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Learning from the past……looking to the future
The Director of Public Health’s Annual Report 2013
Wendy Meredith
Background to report
• 1972 Public Health moves from Council into the NHS
• 2012 Health and Social Care Act• Comparison of then and now• Future working
Looking Back…1972“The outlook for people born in the last 20 years and who will experience this affluence for the whole of their lives must be a cause of great concernunless it is balanced by advances in medicine allowing earlier detection and treatment of this condition [CVD]”
“It is extremely disappointing
that a potentially preventable
condition could appear in suchnumbers in the community”.
“Many teachers whilst prepared to give simple factual health education talks, have felt anxious about dealing with more personal topics in the field of sex education, relationships and the abuse of drugs”.
“Many teachers whilst prepared to give simple factual health education talks, have felt anxious about dealing with more personal topics in the field of sex education, relationships and the abuse of drugs”.
New technology in the form of an Answerphone service was established in April 1972 to increase clinic attendances. Dr. Ross reflected that having received 21,800 calls this was “fulfilling a much needed service in the town”.
New technology in the form of an Answerphone service was established in April 1972 to increase clinic attendances. Dr. Ross reflected that having received 21,800 calls this was “fulfilling a much needed service in the town”.
“These two nurses visit patients on discharge from hospital giving them full support in an effort to decrease the possibility of the elderly person having to be readmitted to hospitaland also to give them the confidence to continue to live in the community”.
“These two nurses visit patients on discharge from hospital giving them full support in an effort to decrease the possibility of the elderly person having to be readmitted to hospitaland also to give them the confidence to continue to live in the community”.
Demographics and Health Need
• Bolton Population 276,800• 24.2% increase in births between
2002 and 2012• 15% of population over 65 years
Demographics and Health Need continued…….
• Coronary Heart Disease
• Stroke
• Respiratory disease
• Lung (& other) cancer
• Obesity & associated conditions
• Alcohol
• Mental Health
Recommendations
• Ensure JSNA develops as a vital resource to support health and social care and wider public service reform
• Engage with local commissioners to identify how Boltons Health Matters can be improved to better meet their needs
• Enhance and develop the Children and Young People’s element of the JSNA
• Develop a systematic approach to gathering, interpretation and presentation of data
• Undertake needs and asset assessments which focus holistically on cohorts of people.
Integrated Health and Wellbeing Services• Significant advances in preventative healthcare
in the last 40 years• Demand for services continues to outstrip
available resources• Positive outcomes and good patient experience
depend upon services working together• A life course approach to commissioning and
developing services to ensure prevention is embedded in the practice of all
Recommendations• Ensure the effective delivery of the Early Years model, prepare for
the implementation of the new model for Health Visiting and the Council’s new commissioning responsibilities
• Re-design the Healthy Child Programme for school age children focusing on the most vulnerable groups
• Further strengthen and expand the provision of services to improve mental health and wellbeing and ensure that key cohorts in the population get the service they need.
• Further develop opportunities within primary care to help people stay well by systematically addressing individuals’ health and social care needs.
• Further develop and implement the Bolton Integrated Health and Social Care model to expand and improve multi-disciplinary care across the borough
Health Protection• Deaths from infectious diseases have
reduced dramatically since 1972
• Increased vaccination and development of robust screening programmes
• STIs remain a challenge, emergence of HIV and importance of early diagnosis
• Good hand hygiene remains a simple but effective tool in controlling the spread of infection
Recommendations• Improve engagement with communities to increase vaccination
uptake rates• Target work to increase flu vaccination uptake in pregnant women
and front line health and social care staff and increase pneumococcal immunisation uptake, especially in women.
• Increase activity to ensure that those communities most at risk of developing TB have improved ,work needs to continue to reduce the stigma associated with the disease and to better enable individuals who have tuberculosis to successfully complete treatment.
• Continue to focus on sexual health improvement, good sex and relationships education and improved access to sexual health services
• Increase awareness of infection prevention and control interventions
Health Improvement
• Health behaviours influenced by more than knowledge
• Affluent more likely to adopt healthier behaviours• Action at population, community and individual
level to enhance outcomes• Use of social media and new technologies• Shift to the concept of “wellbeing”• Health as “everybody’s business”
Recommendations• Explore further the potential of social media in supporting
the achievement of health improvement outcomes (whilst being aware that not everyone has digital access).
• Evaluate and learn from pilot programmes and initiatives such as Farnworth Healthy Weight in order to ensure best use of limited resources.
• Continue to identify and improve health outcomes for vulnerable groups including Black and Minority Ethnic and new and emerging communities.
• Continue to target and develop actions to improve the quality of private sector housing particularly the private rented sector.
Moving Forward• Ensuring delivery of our statutory duties• Assurance in respect of the health protection of Bolton’s
population• Improving life chances for children: Early Years new delivery
model• Linking health and education: commissioning 5-19 children’s
health and wellbeing service• Tackling long term conditions: further develop early
recognition and swift referral• Integrating health and social care: Staying Well• Developing an Asset based approach to community
development• Developing use of new technologies and social media to
improve health
…. and finally“Much has changed in the last 40 years
since Dr Ross’s day. The NHS has experienced many reorganisations.
The transfer of public health responsibilities back to where they belong in local
government offers the greatest opportunity to improve the health of Bolton people in the
next 40 years – public health has come home”
Wendy Meredith, Director of Public Health’s Annual Report 2013
Health Inequalities – Key Issues• People living in the poorest neighbourhoods in
England will on average die seven years earlier than people living in the richest neighbourhoods and spend more of their lives with disability
• It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS
• Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community
The Data – Comparison of Bolton with the rest of England• Life expectancy in Bolton is 1.7 years less than the
rest of England• Bolton has the widest “internal” inequality gap of our
peers (between most and least deprived neighbourhoods)• 12.1 years for men• 9.2 years for women
Health Inequalities are preventable – National recommendations (Marmot)
1. Give every child the best start in life
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives
3. Create fair employment and good work for all
4. Ensure healthy standard of living for all
5. Create and develop healthy and sustainable places and communities
6. Strengthen the role and impact of ill-health prevention.
Our current strategy in BoltonThe Health & Wellbeing Strategy
• A life course strategy from starting well to end of life
• Progress and priorities:• Keeping children healthy (Early Years PSR pilot work;
Developing Well Sub Group of the Children’s trust)• Healthy adults at work (Borough Skills agenda and
Working Well pilot)• Community support for our older people (Health &
Social Care integration)
• Key partnership contributions: housing; Skills and anti-poverty strategy
Discussion - What more can we do?
• What more we can the voluntary and community sector across the spectrum of health determinants?
• Specifically:– Creating fair employment and good work?– Ensuring healthy standard of living for all?– Creating and developing healthy and
sustainable places and communities?
• How do we take this forward?