Messages from Marmot.

Presentation

The Conceptual Framework

Reduce health inequalities and improve health and well-being for all.

Create an enabling society that maximises individual and

community potential.

Ensure social justice, health and sustainability are at heart

of policies.

A. Give every

child the best start in life.

C. Create fair

employment and good work for all.

B. Enable all children, young people and adults to maximise

their capabilities and have control over their lives.

D. Ensure healthy

standard of living for all.

E. Create and develop

healthy and sustainable places and communities.

F. Strengthen the role

and impact of ill health prevention.

Equality and health equity in all policies.

Effective evidence-based delivery systems.

Policy objectives

Policy mechanisms

2

People and Places

• Critical linkage of health, wellbeing and resilience.• Evidence of linkage of low level stress, depression,

isolation especially in communities of multiple deprivation with significant barriers to participation.

“ You can see the deprivation, all you have to do is look outside. Its in your face every day, litter everywhere, rats and rubbish. It’s a dump……it feels like people around you have no meaning to life.I keep my curtains closed at times……….It doesn’t give you a purpose to do anything” (Focus group participant)• Many excluded areas are characterised by lack of

mutual trust, isolation and under developed social cohesion.

“I feel safe but there I places I don’t go” (focus group participant)

Developing Communities: building resilience

• Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and Parsons 2006)

• Impact of personal support critical“ I know I have got back up and that is a big thing” (Mari 2006)

• Learning and skill development impact positively and fosters community action. “ It was just getting worse and worse. The group then decided that we ought to be lobbying people that could help us MPs, local councillors, local members and the Police.” (Shirley)

• Social networks create the conditions in which people thrive“I don’t know what makes other people healthier. I know what makes me healthier and that’s being happy and having friends” (Suzanne 2006)

4

Where are we?

• Comprehensive spending review impact.

• Recasting the relationship Government, State and citizen

– One nation Toryism , Communitarianism, Community Assets,Broken Society

• White Papers– NHS – Public Health– Adult Social Care– Mental Health.

• Bold vision for radical 5 year reform or dangerous gamble??

Where are we?

Putting the Public and Patients first

Choice – any willing provider, choice of consultant led team, GP Practice, choice of treatment.

Health Watch• National CQC• Local credibility – CHC,

Patient Forum , PPI, Links??

• Outcomes not targets• Money follows patients• Information for choice.

Localism• New role for GP Consortia in

commissioning local services• Pathfinder GP consortia

underway:• “ Duty to promote

equalities and to work in partnership with local authorities for instance in relation to health and adult social care, early years services, public health ,safeguarding and the wellbeing of populations”.

• Timeframe 2013?????

Local Democratic legitimacy

• Integration and partnership working between NHS, Social Care and Public Health

• Joint Directors of Public Health• Lead JSNA ? JNAA?• Partnership for change• Early implementors for Health

and Wellbeing Boards sought• Earmarked NHS funding to

Social Care (3.8bn)

........

• Social Care– Personalisation– Independence– Responsibility

• Demography– 85+ years = =85% by 2031

– + cost estimate +300% by 2051• Funding review

– Comprehensive spending review.– Voluntary insurance– Partnership scheme

Forthcoming public health White Paper30th November??

• Political Leadership– “ So I do want to build on the findings of Sir Michael Marmot’s review and the 6 policy

objects he proposes.”( SOS Health July 2010)– “Target those determinants of poor health in ways that fit local circumstances.– “Form new partnerships across different disciplines.”

• Expectations– Behaviour change and personal responsibility– Partnership with Business Sector.– Acknowledgement of the Social Determinants of Health and the 6 policy objectives in

Marmot Review– Big Society and the fostering of health, wellbeing and resilience of individuals and

communities– Emphasis on strategic political leadership and partnerships– Proportionate universalism – action across the gradient but proportionate to

disadvantage

Managing the brave new world

• Focus on extending health, wellbeing and resilience of individuals and communities through greater participation.

• Develop greater democratic accountablity through Health and Wellbeing Boards extending overview and scrutiny.

• Create understanding and focus on the social determinants of health – 80% lies with Child Care, Housing, Education, Urban Planning, Transport, Employment : 20% with NHS access.

• Establish clear strategic frameworks for reducing the health gap rather than over reliance on small scale projects – scale up and intensify action to give a golden tread through all strategies and policies

• Define clear lines of accountability to local partnerships• Focus on place and mainstream spend not the ringfenced public

health monies or the social care transfer budget.(£38bm)• Learn from total place pilots

EVERYONESEES THE

LIIVING WELL AGENDAAS THEIR BUSINESS

Public investment in local communities builds on local

strengths/assets to raise aspiration, build resilience and

release potential

Children get the best start in life

and young people are supported to

become successful adults

All organisations are tackling discrimination,

poverty and social injustice

Environments and communities make it easy for

people to live well

All organisations invest in

extending years of healthy life

lived

‘Living Well’ Statement of direction(NWNHS 2010)