Public Health Transformation Workshop 1

21st March 2012

Introduction

Jason Lowther

Director of Strategy, BCC

Agenda

• Introduction

• Session 1: Vision

• Lunch

• Session 2: Strategic outcomes and intended benefits

• Session 3: Stakeholders

• Conclusion and next steps

Introduction

• Health & Social Care Bill

• Welcome back to local government!

• Transition Plan (SHA)

• Transition Board

• Transformation Approach (CHAMPS2)

The New Public Health System

Government

• DH responsible to parliament, with clear line of sight through system

• Cabinet sub-committee and significant contribution from across departments to improve health outcomes

• CMO to continue to provide independent advice to Government

Public Health England

• New, integrated national body

• Strengthened health protection systems

• Supporting the whole system through expertise, evidence and intelligence

NHS

• Delivering health care and tackling inequalities

• Making every contact count

• Specific public health interventions, such as cancer screening

Local authorities

• New public health functions integrated into their wider role, helping to tackle the wider social and economic determinants of health.

• Leading for improving health and coordinating locally for protecting health

• Promoting population health and wellbeing

The new delivery structure: an integrated whole system approach

Introduction – CHAMPS 2

• Established methodology• Familiarisation course• Web materials• Paper manual• Expert support

Introduction – timeline

Phase Timing

Transformation Initiation to April 2012

Vision

Planning

Design May – Jul 2012

Service Creation Aug – Dec 2012

Proving and Transition Sept 2012 – Apr 2013

Stabilisation Apr – Dec 2013

Benefits Realisation Dec 2013 onwards

• Leadership commitment

• Transition team identified

• Lots of work in various areas

Introduction – progress to date

• Defining the desired strategic outcomes • Understanding customer needs and preferences• Current business capabilities• Development of the future operating model (FOM)• Process design • Organisational design• High level technological design• Assessment of change impact and benefits

Introduction – work needed to complete phases 0-2

Principles

• BCC values and welcomes the skills and expertise coming through transfer of public health.

• The transfer should form part of how the City Council and its health partners achieve the best health and wellbeing outcomes for citizens

• Particularly given the current health status of many of our citizens, the future approach to public health needs to be transformational.

• Adopting Marmot “life stages” framework.

Session 1: Vision

“Birmingham 2026” community strategy• Be healthy’ is about ensuring that people enjoy long, healthy and fulfilling lives.

We want to ensure that Birmingham people live longer and live well, enjoying rich cultural experiences.

By 2026 we want:• Reduced health inequalities and mortality across Birmingham, resulting in people

living longer• More people enabled to choose healthy lifestyles, enjoying rich cultural

experiences and improve their wellbeing, resulting in people living well

A healthy Birmingham will mean that we will:• improve health for all, in particular for people who belong to the least healthy

groups, narrowing the gap in life expectancy between the least healthy areas and the city average

• have more people choosing healthy and active lifestyles, lowering levels of obesity, increasing levels of physical activity, stopping smoking and encouraging healthier eating

• enable more people to live independently for longer

Session 1: Vision (2)

Session 1: Vision (3)Priority One: That in Birmingham every child makes the best start in

life.

• Rationale: given that the city is the youngest in Western Europe, if it fails to achieve the best outcomes for children and young people it will be failing to make use of the asses they represent. Young people will need to be highly skilled, well educated and emotionally connected people to compete in the economy.

Priority Two: That Birmingham is a healthy and sustainable city for adults

• Rationale: the city faces a low growth in numbers of older people but costs growing above the national average due to poverty and poor health. The number of years lived with disability and long term conditions is reducing working age and adding to poverty as well as placing considerable strain upon the care and health systems. Reversing this to achieve better use of resources will also unlock the contribution that older adults bring to the life and economy of the city

Session 1: Vision (4)Redesign principles

• It is for the new health and wellbeing board to adapt new priorities and set out a public health vision. However we should set this within the context of supporting its need to be clear about its shared sense of purpose before moving through strategic and business process issues

• The health strategy should be built as an iterative and incremental process that:– Establishes a deep understanding of local people, their views and aspirations, their health and

needs and how these are best met– Where common agreement exists, the strategy should be developed through to actions– Where further time is needed to establish common perspectives, this should be explicitly taken– Rather than work to deadlines of time the strategy and action plans should move forward set by

common agreement– Long term plans must also be accompanied by clear markers of success and progress.

• Its vital that this opportunity is taken to think anew and to establish public health approaches that work across the five outcomes of the community strategy (succeed economically, stay safe, etc) and at a range of levels:

– Around the individual – altering behaviours, preferences etc– In specific localities or interest groups– At a city wide level– With partners on a sub regional level– At a national level – including influencing key relationships such as the one with the National

Commissioning Board.

Session 1: Vision (5)• Its vital that this opportunity is taken to think anew and to

establish public health approaches that work across the five outcomes of the community strategy (succeed economically, stay safe, etc) and at a range of levels:

– Around the individual – altering behaviours, preferences etc

– In specific localities or interest groups

– At a city wide level

– With partners on a sub regional level

– At a national level – including influencing key relationships such as the one with the National Commissioning Board.

Session 1: Vision (6)

Exercise 1 [30 minutes then 2 mins verbal feedback]

1. Introduce yourselves to each other

2. What is your gut reaction to the vision outlined?

3. Do the “principles” cover the key areas for the transition?

4. Do the two “priorities” cover the more important and urgent issues?

5. Are the “redesign principles” appropriate?

6. What is your most optimistic view of how this might turn out?

Working Lunch Break

Please bring your meal back

to the seminar table

Strategic Outcomes and Intended Benefits

Denise McLellan

Chief Executive, NHS Cluster

LicensingLicensing

Department of Health

Department of Health

CQCCQCNHS Commissioning Board

NHS Commissioning Board

Local HealthWatchLocal HealthWatch

ParliamentParliament

MonitorMonitor

Patients & PublicPatients & Public

2° and 3° Providers2° and 3°

Providers

PartnershipPartnership

Local AuthoritiesLocal Authorities

Clinical Commissioning Groups (CCGs)

Clinical Commissioning Groups (CCGs)

ContractsContracts

Accountability

Funding

Key:

Birmingham HealthWatchBirmingham HealthWatch

Solihull HealthWatchSolihull HealthWatch

Commissioning Support Service (CSS)

Commissioning Support Service (CSS)

Local OfficeLocal Office

NHS System Architecture

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Local Authorities

CCGs/NHS CB

PHE (Local)

Health & Wellbeing

Board

The LA, the CCG/NHS CB and PHE will all play a crucial role in ensuring an effective local delivery system and in improving and protecting health and wellbeing

PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents

• Coordinates local strategy through:

• JSNAs• Joint health and wellbeing

strategy• Review of commissioning

plans• Receives and reviews PHE’s

programme for its locality

LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB

CCGs and NHS CB will • Commission healthcare• Commission specific PH services

(eg QoF, Immunisations, Military and Prison health)

Local Authorities will: • Have a duty to improve health• Bring together holistic approach to

health and wellbeing across full range of their responsibilities

• Receive ring-fenced PH budget• Lead commissioning of public health

services (health improvement, drugs, sexual health)

DPH has specific functions to bring together the local PH system:

• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB

LOCAL ROLE RATIONALE

PHE local units will be part of local delivery system:

• Providing health protection service and expert advice

• Specialist EPRR function

NHS will continue to commission PH services where:• within PC contract• integral part of pathway• 0-5 services and Health Visitors

Session 2: Strategic outcomes and intended benefits

Scope of change– All public health functions including those which will become the

responsibility of the local authority.– Council functions which could significantly impact on public health and

well being

• Key drivers– Economic context– JSNA/ Marmot- wider determinants of health and wellbeing– Opportunities for joined up working - delivery, comms, commissioning– Localisation– Public accountability– The Compact - Uniting for a Healthier Birmingham and Solihull-

binding the NHS system once PCTs abolished

Session 2: Strategic outcomes• A highly effective public health system in Birmingham which addresses

health inequalities and can demonstrate a coordinated approach to impacting on the wider influences on health.

• Key stakeholders (including the Health & Well Being Board and CCGs) are very satisfied with the services provided.

• Public health is perceived by GP commissioning groups to provide timely, reliable and highly usable advice around population health and well being needs, and on healthcare issues.

• Highly efficient operation: removing duplication of effort, streamlining processes, ensuring accurate information is available, reducing costs.

• Evidence-based practice: rigorous analysis of the evidence and costs/benefits of all programmes to ensure the most cost-effective approaches are used in delivering priority outcomes.

• More effective engagement with local areas in terms of front line practitioners, elected members and communities.

Session 2: Intended benefits1. Benefits to customers / stakeholders: better targeted information and advice,

improved customer satisfaction, higher quality and more cost-effective interventions

2. Benefits to employees: better information and networks to deliver their objectives, improved working environment with co-location with key partners in delivering public health outcomes

3. Efficiency savings: reducing costs to free up resource to deliver greater public health benefits

4. A more citizen centric view of health - less top down and target driven

5. Focus on physical and mental wellbeing as well as quality of life

6. Opportunity to redesign current investment in nhs providers, integrate with “place” and regulatory role of city council and increase range of wellbeing services provided by third sector

7. New community leadership role by local politicians

8. Engagement with and stronger accountability to local communities

9. Evidence based approach to policy development, investment and disinvestment

10. Experienced public health team with specialist expertise, clinical networks and established relationships with nhs commissioners

11. Greater clarity about who is responsible for what, especially in relation to commissioning services for vulnerable people

Session 2: Strategic outcomes and intended benefits

Exercise 2 [30 minutes with written feedback]

1. Do these capture the most important strategic outcomes?

2. What are the two most important outcomes?

3. Are the most important benefits identified?

4. What are the two most important benefits?

Stakeholders

Rachel Farthing

Chief Executive’s Project Team

Session 3: Stakeholders

Thanks for completing the survey (n=14)

Increasing our understanding of stakeholders

Today’s work will feed into the stakeholder engagement plan and communications plan

Session 3: Stakeholders High Medium Low

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Importance of stakeholders to the programme Influence / Impact Matrix

Key players – need strong buy-in

Keep informed

Active consultation

Maintain interest

Session 3: Stakeholders – key for matrix

Session 3: Stakeholders - High influence and impact

• Secretary of State for Health• Clinical Commissioning Groups• Health and Wellbeing Board• Department of Health• Birmingham Drug and Alcohol Action Team• PCT Clusters• NHS Commissioning Board• Public Health England (Development)• Local Authority Elected Members• BCC Adult’s and Children’s Services

Session 3: Stakeholders - No consensus on matrix positionThe below may warrant further discussion

• GP Practices• Health Protection Agency• PCTs• Mental Health NHS trusts• West Midlands Public Health• Community pharmacists• SHA Clusters• Acute NHS trusts• West Midlands Police• Criminal Justice, Youth offending, Probation• Sports and leisure groups• Unions• Local Media• MPs

Stakeholder needs and experiences will need to be more precisely analysed including:

– What are the customers’ real expectations, requirements and judgement criteria?

– What do they say they want and what do they really need?

– What problems do they have? – How do they use the services and products? – How do these differ between different customers (eg

CCGs, PHE, general public)?

Session 3: Stakeholders

Session 3: Stakeholders

Exercise 3 [30 minutes with written feedback]

1. Is the mapping of stakeholders roughly right?

2. Are there any major amendments needed?

3. What do we already know about the needs and views of each group?

4. How can we improve our understanding especially of the groups with the highest impact and influence?

1. Write up of today’s discussions:

– Vision– Strategic outcomes– Intended benefits– Stakeholders

Conclusions and next steps

2. Next workshop (4th April)

– Review of today’s discussions– Overview of current business capabilities– Refine design principles– Identify key components of the future

business– Identify the key differences against the

current operation – Start to outline key changes required

Conclusions and next steps

Public Health Transformation Workshop 2

4th April 2012