Birmingham Health & Wellbeing Board Summit - July 2012

bhwbb.net@bhwbb #bhwbb

Birmingham's Way to WellbeingBirmingham’s Joint Health and Wellbeing and Social Inclusion Process Summit

Thursday 12th July, 9am to 2pm

The Bordesley Centre, Birmingham


Welcome and introductions

Cllr. Steve BedserCabinet Member for Health and Wellbeing,

Birmingham City Council


Definitions and concepts - what does it all mean?

Dr Neil DeucharMedical Director (Mental Health)NHS Midlands and East

West Midlands Strategic Health Authority

NHS Midlands and East is a cluster of SHAs comprising NHS East Midlands, NHS East of England and NHS West MidlandsChair: Sarah Boulton Chief Executive: Sir Neil McKay CB

Wellbeing – Wellbeing – What does it all meanWhat does it all mean??

Neil Deuchar Neil Deuchar Associate Medical DirectorAssociate Medical Director

NHS Midlands and EastNHS Midlands and East



What’s in a name.....

quality of life

mental health positive

mental health

happinesswellbeing

resilience

mental capital

flourishing

emotional wellbeing



Wellbeing is the subjective experience of mental, social and spiritual health

It is not merely the absence of illness

It involves a sense of purpose, fulfillment, agency, belonging and connectedness



Wellbeing is similar to quality of life

Wellbeing derives from and confers psychological resilience

Wellbeing in enough individuals produces mental and social capital across communities

Psychological resilience reduces both mental and physical illness



There are "Five Ways to Wellbeing" (Foresight/NEF) –

ConnectGiveNoticeLearn Be Active

Prosocial behaviour enacts the "Five Ways"

This means active citizenship (personal rights and responsibilities to each other)



Public Mental Health is the promotion of Mental Health / Wellbeing in communities and the prevention of mental illnesses in people at risk

Addressing public mental health reduces physical illnesses, alcohol and drugs use

Adopting the "Five Ways" improves public mental health


Understanding the determinants and what works

Dr Lynne FriedliMental Health Promotion SpecialistWorld Health Organisation

Mental health and wellbeing: understanding

the determinants and what works

Dr Lynne Friedli

Wellbeing SummitBirmingham Health & Wellbeing

Birmingham

12th July 2012

Birmingham Wellbeing Summit [email protected]

Source: Ingram Pinn, Financial Times

Summary

• Mentally flourishing communities

• Recovery Oriented Communities

• Social Justice, Citizenship &

Human Rights

• Commissioning for social value

• Health topics: RIP


how we feel

about & experience our

lives

What we all need....

To be:• Heard• Believed• Understood• Respected


Picture Source: http://sarahdrummond.wordpress.com/2010/12/13/an-assets-alliance-scotland/

Mental health, and the factors that influence mental health,

have never been more important


S

Mental

Health

Social Determinants

Commission on the Social Determinants of Health

•material requisites•psycho-social (control over lives)•political voice (participation in decision making)


Status Control Relatedness

Some living conditions deliver to people a life that is worthy of the human dignity that they possess, and others do not. Dignity can be like a cheque that has come back marked ‘insufficient funds’

Martha Nussbaum

Best start

Quality work

Income

Prevention

Healthy places

Education & skills

Explaining the social gradient: mental illness journeys...

• Adverse childhood experiences/stressful life events

• Racism and other forms of discrimination• Contact with criminal justice system • Socio economic status – parental income,

tenure, education, occupation• Institutional care in childhood


Most of the experiences that cause mental distress are directly linked to a lack of money....... powerlessness linked to poverty

Peter Campbell Beyond the Water Tower 2005

Social Epigenesis: biological embedding *


Status Control Relatedness


Meta analysis: comparative odds of decreased mortality

The relative value of social support/ social integrationSource: Holt-Lundstad et al 2010


Quality of life

Full citizens

hip

Human rights

Recovery oriented communities

People with mental health

problems have access to everyday activities, resources,

relationships and

opportunities

They are saying that they are missing from the community, they want to give and contribute and that the community is missing out on their contribution.

PFG Doncaster

Why bother? What works?



Austerity solutions....

Because it’s worth it....


•Contribution mental wellbeing and mental illness make to wide range of outcomes

•The ‘unexplained excess’ – classical risk factors do not account for level of variation in outcomes

•Improving wellbeing saves (a lot of) money

•Improving wellbeing delivers social (as well as economic) returns

•Improving wellbeing reduces inequalities

While there are multiple barriers to economic growth, the growth of human potential is unlimited

Coote and Franklin 2010


NO HEALTH WITHOUT MENTAL HEALTH

PUBLIC HEALTH

OUTCOMES FRAMEWORK

ADULT SOCIAL CARE OUTCOMES

FRAMEWORK

NHS OUTCOMES

FRAMEWORK

MENTAL HEALTH AND WELLBEING

Using data and evidence from: Delivering better mental health outcomes; Economic Case http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123766; See also Champs www.champspublichealth.com

Reduce pressure here

Get it right here

Birmingham Wellbeing Summit

Scope of Action

Relationships and Respect

Social support, collectivity, respect for people experiencing

misfortune

Material resourcesIncreasing equitable access

to assets that support mental wellbeing

Interventions to

promote mental

wellbeing

Inner resources

Opportunities to develop

senses, imagination,

reason, thought

Meaningful activityOpportuniti

es to contribute

(Martha Nussbaum Capabilities)[email protected]

‘best buys’•Supporting family life: parenting; HLE; reading ; infant sleep•Supporting lifelong learning: h/p schools; SEAL; anti-bullying continuing education; reading recovery•Improving work: employment/ workplace

•Lifestyle/screening/brief interventions (diet, exercise, alcohol) social support/integration social support/integration

•Supporting communities: environment/environmental justice; green space; bridge safety; debt services


Befriending, volunteering, Timebanks, community development

Source: Friedli & Parsonage 2009

Net return on investment

Source: Knapp, McDaid & Parsonage 2011

0

100

200

300

400

£s

mill

ions

per

ann

um a

void

ed Extension of FlexibleWorking Arrangements

Integration ofOccupational andPrimary Health

Implementing Stressand Wellbeing Audits

Source: Mental Capital & Wellbeing: Foresight 2008 – Overhead David McDaid

Tentative analysis of economic case: workplace

Mental health risk and debt

(OR

) risk o

f poor m

en

tal h

ealth

Number of debts

Unadjusted

Income adjusted Adjusted for income and socio-demographic variables

Source: Jenkins R et al 2008 Debt, income and mental disorder in the generalPopulation Psychological Medicine 38:1485–1493.

[email protected]

Routes to partnership/joined up delivery

Health & Wellbeing Boards

NHS Commissioning(for social value)

Community

Referral Hub

Food TrainPrima

ry Care

Debt advice/cr

edit unionLangua

ge and literacy

Community

Garden

Time bank

Health & Wellbeing Strategies

•Referral criteria•Feedback loops•Extended consultation

Wild swimming club

Link workers

Midnight

football

Local Area

CoordinationSoci

al Care

Integrated

Wellness

Service

Birmingham Wellbeing Summit

Priorities for moving forward

• Commission for social value – each £ spent also produces wider community wellbeing

• End health topics: whole life/total place /wellbeing services

• Join up delivery: wellbeing, recovery, resources for citizenship

• Develop an inequalities imagination (Angie Hart)


Innovation is hard. And social innovation is doubly hard. The system will often absorb new ideas, and then spit them out in forms that their originators would not recognise... Simon Duffy

Return to the social....


•Wellbeing is produced socially

•Quality of social relationships has a material context

• I am, because we are...


Select bibliography

Warwick-Edinburgh Mental Well-being Scale www.healthscotland.com/documents/1467.aspx

Cooke, A., Friedli, L., Coggins, T., Edmonds, N., O’Hara, K., Snowden, L., Stansfield, J., Steuer, N. and Scott-Samuel, A. (2010) The mental well-being impact assessment toolkit. 2nd ed., London: National Mental Health Development Unit

http://www.apho.org.uk/resource/item.aspx?RID=95836

Friedli L (2009) Mental health, resilience and inequalities WHO Europe London/ Copenhagen http://www.euro.who.int/document/e92227.pdf

Friedli L and Parsonage M (2009) Promoting mental health and preventing mental illness: the economic case for investment in Wales Cardiff: All Wales Mental Health Promotion Network http://www.publicmentalhealth.org/Documents/749/Promoting%20Mental%20Health%20Report%20%28English%29.pdf


Select bibliographyKnapp M, McDaid D and Parsonage M (2011) Mental health promotion

and mental illness prevention: the economic case Department of Health

Campbell F (2010) Social determinants and the role of local government http://www.idea.gov.uk/idk/aio/17778155

Newbigging K and Heginbotham C (2010) Commissioning mental wellbeing for all : a toolkit for commissioners UCLAN http://www.nmhdu.org.uk/news/commissioning-wellbeing-for-all-a-toolkit-for-commissioners/

DH (2011) No Health Without Mental Health: A Cross-Government Mental Health Strategy for people of all ages (Feb 2011) gateway reference 14679Solar O and Irwin A (2011) A conceptual framework for action on the social determinants of health Geneva: WHO

Dept of Health (2011) The economic case for improving quality and efficiency in mental health http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123993.pdf

OECD 2011 Divided we stand: why inequality keeps rising http://www.oecd.org/document/51/0,3746,en_2649_33933_49147827_1_1_1_1,00.htmlBirmingham Wellbeing Summit lynne.friedli@btopenwo

rld.com


What makes us healthy?

Jane FootIndependent Public Policy Adviser

www.janefoot.co.uk 38

What makes us healthy?

Birmingham Wellbeing Summit12 July 2012

Jane Footwww.janefoot.co.uk


Reframing our thinking

When we work with people and communities we focus too much on their failings, deficiencies, problems and needs. And we prescribe services to fix those problems.

We don’t actively look for what creates health and sustains wellbeing, the things that are working, the potential for people to connect their own and others’ assets to improve their lives.


What are health assets ? An asset can be defined as any factor or resource

which enhances the ability of individuals, communities and populations to maintain and sustain health and well-being. These assets operate at the level of the individual, family or community as protective and promoting factors to buffer against life’s stresses. Skills, capacity or knowledge of individuals Skills, capacity or knowledge of individuals Passion of families and neighbours that give them energy for Passion of families and neighbours that give them energy for

changechange Networks and connections in a community – place, identity, Networks and connections in a community – place, identity,

interestinterest Effectiveness of community associations Effectiveness of community associations Resources of institutions – public, private or third sector Resources of institutions – public, private or third sector Physical, environmental and economic resourcesPhysical, environmental and economic resources


What is the evidence?

Resilience – what are the social factors that support resilience

Social networks make you healthier and happier. Stress and isolation are bad for you.

Mental wellbeing and psychosocial factors – both a cause and a consequence of inequality

Good wellbeing makes it possible to ‘get ill better’.

Evaluative task is to understand assets and the dynamics that link assets to change


An assets approach People are a resource rather than a problem Identifies and connects the assets that can enhance

wellbeing Values what works well in an area and what has the

potential to improve health Sees citizens and communities as co-producers of their

health rather than recipients of services Promotes community networks, relationships and

friendships that can provide caring, mutual help and empowerment

Supports individuals health and wellbeing through self esteem, coping strategies, resilience skills, networks, knowledge,

Empowers communities to control their futures – capacity releasing

Creates tangible resources such as services, funds, buildings


1. Health & Wellbeing Boards

Shared understanding of health as a positive state and its determinants as those things that protect and promote good health

Prioritise the ‘causes of the causes’ Whole system – everyone who contributes

to health assets Whole life course Shift from targeting to whole community Commissioning framework – redesign,

support, procurement


2. Asset mapping & mobilising & mobilising

Makes us learn to ask what communities have to offer and care about

Improves our understanding of HOW people understand wellbeing and what helps them cope

It makes explicit the knowledge, skills, resources and capacities that already exist

Helps to make best use of individual skills , physical and organisational resources within the community

It helps to build trust between professionals and the local community

Assets are a resource to meet needs – influences commissioning


3. Community development – build social capital

Core health and wellbeing asset Intentional community building Work with existing community

networks and activities Release the capacity and strengths Do not undermine networks and

social support


4. Co-production

Professionals, service users, families, neighbours are involved in an equal and reciprocal relationship

Planning, design and delivery of agreed outcomes

Services do not produce positive health outcomes – people do

An awareness of assets in the area means that residents are valued for their contribution

Pooling of different knowledge and skills



5. JSNA + Assets

A better balance of information between needs and assets.

Explore ways of collecting analysing and understanding assets – not just the what but also the how.

Align with data on needs and resources

Commission to sustain the health assets


5. Commissioning for outcomes

The potential of co-production and asset approaches is not best served by our current procurement models

Co-production + asset-rich communities – requires a new commissioning framework

Require providers to identify and build on assets in the families and neighbourhoods.

Intentionally support community development and social capital

Do our services undermine health assets?


Health inequalities are driven by underlying social factors and action is required to address these ‘causes of the causes’.

“the health and wellbeing of people is heavily influenced by their local community and social networks. Those networks and greater social capital provide a source of resilience. The extent to which people can participate and have control over their lives makes a critical contribution to psychosocial wellbeing and to health”

Professor Sir Michael Marmot, Foreword to What makes us healthy?


WHAT MAKES US HEALTHY ?

The asset approach in practice: evidence, action and evaluation

Free download at www.janefoot.co.ukwww.assetbasedconsulting.net

Foot (2012) ISBN 978-1-907352-05-08


Integrating Primary Care Mental Health and Well Being ServicesDr Ian WaltonClinical lead for Primary Care Mental Health Services SWB CCG

‘‘Integrating Primary Care Integrating Primary Care Mental Health and Well Mental Health and Well Being Services’Being Services’

Dr Ian WaltonGP, PEC chair and mental health lead for Sandwell and West Birmingham Clinical Commissioning [email protected]

Complex Patients or complex Complex Patients or complex servicesservices

Low Aspirations◦ Patients◦ Clinicians◦ Statutory sector

Dealing with Individuals and their families not Populations

High level needs analysisSilo Approach to commissioning and provisionNICE had led to a disease focussed model Wrong care, wrong service, wrong person,

wrong time

Needs Analysis Needs Analysis

Breadth and depth of need at whole population level◦ GP population and individual

Large amount of sick people and their carers◦Correlated with poor and inadequate housing◦Worklessness◦Physical and Mental Ill Health and Addictions

The Challenge – To improve The Challenge – To improve the outcome of the whole the outcome of the whole population including……population including…… Frequent attendees Complex needs Medically Unexplained Symptoms Prevention and early detection Those not meeting ‘psychiatry ‘ criteria – sub

threshold Emotional distressed Socially Excluded Homeless Diverse needs Not mentally ill but emotionally distressed eg

Sadness , grief, loneliness– crisis v crysis Services did not fit the patient

Targeted groupsTargeted groups

Young people at risk of mental ill health/asbo

Deaf populationSouth Asian womenCarersMenPeople with existing mental

health problems

How did we do it?How did we do it?

Listened Asset mapped locally National and international best practice

that worksIdentified a series of pre and post

outcome measuresQuantitative and Qualitative approachesSourced fundingEstablished benchmarksMore pilots than British Airways.......

Human Needs Human Needs Security-a safe territory-a space to growAttention (to give and receive)Having a sense of Autonomy and ControlEmotionally connected to others-

intimacyBeing part of a wider communityThe need for privacy to reflect and

consolidate experienceSelf esteem – via confidence and

achievementThe need to be stretched which comes

from a sense of meaning and purpose.Compassion

Books on prescriptionBooks on prescription

A Social Prescribing projectAfter a successful pilot in Cardiff in 2003, similar schemes have been taken up across many areas in the UK.

Sandwell first piloted Books on Prescription in 2006, and the service became mainstreamed across all Sandwell libraries and GP surgeries in 2007.

National FindingsNational Findings Patients get more information and a greater

understanding of their condition

Helps them recover from the problems they are experiencing

Helps them make informed choices and take a proactive part in improving their health

Anecdotal evidence indicates that there has been a low rate of people returning to their GP once taking up the book prescription

Patients prescribed books whilst on the waiting list for psychological therapy resulted in 50% reduction in the number of sessions they then required

But no-one reads in But no-one reads in Sandwell!Sandwell!Approximately 1100 book issues per yearPatients are more likely to access if a GP

refers them to the scheme Majority of our current referrals are self-

referrals 83% of B.O.P. users have applied the

techniques they learnt by reading the books

83% report improvements in their general wellbeing and mood as a result of accessing the scheme

Health Improvement Health Improvement ProgrammesProgrammes

Since the services started we have had over 4,000 people complete prevention,wellbeing and health improvement programmes this equates to £800,000 prevention costs.

1007 Stress Awareness 769 Health Improvement

programme 351 Food and Mood workshops 333 Laughter Yoga 305 Happiness and Wellbeing 218 Chin-up 102 Music and Wellbeing 89 Yoga 70 Positive Mental Training 67 Tai Chi 64 Happiness and Wellbeing

(FLW)

64 Long Term Conditions 58 Relationships 57 Self Defence and

Empowerment 56 Workplace Wellbeing 50 cCBT 47 Wellbeing Awareness Training 35 Relaxation 33 EFT - Emotional Freedom

Technique 25 Make Friends with a Book 22 Yoga (FLW) 17 Stress and Relaxation (FLW) 16 Flourish 15 Redundancy 12 Laughter Yoga (FLW) 11 Food and Mood Workshops

(FLW) 7 Capnography 2 Maternal Mental Health HIP

Plus over 3,000 people access talking therapies which using the same formulae would be £600,000

Chin up programmeChin up programmeAimed at youngsters “at risk of

offending”Originally given 8 teenage girlsThey told 20 of their mates..You can’t have the lads they

really are too much troubleTop of our league tables for

improving wellbeing

Conditions Management Conditions Management ProgrammesProgrammesLong term conditionsCapnographyPositive Mental TrainingWellbeing programmesEmotional Freedom Technique

www.confidenceandwellbeing.co.uk

Local outcomesLocal outcomes

3,468 sessions run 2011 -12 for 1,640 patients all programmes show a measurable difference clinically

and also in their wellbeing and social needs

Welfare Rights - 240 cases gains of £157,544, Reduction in referral to crisis services Frequent attenders managed in partnership with

probation and A and E at SWBH Access pathways to health for refugees and asylum

seekers, homeless people 59.5% average recovery rates for IAPT one of top IAPT

services nationally Other services are showing comparable results and

impact on wellbeing

Outcomes - corenet dataOutcomes - corenet data

Outcomes – wemwbs dataOutcomes – wemwbs data

www.primhe.org.uk 70

basrse

Training GPs

The magic formulaThe magic formulaAssets V needsStarfishCollaborative care - warm hands.Integrated budgetsCo- location Integrated care across all

conditions Education and training for all

Conclusion Conclusion Invest in prevention and not in

sick people

Money talks and there is a business case for this

KNAPP Martin; MCDAID David; PARSONAGE Michael; (eds.); Mental health promotion and prevention: the economic caseLondon: Personal Social Services Research Unit, 2011. 43p

http://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise/pdf/PSSRUfeb2011.pdf

ThanksThanksWith particular thanks to Lisa Hill,

Primary Mental Health Improvement Lead Sandwell PCT.

[email protected].

[email protected]


Question and Answer Session

Plenary Panel


Key Line of Enquiry: Preliminary Findings

Karen JerwoodHead of Sport and Physical ActivityBirmingham City Council


Introduction to table-top workshop

Dr. Jerry TewSenior Lecturer, Institute of Applied Social Studies University of Birmingham


Health and Wellbeing Update- 12th July 2012 Summit

Alan LotingaDirector of Health and Wellbeing


Ongoing Top Joint Priorities

• Making the transition to new health and care systems and structures– Keeping eye on whole system consequences of change : so

many things starting from April 2013

• Joining up transformation programmes– e.g. frail elderly, children's services, personal budgets

• Massive efficiency and productivity challenges - recurring savings– e.g. joint commissioning


Ongoing Top Joint Priorities

• Maintaining and improving where possible service quality, safety and performance, with particular emphasis on personal experience

• Health inequalities


Some important opportunities to build on

• Year 3 of biggest pooled budget, mental health/learning disabilities. Highly successful – savings, better services. 10% of total City health and care spend

• Health and care partnership Compact agreed• “Frail Elderly” transformation programme to build on (and others

commencing)• Strong support for place-based budgeting approach – e.g. Troubled

families• Big push towards integration with primary care• City Council’s Leader’s Policy Statement – “Promoting health and

wellbeing so that older citizens, children and young people are active and healthy, and live with dignity and independence. We will use the transfer of public health responsibility…to eliminate health inequality between the rich and poor and working through the Health and Wellbeing Board to achieve this.”

• Wellbeing Key Lines of Enquiry - the work and next steps from today.


Next Steps with our Health and Wellbeing Board• Next meeting 24 July• March 2012 review by existing members – what works, what to

improve. Purpose, membership, network of relationships (many new).

• Labour Council, “no” vote for Mayor, localisation agenda and determination to address inequality.

• Strategic guide to our health and care system.• A number of areas where better links sub-structures need

creating, co-opted, to support the work programme eg 3rd Sector generally, MH/LD joint commissioning, Children's Services, NHS Provider Forum, Quality and Safeguarding, Enterprise and Jobs, Crime and Safety.

• Importance of informal meetings and discussion.


Purpose of the Board

• Hold the “centre ground” to prioritising and applying resources across all agencies, not a magnet for all issues and not a scrutiny function

• Little direct infrastructure available, therefore need strong members and networks

• Deliver Marmot objectives, e.g. service integration and joint commissioning are key means to deliver these ends

• Strategy based on the “big issues” of the city (as defined by the JSNA), and deliver

• Keep close eye on big changes (Public Health transfer, CCG set up, Healthwatch) and whole system issues (de-commissioning, prevention and enablement activity, QIPP activity)


Health and Wellbeing Board – Network of relationships

• National

- Department of Health

- NHS Commissioning Board

- Public Health England

- Care Quality Commission

- HealthWatch England

- Monitor

- NICE


Health and Wellbeing Board – Network of relationships

• Sub National- Regional “arms” of above- Clinical Networks and Senates- Possible HWB federations- Joint Scrutiny

• Local (providers, partnerships, communities)- NHS Provider Trusts- Private Sector- voluntary and community providers- other partnerships – children, enterprise, crime and safety,

safeguarding, environment- Council departments- Patients, service users, carers, the public


• This strategy is an opportunity for us to be clear about our vision for the health and wellbeing of our City, and identify what the key partners – the City Council, NHS and others – will do together to achieve it. We want our citizens to be able to live healthier and happier lives, and for the services we commission to be better at supporting this.

Birmingham Draft Joint Health and Wellbeing Strategy


• The Strategy is not a statement of everything we need to do in health, public health and social care in Birmingham but a statement of what the most important priorities in health and care should be.

Many of the most challenging health issues in Birmingham are significantly affected by educational attainment, standard of living (good employment) and other factors like the places we live in. This strategy seeks to reflect that.

Making better use of community assets, co-production, more involvement of local communities, as well as agencies working better together, will be crucial to delivery (key themes from today).

Birmingham Draft Joint Health and Wellbeing Strategy


Online at • http://bhwbb.net/joint-strategic-needs-assessment/

health-and-wellbeing-strategy-consultation

Email by requesting from • [email protected]

Or Phone Birmingham Public Health • Kulwant Ghaleigh, 0121 465 8029

Respond by :7th September 2012


Feedback, conclusions and proposals

Karen JerwoodHead of Sport and Physical ActivityBirmingham City Council


All presentations for today can be found at:http://bhwbb.net/download/BHWBB%20Summit%20%20July%202012%20v2.ppt

Health & Medicine

Birmingham Health & Wellbeing Board Summit - July 2012