VCS Public Health White Paper Event9th March 2011

Jim McManusJoint Director of Public Health

The post-transformation world

Key Issues

Issues

• Changed NHS• Smaller local government• Comprehensive Spending

Review• The Localism agenda• Big Society• JSNA

Stakeholders

• DsPH• GP Consortia/Federations• Local Govt• Health & Wellbeing Boards• Scrutiny• HealthWatch• Public Health England• NHS Commissioning Board

1. Some Key Observations on Public Health Interventions

Implications in the new world

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

Long term, medium term, short term impacts

Building a “Whole Council Approach” through Domains of Public Health

FALLS PREVENTION

Service Quality andImprovement

Timeframes of impact/yield

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

A new care model & public health

Citizen purchased care – state resources

Enablement

Prevention

Universal offer

Citizen (purchased) care – own resources

MEANS

NEEDS

2. Getting yourself ready for the new world

Contributions, Stakeholders and Influencing Processes

Choices

• Prevention

• Care

• Enablement

• All of them?

• Outcomes

• Benefits

What Outcomes can I contribute to?

Which Stakeholders

Influence

Money

DsPH

HWBB

GP Consortia LA PHE

NHSCB

Scrutiny

Healthwatch?

Learning the lessons from theNational Audit Office 2010not on course!

Smart Moves

• Understand the trends and embed them into how you work

• Show you understand how local government works• Get to know your GP Commissioning Consortium/a• Get to know lead elected members• Understand their agendas• Address them explicitly – what do health trainers do for

them?• Early discussion at Health and Wellbeing Board• Don’t waste time meeting the world and its dog

3. Case Study

Behaviour Change in Local Government

Life Expectancy by Ward

The drivers for behaviour change

• Personalisation• The White Paper – new

strategic role for local government

• Other White Papers– Children, Public Health,

• The drive to integration

• The Local Government Act 2002

• The Financial Crisis• Business Transformation• Behaviour Change as an

economic imperative• Funding Adult Social

Care• Community cohesion –

immigration and TB as examples

Birmingham by Cadbury Neighbourhood Classifications

• Understanding these as drivers and intervening variables

• Transit or Escalator– move to less deprived areas

• Isolate – move to equally or more deprived areas

The new public health duties

Coming into Las where….• Money has been removed

and services cut. Whole landscape changed

• There’s a ring-fenced budget and everybody wants some of it

• Public health is not a known or necessarily trusted quantity (just how joint is your joint DPH?)

Implications

• DsPH in the real world please. Address what value you bring

• Identify value and priorities with clear business case linked to core authority priorities

• Identify what you can add to LA core agenda and what outcomes

Financial Options for Councils

• Go bust very quickly indeed• Create parish/town councils and shove stuff on them• Cut, cut, cut – deny people services – 33% less?• Change your model – targeted services for those with

greatest need, preventive and universal for others– Spread risk and co-produce/outsource

• CAN HEALTH TRAINERS BE AGILE ENOUGH FOR THIS CHALLENGE?

Birmingham

• Prediction & Prevention– Falls prevention in social care– Telecare

• Pro - Environmental Behaviour• Pro-Social Behaviour• Obesity in 29 highest priority schools• Staff Sickness• Staff Productivity (Smoking Cessation)• Industrial Disease & Accident Prevention

The Opportunities

• Public health delivering outcomes

• Joined up Outcomes

• A balanced public health function

• Interface between GPs and Social care to save both sides of the system money

• Behavioural solutions to thorny and expensive problems

Smart Moves

• Understand the trends and embed them into how you work

• Show you understand how local government works• Get to know your GP Commissioning Consortium/a• Get to know lead elected members• Understand their agendas• Address them explicitly – what do health trainers do for

them?• Early discussion at Health and Wellbeing Board• Don’t waste time meeting the world and its dog

What does a business case forbehaviour change look like?

• What are you offering?• Why should local

government care?– Strategically– Financially – Priorities and outcomes

• Show an understanding of the trends this service needs to address– personalisation, eg

• How can you address these?– Be specific

– Be SMART

• Identify return on investment in value terms– Costed investment,

– costed benefit

• Argue for a relationship type which sits well with that council

Thank you!

Jim.mcmanus@birmingham.gov.uk