broxbourne scrutiny public health update april 2017

www.hertsdirect.org

Public Health Update and next steps11th April 2017

Prof Jim McManus, Director of Public Health,

Hertfordshire County Council

[email protected]

Scrutiny Committee, Broxbourne Borough Council

www.hertfordshire.gov.uk

A word of thanks

• I wont cover the significant work going on locally led by Broxbourne members and Officers, I’m assuming you’re aware of this

• But I do want to say a heartfelt thank you for what you do


Some of what HCC PH do for Hertfordshire • 142 workstreams ranging from health protection to

health improvement

• 40 staff on commissioning and technical/specialist side

• £50m budget reducing to £46

• 35,000 hours of school nursing a year

• 8000 hours of health visiting a week

• 60,000 people using sexual health services

• 15,000 children weight measured every year

• 96% of children get hearing and eye screening

• Immunising children and young people


Layers of what we do

CommissioningProvided by NHS, Schools, Third Sector, GPs, Private SectorLargest HealthWalks programme in UK

Drugs and Alcohol, Sexual Health, Child Measurement, School Nursing, Health Visiting, Health Improvement, Preventive Work, Contraception, Smoking Cessation, HIV Testing

Assurance, Safeguarding•HCV Infected healthcare worker•Rare disease outbreaks•TB Control Board•Infection control in care and nursing homes•Child Death Overview Panel•Health Visitors and MASH

Cancer ScreeningMentally Disordered OffendersDiabetes ScreeningVaccinations, ImmunisationsHealth Protection,NHS Resilience, novel diseases

Advice Licensing, Pathways for CareScientific Issues NHS Spend and Commissioning

“System Leadership” JSNA, PNA, Specific ReviewsCAMHS ReviewStrategic Prevention Workstream

Partnerships. PH Board Partnership with Districts and other key partners


Some current projects

• JSNA

• Get Active

• Mental Health

• Suicide and Self Harm

• One You

• Service redesign

• Safe and Well checks

• National Diabetes Prevention Programme

• Physical Activity and Health


Big Strategic Issues for us all

• Sport Strategy

• NHS STP

• Strategic Shift to Prevention

• Finances

• Demographic Growth in Demand

• Continuing Health Challenges

• Air Quality


Recent Wins

• Smoking prevalence reducing in most areas

• 2 Social enterprises getting people off drugs and into employment

• 650 workplace mental health advocates

• Suicide rate reducing and one of lowest in England

• Infection control in care homes

• 85% of injecting drug users protected against Hepatitis B

• HIV late diagnosis going down for five years (slowly)

• Mental Health Champions


Recent Wins

• Year of Mental Health

• Air Quality Equipment funded by PH

• £0.4m spent on making leisure services disabled accessible

• CAMHS Review and £2m CAMHS investment from DH

• £160k from DoE for School Mental Health

• £2.5m from Sport England across County

• New, effective Health Improvement interventions

• Reducing suicides


Health Protection

• A multi agency Health Protection Committee comprising Districts, Boroughs, County and Public Health England meets.

• partnership working across the local government family


The problems• Early and avoidable disability and disease

• Early avoidable death

• Smoking prevalence uneven

• Obesity rising in adults, flattening in children in most places, rising in some

• Alcohol related disease on the increase

• Preventable cost to public health

• Multiple needs, worklessnessThe Tartan Rug and local profiles give much more info on this

[email protected]


History and Funding• 2012 – PCT total Child Obesity budget £20,000 (yes £20k) (not

including NCMP); 2013 healthy weight into Health and Wellbeing Strategy

• 2015• Child Healthy Weight – £499k (Excluding NCMP)

• Beat the Streets £100k

• School Nurses £4.02m

• PH funding to School Catering £100k

• Full time nutritionist in School Catering £60k

• Cycling Training and Support in Schools £60k

• Planning and Environment workstreams

• Major physical activity programmes

• Disabled Access to physical Activity £250k

• Two district councils with major focus on Child Obesity and Stevenage

• Share of £1m District Council Partnership Funding


Adult weight management schemes

• 10,359 residents referred to the programme so far: • free access to one course• for people who are obese

• Evaluation: (5,000+ people)• 62% completed the 12 week

programme – above national standards

• ⅔ completers lose 5%+ of body weight – a significant benefit to their health


Men’s Weight Management • “Shape Up” with Watford FC

– Male focused, to increase uptake, following evidence

– Good results – • 3361 donuts “lost” by first cohort

• 206 men started, ¾ complete

• Half of completers benefit significantly

– Potential for external funding


Public Health

• £54m budget reducing to £46m

• Growing need

– Demographic pressures sexual health

• Burden of avoidable ill health growing

• Burden of avoidable disability growing


Strategic Challenges

1. Delivering core public health must dos for less

2. Service Redesign (Children)

3. Preventing cost and adverse outcome (Falls going up in some areas)

4. Levering whole system redesign and prevention using everyone’s resources to save money and improve outcomes

5. Using PH skills within this to best advantage for the system

6. Using PH budget within this to best advantage for the system


Strategic Priorities

• Shift to prevention by everyone esp primary and secondary care

• Physical activity as part of this

• Mental health and resilience – social prescribing

• Redesign mandated services to cost less but but keep outcomes

• Better outcomes through integration?


Future School Nurse Service (ONE part of our offer)


One You

• One You aims to help people recognise that they have the power to change and provides them with practical advice to make it easier to do so.

• As part of the campaign, people are being encouraged to take an online quiz to see how healthy they are: www.hertsdirect.org/oneyou


One You Day 7 July

• The way in which you can contribute is entirely up to you, but could include:

• promoting the campaign visually with posters and leaflets

• If you require more information or would like to request some materials please contact Gemma McKelvey in comms [email protected] or 01992 555567 (25567)


What is Prevention?

• The avoidance, whether permanent or temporary, of need for public service or an adverse event/hazard or exposure leading to need for public service

– SHORT TERM (eg up to 24 months)– MEDIUM TERM (eg 2-5years)– LONGER TERM (eg 5 years plus)

• Prevention is NOT rationing or restricting eligibility

© Copyright, 2017 Hertfordshire County Council Public Health


Levels of Prevention• three levels. Preventative activities may be delivered by any

agency.

• Primary Prevention – ‘prevent’ or stop harm or need for service arising in first place – physical activity, recycling

• Secondary Prevention – ‘reverse’ harm or need for service – rehabilitation

• Tertiary Prevention – ‘reduce’ or mitigate harm/need for service – an Anti Social Behaviour Order? A wheelchair for a diabetic foot amputation

© Copyright, 2017 Hertfordshire County Council Public Health


Prevention Pyramid – Adults(with thanks to Jeanelle de Gruchy, DPH Haringey)


Prevention Pyramid – Children(with thanks to Jeanelle de Gruchy, DPH Haringey)


Mainstreaming Prevention

Herts & West Essex Governance Structure v4

Healthier Population

needing fewer specialist

resources


Prioritising Prevention – the Decision Cycle

What population?

What issue/need?

What outcomes do we want?

Which interventions fit

best?

How do we know it’s working?(Evaluation)

1. Service cost and demand

2. Needs (JSNA)

Define the outcomes clearly so you can really assess

feasibility

1. Financial Assessment2. Evidence Assessment

3. Logic mode where evidence silent

1. Financial Assessment2. Outcome Assessment

Questions to ask Tools for HCC


Mainstreaming Prevention

Herts & West Essex Governance Structure v4

Healthier Population

needing fewer specialist

resources


Developing Work

• Herts, Haringey, Sheffield and Kirlees forming a “prevention led council” learning set

• ADPH and LGA working on a national narrative for prevention


Levels of Prevention

• three levels. Preventative activities may be delivered by any agency.

• Primary Prevention – ‘prevent’ or stop harm or need for service arising in first place

• Secondary Prevention – ‘reverse’ harm or need for service

• Tertiary Prevention – ‘reduce’ or mitigate harm/need for service


Reducing the need and spend curve: Preventing avoidable spend in public service

Volume of spend

Severity

Existing curve

The Achievable curve?

Reduce or delay need here

Highest cost. Reduce and delayNeed here

Intervene here before needescalates


HCC Strategy for prevention

• Identify those areas which will generate best returns (demand management or activity reduction) first and work on them

• Assess if this is primary, secondary or tertiary using the decision cycle

• Assess feasibility

• Implement

• Provide a basis for decisions for investment or disinvestment


Prioritising Prevention – the Decision Cycle

What population?

What issue/need?

What outcomes do we want?

Which interventions fit

best?

How do we know it’s working?(Evaluation)

1. Service cost and demand

2. Needs (JSNA)

Define the outcomes clearly so you can really assess

feasibility

1. Financial Assessment2. Evidence Assessment

3. Logic mode where evidence silent

1. Financial Assessment2. Outcome Assessment

Questions to ask Tools for HCC

broxbourne scrutiny public health update april 2017

Health & Medicine