
• Does Public Health have anything to say on the improvement agenda for social care?
My Suggested Answer
• A role in identifying priorities and ways of evidencing whether we meet them,
• A definite role in improving and innovating in social care for our communities, much under-developed in public health hitherto
Synopsis 2 – Achieving Change
Suggested Answer
• A role in identifying priorities and ways of evidencing whether we meet them,
• A definite role in improving and innovating in social care for our communities, much under-developed in public health hitherto
This needs
• Mutual understanding of priority setting and outcome setting, and evidencing– DPH can’t lead this unless s/he
understands LA– A distributed leadership task
• Needs mutual confluence between public health and social care professionals and research communities
Synopsis 3 - Birmingham
Suggested Answer
• A role in identifying priorities and ways of evidencing whether we meet them,
• A definite role in improving and innovating in social care for our communities, much under-developed in public health hitherto
Birmingham doing…
• JSNA and Corporate I and A Board informs Council priorities
• A social care programme for public health from telecare and winter deaths to prevention
Government Intention – Public Health
• Directors of Public Health in Local Government
• Transition of Staff
• Remit across Health Improvement, Health Protection, Advice for Commissioners
• JSNA and Health and Wellbeing Strategy
• Public Health England
• Outcome Frameworks
• But given timescales there is a need for us to start doing and shaping things towards this
Example - National Audit Office 2010not on course for HI
Health Improvement
Health Protection
Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation
Ensuring we have the right frameworks in place. Major challenges
Long term, medium term, short term impacts
The domains of public health and where ittouches Sector –led Improvement
Interface -FALLS PREVENTION
Service Quality andImprovement
Four Quick Wins or Challenges
1. Common approaches to the problem of evidence, especially where there isn’t any
2. Identifying outcomes together
3. Integrated approach to improvement
4. Pick some thorny issues
Timeframes of impact/yield and Sector-led Improvement
Years0 1 5 10 15
Planning Frameworks and Core Strategies
Education
Vitamin Supplements
Decent Homes
Air Pollution
Primary Care
Air Pollution
Decent Homes
Reducing Worklessness
Primary Care
The Challenge
• Helping LAs make optimal decisions – did we ever help the NHS do that?
• Distributed nature of evidence based practice in Local Govt
• Evidence and its role in the political decision making process
• Critiques of the problems with evidence based practice
The limits of evidence basedpractice
• The limits of evidence – where evidence is silent
• The current hierarchy of evidence – biomedical not social scientific
• The role of evidence in the political process• Contested space – everyone who can have
an opinion on it does, and not always helpful• What does this say about elected members?
Birmingham ApproachIdentify where evidence does and doesn’t have somethinguseful to say
Where it does
• Search, Sift and Appraise• Devise and implement a
process stakeholders can work with for this
• Identify clear priorities and strength of evidence
• Doing this on Children, Corporate, Housing, Social Care
Where it doesn’t
• Identify “best bets” • Create a methodology to
identify outcomes and assess whether they have been met
• Commission directly the modelling to make business cases
Public Health yield across the lifespanHousing
• Evidence review group – identifying key interventions
• Evidence review paper for Members and Officers – 8 pages
• Summits, Workshops, Briefings
• Action Plan created
• Review
Systems thinking in health interventionsGetting everyone on the same systems page
The wider determinants of Health and Local Government functions
The Lives people lead and whether LA functions help or hinder healthy lifestyles
The services people access such as primary care
Implications
• Selecting Outcomes
• Prioritising interventions by timescale
• Evidence for differing interventions
• System wide approaches
• Need to understand and work with complexity
Public Health Outcomes Framework – alignment with the NHS AND Adult Social Care
Adult Social Care
NHS
Adult Social Care and Public Health:
Maintaining good healthand wellbeing.
Preventing avoidable ill health or injury, including
through reablement orintermediate care services
and early intervention.Adult Social Care and NHS:Supported discharge fromNHS to social care.Impact of reablement orintermediate care serviceson reducing repeat emergency admissions.Supporting carers and involving in care planning.
ASC, NHS and Public Health:The focus of Joint Strategic Needs Assessment: shared local
health and wellbeing issues for joint approaches.
NHS and Public Health:Preventing ill healthand lifestyle diseasesand tackling theirdeterminants.Awareness and early detection of major conditions
Which Framework? Marmot and the Lifespan?
What does Marmot offer?
• Provides high level outcomes which can unify across frameworks and agencies
• Evidence based• Enables us to track progress• An aid to the 4Es duty• Clear Hierarchy of Outcomes, Priorities and Interventions• Clearer success and clearer failure• Lancs, Leics, Lincs and Rotherham already used Marmot for
JSNA• Yorkshire’s Big Opportunity Report
Worked Example
Case Study Regulatory Services and Marmot Outcomes
• Trading Standards – A,E,,D• Environmental Health (inc pest control and animal
Welfare) – A,B,C,D,E,F
• Licensing – D,E,FSkills• Holistic approach to solving problems• Education skills• Enforcement skills• Established partnership working• Local contact – over 7000 businesses visits and over 20,000 homes
visited per year
Some ongoing projectsby their Marmot Outcomes
• B– Health Tums – changing attitudes of young people inspiring a lifetime of
healthier eating– Preparing young people for work with knowledge of health and safety
• D– Doorstep crime – mental health wellbeing– Health choices – promote healthy eating and healthy lifestyles (educating
catering businesses)– Low emissions in cites - promote uptake of low emissions technologies to
reduce oxides of nitrogen– Preventing scalding in residential homes
• E– Illicit tobacco – counterfeit, smuggled, novel tobacco– Cosmetic safety – heavy metals in produces esp around young people
• F– Shisha – compliance and health choice messages– Illicit tobacco – counterfeit, smuggled, novel tobacco
An integrated obesity strategy(truncated due to space)
Primary Prevention
Secondary Prevention
Tertiary Prevention
Current Performance
Area of Work and timescale to deliver visible results
PlanningTimescale
2-15 years
Planning restrictions on hot food takeaways to ensure vibrant town centres and diverse food choice
This is not really a role for planning
Poorly performing
Leisure and Sport
Timescale 1-5 years
Getting people more active as a routine part of their week
Integrated care pathway covering all agencies
Be Active and Be Active + offered. Sports Partnership also engaged.
