Public Health and Ageing Well - what will “good” look like?

Liam Hughes, National Adviser for Healthy Communities

16/12/2010

Public Health and Ageing Well – what will “good” look like?

• The new context

• Public health is coming home!

• Why should councils take it on?

• What will “good” look like?

• Public health and ageing well

• Six things that councils can do to help

• Health, democracy and civil society

The new context• Fiscal pressure and reduced public

expenditure • The Coalition Programme• Rebalancing state, business and civil society• Service transformation, productivity and

efficiency • Sector-led improvement and the LGG offer• Localism and democratic pressure on

performance

The White Papers, Command Paper and Outcome Frameworks….

The Health White Paper

• Patients and Carers (Health Watch)• Standards (CQC and NICE)• Managing the market (Monitor)• “Any Willing Provider”• The NHS Commissioning Board• GP Commissioning Consortia• Health and Wellbeing Boards• Public Health England and Local Public Health

The LGA View

• Huge potential – public health has come home!• Not local enough! Not soon enough!• Not enough cash! Too many hands on the money!• Opposition to ring-fenced and reward monies!• Transferring the PH staff - councils should choose!• Influencing GP-Consortia- via the NHS C. Board?• Overview and Scrutiny!!! –a misunderstanding!!!

“Public health is coming home to local councils!”

• Not the same public health!

• Not the same councils!

• Not the same public!

• Not all parts of public health will return!

• Some parts never left!

Public health is coming home, but what is public health?

• What do you think it is?

• How well do you know your DPH and the team?

• What do you know about their education and training?

• Have you talked to them about older people and active ageing?

Public Health is contested territory!

• Tackling the wider determinants of health• Promoting health supporting behaviours• Securing improvements in health services• Protecting the health of the population• Regulation, education, social marketing, community

health development, “nudge” and “push”!• System, scale and energy – large scale change!• The links with wider social and economic conditions

– fairness and inequalities.

Why should local councils take it on?

• The new statutory duty – a legal obligation

• The moral argument – health inequalities are unfair

• The business case – it is a good investment

• The argument from community leadership

- people, places and local democracy

- the life course approach

Health improvement and health inequalities – what do you think?

- “The health of the population is getting better!”- “Health inequalities are not reducing and may soon

widen further!”. - “The focus over the last decade has been on

“tackling the tail” – the places where health risks are greatest – and progress has been limited!”

- “Poor health can be found everywhere – health inequalities are at their widest in more affluent areas”

- “Levelling the health gradient would produce better health for everyone!”

Improving health, not reducing health inequalities – still a long way to go!

What will “good” look like?

• Telling the story of local health and wellbeing (the JSNA – deficits and assets)• Leadership and vision (the Health and Wellbeing Strategy)• Whole council, whole system approach (Total Place and Community Budgeting)• Partnerships for better outcomes (Health and Wellbeing Boards)• Quality, Improvement, Productivity, Partnership (Accelerating the QIPP)

Health and Wellbeing Boards - the key to success

• Strategic and inclusive partnerships

• Providing the local “adhesive” for local improvements in health and wellbeing

• Knowing the local community (JSNAs)

• Closer integration of children`s services, adult social care and public health

• Participation of GP-Consortia

• Districts and boroughs?

Six things councils can do to support health improvement and the reduction in health inequalities

1)Support the wider determinants of health

2)Help change behaviours

3)Work to integrate health and social care

4)Make use of Overview and Scrutiny

5)Build up local resilience – the health protection system

6)Strengthen civil society

The Marmot Report on Health Inequalities

• The wider determinants of health – this is what councils do!

• “Social Justice with Evidence!”

• The life-course approach

• Handling transitions

• Rather thin on ageing well

• Staying active and engaged beyond 50!

Helping people change their behaviours

Councils already do this:

• Regulation and enforcement

• Health education and health promotion

• Social marketing

• Community health development

• “Nudge” and “push”

What does it mean for older people?

• Knowing the local community - does the JSNA demonstrate that it is well informed about older people, their needs, aspirations and resources ?

• Strategy: do the Health and Wellbeing Board and the Health and Wellbeing Plan show that they are tackling the agenda for active ageing?

• Is there a whole council, whole systems approach?• Is there action on all six steps together? • Is there a local grip on the Outcomes Frameworks

and QIPP?

Good investments for local councils

• “Pensions protect health!” – council staff and SMEs

• “Walking and talking your way to health!”

• “Keeping warm, keeping cool!”

• “Starting early, but it is never too late to change!”.

Some risks?

• The “cloak of invisibility” surrounding old age

• Older people are more than their deficits – building on the assets that people bring!

• Intergenerational ignorance and tension

• The infrastructure of support is fragile

• Lack of trust and cultural differences between GPs and Councillors

Partnerships depend on Trust

Some issues

• What will local councils look like in five years time and what will council-led PH look like?

• Central/local tensions?

• The Health and Wellbeing platform carries a heavy load

• Public health staff are right in the middle!

• The “Harry Potter” effect!

Health, democracy and civil society

• Community leadership in hard times – putting democracy back into health

• The debate about the Big Society and the Good Society

• HealthWatch and Scrutiny

• “Co-design and co-production”

• “Innovation out of adversity” – the silver lining?

Making the jigsaw fit at local level:what help is available?

The Offer from the Local Government Group

• Supporting sector–led improvement

• Community-based budgeting

• Productivity and efficiency

• Transformation and new organisational forms

• Healthy Communities, Ageing Well, Social Care, Third Sector, Culture and Sport…

Sector-led improvement

The cycle of sector-led improvement support and challenge

Self assessment

Peer review & challenge/external

validation

Sector-led improvement support offer

Brokerage arrangements

Monitoring/ongoing self assessment

Decisions on what, if any,

support needed

Continuous improvement

CQC inspection

Improvement made? Peer review/external

challenge

Yes

LA has capacity to

improve

LA does not have capacity

to improve

No

Intervention

Improvement support might be commissioned from within the LA sector, community/voluntary or

private sectors

Significant failure identified? YesNo

Tripartite decisions on improvement needs –

Government, sector and LA

LA commissions improvement

support

The Local Government Group

• The LGA• Local Government Employers• Local Government Regulation• Local Partners• Local Government Improvement and

Development • Centre for Public Scrutiny

The Healthy Communities Programme

• Funded by DH to autumn 2011• Endorsed by the LGA• Building capacity for health improvement in local

government• Focusing on health inequalities• New workstreams: - Health and Wellbeing Boards - JSNAs - GP Consortia and LAs

The Healthy Community Programme

• Leadership and Partnership• Local Councils and GP Consortia• Partnerships• Health and Wellbeing Boards• JSNAs – Telling the Local Story• Overview and Scrutiny – the Centre for Public Scrutiny• Community Engagement and Community Asset-Mapping• Workforce Health• The Business Case for Improving Health• Knowledge Website and Communities of Practice

Contacts

Healthy Communities Team at LGID

(“funded by DH to help councils tackle health inequalities”)

healthy.communities@local.gov.uk

Liam Hughes (Msc,MEd,MBA),

National Adviser, Healthy Communities

liam.hughes@local.gov.uk