From Strategy to delivery, a Public Health opportunity for the UK

True Blue Vince Ion Consultancy

From Strategy to delivery, a From Strategy to delivery, a Public Health opportunity for Public Health opportunity for

the UKthe UK

Vince IonVince IonTrueBlue ConsultancyTrueBlue Consultancy

& Honorary Lecturer at & Honorary Lecturer at Sheffield Hallam UniversitySheffield Hallam University

True Blue

Vince Ion Consultancy

TransformationTransformation

•The changing context of healthcare

•A new focus for healthcare ‘provision’

•What sorts of skills and capabilities are needed?

•How can learning support & promote change

True Blue


Change all over the Change all over the worldworld

True Blue


The Changing Nature of The Changing Nature of HealthcareHealthcare

• Increase in ‘out of hospitals careIncrease in ‘out of hospitals care• Focus on chronic/long-term Focus on chronic/long-term

conditionsconditions• Promotion of healthy living Promotion of healthy living • Public health concerns– flu Public health concerns– flu

pandemic, terrorism, avian flu etcpandemic, terrorism, avian flu etc• More ‘self-care’More ‘self-care’• More voice, influence of patients, More voice, influence of patients,

service users and the citizenservice users and the citizen• Health as core element of Health as core element of

community development & social community development & social capitalcapital

True Blue


The Drive for SkillsThe Drive for Skills

True Blue


Towards ‘Risk Society’ (Beck)Towards ‘Risk Society’ (Beck)

Risk Society

Choice

Multiple &Contested Information

& Knowledge

‘Fuzzy’Boundaries

Un-sustainability

BeyondConventions,

Rules & Structures

Unreliability Uncertainty

UbiquitousChange

Unpredictability

True Blue


Four key elements of contemporary Four key elements of contemporary Social & Political PolicySocial & Political Policy

Lifelong learning

Choice

Personalisation

E-learning

Citizens & Workers

True Blue


The Core Purposes of LearningThe Core Purposes of LearningAccording to the celebrated Jacques Delors According to the celebrated Jacques Delors

Commission on Lifelong Learning, “The Commission on Lifelong Learning, “The Treasure WithinTreasure Within””

Learning to KnowLearning to Know (learning to learn, (learning to learn, general knowledge & understanding)general knowledge & understanding)

Learning to DoLearning to Do (skills, competence, (skills, competence, practical ability in a variety of practical ability in a variety of settings)settings)

Learning to Live TogetherLearning to Live Together (tolerance, mutual understanding, (tolerance, mutual understanding, interdependence)interdependence)

Learning to BeLearning to Be (personal autonomy (personal autonomy & responsibility, memory, aesthetics, & responsibility, memory, aesthetics, ethics, communication & physical ethics, communication & physical capacity)capacity)

True Blue


So is this the Future?So is this the Future?

True Blue


NHS Next Stage ReviewNHS Next Stage Review

True Blue


Healthy Ambitions for Healthy Ambitions for Y&HY&H

True Blue


UK based future Model for deliveryUK based future Model for deliveryHealthy AmbitionsHealthy Ambitions

• The model for delivering Healthy Ambitions is based The model for delivering Healthy Ambitions is based on that developed by the Institute for Healthcare on that developed by the Institute for Healthcare Improvement based on an analysis of high Improvement based on an analysis of high performing and high transforming health systems. It performing and high transforming health systems. It emphasizes 3 key ingredients for major change: emphasizes 3 key ingredients for major change: – will will – you need to create shared purpose about – you need to create shared purpose about

your objectives your objectives – ideas ideas – you need to be specific about what you – you need to be specific about what you

want to change and test out how you can make want to change and test out how you can make those changes those changes

– execution execution – you need project plans, with – you need project plans, with timescales and milestones, measurements and timescales and milestones, measurements and clear accountability.clear accountability.

True Blue


Our Principles for DeliveryOur Principles for Delivery

• clarity of purposeclarity of purpose:: keep the objectives of the keep the objectives of the report – improving health and health care – at report – improving health and health care – at the forefront of all discussionsthe forefront of all discussions

• collaborative productioncollaborative production:: design design implementation programmes as much as implementation programmes as much as possible with the NHS, local authorities and key possible with the NHS, local authorities and key stakeholdersstakeholders

• subsidiaritysubsidiarity:: ensure that where details of ensure that where details of implementation can be determined locally, they implementation can be determined locally, they should be should be

True Blue


Our Principles for DeliveryOur Principles for Delivery• clinical ownership and leadershipclinical ownership and leadership:: build and build and

sustain clinical engagement and leadership sustain clinical engagement and leadership through all elements of implementationthrough all elements of implementation

• system alignmentsystem alignment:: incorporate implementation incorporate implementation into mainstream processes, and align our into mainstream processes, and align our objectives to the goals of Healthy Ambitionsobjectives to the goals of Healthy Ambitions

True Blue


Levels of delivery

Do it once

Need for regional consistency

Coordination/collaboration helpsNeed for difference by design

Local delivery – SHA holds to local organisations to account, provides confirm and challenge

Regional

Local

Region wide consistency essential - local where possible

Direction regional – pace local

True Blue


Making it happen – the Making it happen – the processprocess

Healthy Ambitions

from pledge to practice

• One key pledge

• Detailed pathway recommendations

• Agreed with PCTs

• PCT strategic plans

• WCC

• PCT annual operating plans

• Metrics

• Dashboard

• Local monitoring

• Pathway delivery board

• Strategic Commissioning Board

Pathway Pledge

Clinical Recommen-dations

Levels of Delivery

Local Priority Delivery Measure Oversight

True Blue


Making it happen – Staying Making it happen – Staying HealthyHealthy

Pathway Recommendations

Level of Delivery

Local Prioritisation

Annual Operating Plan

Metrics / Dashboard

Detailed pathway recommendations

Agreed with PCT CEs – local delivery wherever possible, sub-regional or regional where required

Recommendations prioritised according to local circumstances. PCT Strategic Plans outline local delivery & are assured by the SHA

Details of local initiatives, funding and timescales to deliver local priorities

Pathway metrics developed and local trajectories agreed. Healthy Ambitions Dashboard shows progress against trajectories

Oversight Local monitoring Pathway Delivery Board Strategic Commissioning

Board

Halt in the rise of obesity

Localised commissioning

PCT Strategic Plan

Annual Operating Plan

Obesity Prevalence

Reception & Year 6 Children

Staying Healthy PDB

Pathway Pledge One key high-level pledge per pathway

e.g. Commissioning

weight management services

True Blue


Recommendations re Recommendations re obesityobesity

• Every local organisation (Primary Care Trust) should Every local organisation (Primary Care Trust) should commission localised weight management services commission localised weight management services for their local population. To meet life expectancy for their local population. To meet life expectancy targets these should focus on adults at mid-lifetargets these should focus on adults at mid-life

• Brief interventions should be implemented Brief interventions should be implemented consistently by a wide range of NHS settings and staffconsistently by a wide range of NHS settings and staff

• Surgery for people who are morbidly obese. PCT Surgery for people who are morbidly obese. PCT should proactively collaborate on specification, should proactively collaborate on specification, services and common standardsservices and common standards

True Blue


Recommendations: Recommendations: ObesityObesity

• Link with Gov initiative on child weight managementLink with Gov initiative on child weight management• There should be systematic programme of local work to There should be systematic programme of local work to

reduce the levels of obesity through the development of:reduce the levels of obesity through the development of:– Food [policy and better food skills for adultsFood [policy and better food skills for adults– Transport and the built environment – making activity easier/ saferTransport and the built environment – making activity easier/ safer– More opportunities for active leisureMore opportunities for active leisure– Local employmentLocal employment– Quality of school food, drink and activity programmesQuality of school food, drink and activity programmes

True Blue


Human Resources:Workforce Planning &

development, Education & training.

Workforce wellbeing

Staying Healthy Workforce approach

True Blue


Regional

Local

Workforce strategies, job descriptions, new roles, development opportunities

Staying Healthy Pathway – levels of delivery

Making every Contact Count ConferenceWorkforce Ambitions – March 09Competence framework commissioned– Sheffield Hallam University

True Blue


Healthy Ambitions for Healthy Ambitions for Y&HY&H

True Blue


True Blue


Healthy CitiesHealthy Cities

True Blue


What next to deliverWhat next to deliver• Regional need to develop public Regional need to develop public

health competencies. Dec 2008health competencies. Dec 2008• Tender process Jan 2009Tender process Jan 2009• Sheffield Hallam university chosen as Sheffield Hallam university chosen as

provider Feb 2009provider Feb 2009• Framework delivery May 2009Framework delivery May 2009• Testing June-Aug 2009Testing June-Aug 2009• Final framework Oct 2009Final framework Oct 2009

True Blue


What we are trying to do!What we are trying to do!

• Develop a competence framework for Develop a competence framework for behaviour change interventions that can be behaviour change interventions that can be used by:used by:– Service and Education Service and Education

CommissionersCommissioners: as a tool to support : as a tool to support commissioning behaviour change servicescommissioning behaviour change services

– Education providersEducation providers: as a tool for : as a tool for developing targeted education and developing targeted education and developmentdevelopment

– IndividualsIndividuals: as a tool to identify their : as a tool to identify their existing competences and development existing competences and development needs.needs.

True Blue


The Challenge!The Challenge!

Foresight. (2007)

True Blue


Why are we doing it?Why are we doing it?

EVERY CONTACT COUNTS

True Blue


Who is Doing It?Who is Doing It?•CommissionerCommissioner•Policy AnalystPolicy Analyst•EducationalistsEducationalists•Behaviour Change Behaviour Change

expertsexperts•Occupational Occupational

PsychologistPsychologist•Public Health SpecialistPublic Health Specialist•Developing New RolesDeveloping New Roles

True Blue


The ProjectThe Project

• ApproachApproach• Phase 1: Review of Phase 1: Review of

evidence baseevidence base• Phase 2: Construction of Phase 2: Construction of

FrameworkFramework• Phase 3: Piloting & Phase 3: Piloting &

testingtesting

True Blue


The Project 2The Project 2• Deliverables:Deliverables:• Evidence Digest for Evidence Digest for

Commissioners of Commissioners of Services and EducationServices and Education

• Behaviour Change Behaviour Change Competence FrameworkCompetence Framework

True Blue


The Evidence BaseThe Evidence Base•Muliti-factoral and very Muliti-factoral and very

complexcomplex•Motivation is keyMotivation is key•Limited evidence of Limited evidence of

effectivenesseffectiveness•Multi-stranded Multi-stranded

approachesapproaches•What is the key What is the key

ingredient?ingredient?

True Blue


Overview of the FrameworkOverview of the Framework• "Start Where the Person/Population Is""Start Where the Person/Population Is"• Identifies the main behaviour change Identifies the main behaviour change

approaches and interventions relevant to approaches and interventions relevant to stage of changestage of change

• Identifies the generic competences and Identifies the generic competences and associated Knowledge and Skillsassociated Knowledge and Skills

• Aimed at those people who undertake Aimed at those people who undertake behaviour change in addition to their normal behaviour change in addition to their normal role, therefore levels of practice are not role role, therefore levels of practice are not role specificspecific

True Blue


Start Where the Person /Population IsStart Where the Person /Population Is

Adapted from Prochaska & DiClemente (1983)

True Blue


The Draft Framework The Draft Framework

• Evidence identifies basic competences common to all approaches, e.g., empathy, communication, empowerment

• Levels of practice will be mapped against intensity of intervention required to move people through the stages of change.

True Blue


Next stepsNext steps• Translate evidence review Translate evidence review

into useable digestinto useable digest• Continue development of Continue development of

competences and competences and associated knowledge & associated knowledge & skillsskills

• Pilot testingPilot testing

True Blue


ReferencesReferencesTowards a Risk SocietyTowards a Risk Society

The Treasure WithinThe Treasure Within

High Quality Care For AllHigh Quality Care For All

NHS Next Stage ReviewNHS Next Stage Review

Healthy Ambitions Healthy Ambitions

Delivering Healthy AmbitionsDelivering Healthy Ambitions

Beck.U. Sage London 1992

Delours Jack E.U. Commission on Life Long Learning

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085937

http://www.healthyambitions.co.uk/

http://www.healthyambitions.co.uk/DeliveringHealthyAmbitions/

True Blue


ReferencesReferencesWorkforceWorkforce Ambitions 2009 – 214Ambitions 2009 – 214

Commissioning and Behaviour Change – Commissioning and Behaviour Change –

Kicking Bad Habits – Final Report (King’s Kicking Bad Habits – Final Report (King’s Fund)Fund)

Change for LifeChange for Life

Tackling obesities-: Future ChoicesTackling obesities-: Future Choices

Stages and processes of self-change of Stages and processes of self-change of smoking: Toward an integrative model of smoking: Toward an integrative model of changechange

http://www.yorksandhumber.nhs.uk/what_we_do/workforce_education_and_training/workforce_strategy

World Class commissioning DH 2008

http://www.kingsfund.org.uk/publications/the_kings_fund_publications/kbh_final_report.html

http://www.nhs.uk/change4life/Pages/default.aspx

Butland B. UK Government 2007

Prochaska, James O.; DiClemente, Carlo C. Journal of Consulting and Clinical Psychology. Vol 51(3), Jun 1983, 390-395

True Blue


How can you find out more?How can you find out more? Vince IonVince Ion

True Blue ConsultancyTrue Blue Consultancy & Honorary Lecturer & Honorary Lecturer at Sheffield Hallam at Sheffield Hallam

UniversityUniversity

[email protected]@btconnect.comTel 07796 888 573Tel 07796 888 573Fax 01636 821 528Fax 01636 821 528

Documents

From Strategy to delivery, a Public Health opportunity for the UK