jim mcmanus
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Jim McManusJoint Director of Public Health
Birmingham City Council
Prevent, Enable, Personalise, Realise some tentative experience from Birmingham
COSLA Annual Conference 2012
Jim McManus
Joint Director of Public Health
Birmingham City Council16th February 2012
Delivering Success:
Public Service Reform – Big Tasks
1. Localism Act
2. Elected Mayors??? Errr...
3. NHS Reforms – public health, clinical commissioning groups, NHS Commissioning Board, Health and Wellbeing Boards
4. Police and Crime Commissioners
5. Open Public Services White Paper
6. Spending Review
7. Social Care Funding
Big Asks
• Do better with a lot less• And by the way your population is still getting older, needier and
growing• And you will have a 25% increase in dementia• And immigration will bring costly TB and CVD• Oh, and you’ll have more folk with learning disabilities• And they all have to have personal budgets
The basic message – complex relationships, big tasks
Life circumstances
Good outcome
Bad outcome
Behaviours
The arrows include public services and access
The basic message – interventions = big asks
Life circumstances
Good Health
Ill Health
Behaviours
Birmingham ChangePrevent, Enable, Personalise, Realise
• Major Change – reducing buildings, reducing costs, outsourcing, mutuals
• New single contract (50,000 people)
• New operating model for children – universal, targeted, special and complex
• New Operating Model for adult social care – prevent, enable, personalise
• Benefits realisation• Radical new ways of doing
things
New Ways of Working
• Not just rely upon commissioning• Working with wide range of civil society partners• Shared leadership of Health and Well-Being Board• Support from HealthWatch• Using new powers and new resources to create healthier communities
The Big Ask: What success looks like...
£37million
Range of targeted/ Flexible Services
Support to service user /Citizens
Number of those receiving
preventive services
Prediction and Prevention
Self management
Supported to stay in their Home
Customer Satisfaction
Increased Improved flexibility
Increased
Increased through joint interventions
Increased through community resources
People supported to manage LTC
Why does service change matter?
Life Expectancy against Core Cities
Male Female
England 78.3 82.3
Sheffield 77.8 81.5
Leeds 77.7 82.0
Bristol 77.2 81.9
Birmingham 76.4 81.3
Newcastle 76.2 81.0
Nottingham 75.2 80.3
Liverpool 74.5 79.2
Manchester 74.0 79.1
4th out of 8 Male5th out of 8 female
Life Expectancy by Ward
Gaps in school readiness at 3 and 5 years by family income: UK
Ave
rage
per
cent
ile s
core
Waldfogel & Washbrook 2008
National Audit Office 2010not on course!
And what has got us there? Barriers to reform
• Focus, or lack of it• Starting with a promising intervention, then making sure it is doomed to
fail by tinkering about• Scientific Grounding and Understanding of Need (or lack thereof)• Partnerships – obsessed with structure and governance• Poor integration of joint commissioning• Cultures...Aaarrrghhh!!!!!• Deficit – We know more than you
Not getting value of
Intelligence in achieving Better Outcomes...
Does anyone actuallyReally do all this?
What did we achieve?
Keeping on Track
Prioritisation
Best Buys/Best Dos
Need
Writ across all Programmes
1. Telecare £14 million
2. Intelligence and Information Programme
3. Predicting need in social care
4. Data sharing with GPs
5. Diverting people from social care and hospital
6. Targeting young people to reduce risk
7. Worklessness
8. Decent Housing
9. Preventing Extremism
10. Enablement
11. Public Health Transition
Critical Success Criteria – Fire Service
• Falls Assessment• Telecare Assessment• JSNA and data sharing• Population density of fire and need• Sharing populations• Well constructed outcomes based agreements
Health and Care: Our Burdens of Disease mean Prevention is wrong way round
Primary Secondary Tertiary
The Big Ask: What success looks like...
£37million
Range of targeted/ Flexible Services
Support to service user /Citizens
Number of those receiving
preventive services
Prediction and Prevention
Self management
Supported to stay in their Home
Customer Satisfaction
Increased Improved flexibility
Increased
Increased through joint interventions
Increased through community resources
People supported to manage LTC
Whole System plus focused action
The example of health inequalities
The Conceptual FrameworkReduce 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
The Golden Thread
Need, Outcomes Priorities, Interventions
Health Inequalities : What we know
• Edinburgh World Congress of Epidemiology 2011• Non Communicable Diseases• Impoverished understanding of behavioural sciences in some public
health programmes• Multiple Tracks. Public policy action in all of them
Policy History...Zzzzz
• Black Report 1982 (UK)• Ottawa Charter 1986 (World)• Health of the Nation 1984 (England & Wales)• Our Healthier Nation 1998 (England & Wales)• Healthier Wales 2000 (Wales)• Choosing Health 2005 (England)• WHO Commission on Social Determinants 2009• Marmot Review of Health Inequalities 2010
2008
2007
The upshot of all this is that whatever framework you use.....
It’s the same problem!
The Big Tasks
• Short term challenge of tertiary prevention• Medium term problem of keeping the ill well• Short term problem of stopping avoidable events• Long term problem of changing determinants of health, health
expectations, behaviour and culture
The Big Tasks
The Ask
• Short term challenge of tertiary prevention
• Medium term problem of keeping the ill well
• Short term problem of stopping avoidable events
• Long term problem of changing determinants of health, health expectations, behaviour and culture
Who
• Social Care, NHS, Housing
• NHS, Social Care, Housing, Leisure
• NHS, Leisure
• Local government par excellence
Birmingham’s use of Marmot
Activities Framework
• 1. Adopt the Outcomes
• Starting well
• Developing well
• Living well
• Working well
• Ageing well
• 2. Add an outcome “dying well”
• 3.Cut our JSNA and Strategy across the Lifespan
• 4. Use as “golden thread”
• For Health Inequalities Action
• For JSNA
• For Health and Wellbeing Strategy
• For Integration
• As a lifecourse approach to human ecology
Examples of Marmot in practice
LGBT MENTAL HEALTH PREVENTION
• Lifecourse approach using Marmot
• Early development• Mental health problems onset• Tasks for each lifestage• Community and Public Sector
tasks• Interdependencies
• Use of Marmot Framework across lifecourse
• Tasks for adult social care and older adult social care elucidated
• Incorporation into third sector contracts with third sector
• Preventive workstream
ExamplesStart Well Develop Well Age Well
Adults & Communities
High priority parents in touch with A & C
Transition Older Peoples’ offer from prevention to very high need
Homes & Neighbourhoods
Overcrowding and infant mortality
Decent Homes Standard Access, Trips, Falls, Extreme Weather, Adaptability,
Development Back to work packagesDigital inclusion
Back to work packages for parentsDigital Inclusion
Volunteering and work packagesDigital Inclusion
NHS Infant MortalityConception
Frail Elderly
Demonstrated
• The role of public health sciences in public service can be significant
• The role of behavioural sciences in public service reform can be significant
• Public health disciplines can be applied across public service reform
Thank You!Jim.mcmanus@birmingham.gov.uk
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