Staffordshire Public Health

Overview of Public Health Changes in the NHS Reform

Start Active, Stay Active Conference

Dr Aliko AhmedDirector of Public Health, Staffordshire

22 February 2012

Public Health

NHS Reforms – New Leadership and Decision Making

Provider

Clinical Commissioning

Groups

NHS commissioning

board

The New Public Health System

1. What we are trying to achieve – and How

2. Who does what

3. Making it happen in Staffordshire

What we are trying to achieve and How

Public Health Overview: Inequalities begin from birth

BabyBorn to a single mum – smokes and drinks. Not educated.

Incomplete immunisation

John will not live to see his first birthday.

John People• Life expectancy

• Disease

• Lifestyle risks

Place• Opportunities

• Chances

• Wellbeing

Charles

Baby Age 10 Age 20 Age 45 Age 60Born to affluent parents –will live 10 years longer than Mark

Enjoying a good life, lots of opportunity to play sport

At university with 10 x A* at GCSE. Plays rugby and eats a healthy diet

Fit and healthy businessman, manages stress by playing squash

Retired early to spend time with his grand-children and travel

Baby Age 10 Age 20 Age 45One of teenage conceptions. Will live 10 years less than Charles

Growing up in poverty

Left school with no qualifications, casual labourer, drinks, smokes and takes drugs

Weighs 18 stone, has high cholesterol, type 2 diabetes

Died from massive stroke

Mark

Age 60

PH Challenges in Staffordshire - NOW

People - proud to live in Staffordshire, but believe public services are “not good”

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Staffordshire Public health Challenges

Source: Health Profiles 2010, Association of Public Health Observatories (APHO), Teenage Pregnancy Unit, Office for National Statistics and National Centre for Health Outcomes Development (NCHOD)

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Smoking Obesity Binge drinking Teenage pregnancy Premature CVD mortality

Public Health – Meaning and Value

"the science and art of preventing disease, promoting health and prolonging life through the organized efforts and informed choices of society

Value – improving health of population and reducing health inequalities

Who is the PH workforce?- PH Roles ~ everyone’s contribution to PH outcomes

- PH Functions ~ areas of PH practice but not necessarily led by DPH

- PH Responsibilities ~ areas of PH practice align with accountability and resources (leadership)

Public health is everyone’s business:

DeathSeveredisease

Early onset of disease

Unhealthy lifestyles

Poor life chances

Unemployment Poor housing Poor Education

Smoking Alcohol/drugs Obesity Crime/disorder

Diabetes Hypertension etc

CHD COPD Heart Failure

Prolonging life and quality of carePreventing ill health

“diseases emerge as part of a process – of sickness, poor lifestyle choices and opportunities including the environment in which humans live and work”

Cancer Excess winter death

“differences in health outcomes are the result of toxic combination of poor social policies & programmes, unfair economic arrangements and bad politics” - Marmot, 2010

Estimated Health Impact of ‘Services’ on Population Health Status

Local government is well placed to change life circumstances & improve health

Source: Canadian Institute for a Advanced Research

Social and economic

environment 50%

Illness care system

25%

Physical environment

10%

Genetic endowment

15%

Public Health Improvement

An individuals life circumstances contribute more to health improvement than health care services

Improving Health and Reducing Inequalities: Fair Society, Healthy Lives (Marmot, 2010)

Birth Death

Health/Wellbeing Disability/Disease

Staffordshire priority outcome:people to live longer, healthier and fulfilling lives

leadership role for local authorities

working alongside the NHS, with its continuing role promoting health through clinical services

stronger focus on health outcomes, supported by the Public Health Outcomes Framework

supported by a new integrated public health service, Public Health England

public health as a clear priority for Government, backed by ring fenced resources

The New Public Health System

new roles and responsibilities

clear priorities

Why is PH moving to LA?

• Population focus– democratically accountable stewards of local

populations’ well being

• Shapers of place– ability to shape services to meet local needs– better citizens insight/engagement

• Influence on social determinants of health– levers for promoting well being ~ conditions of living

(born, grow, live and work) – ability to tackle health inequalities

Who does what

Roles in the new Public Health System

Local Authorities

CCGs/NHS CB

PHE Units

•Duty to improve health•Brings together holistic approach to health and wellbeing

•Employ DPH•Ringfenced PH budget•Mandated services

•Commissioning healthcare•Commissioning some public health services

•Functions in development (inc health protection services)

•Core offer to the NHS, including PH advice on health services

Health and Wellbeing Board

Coordinates local strategy through•JSNA•JSHWS•Review of commissioning plans

Local government’s new public health functions

- New duty to improve the health of the population:

• commissioning services from a range of providers

• working with Clinical Commissioning Groups to integrate care pathways

• using health and wellbeing board to integrate commissioning approaches

• providing population healthcare advice to the NHS

• duty to ensure plans in place to protect health.

- Local political leadership critical to making this work.

PH Commissioning:Direct responsibilities and accountabilities

• Commissioning services• Tobacco Control• Alcohol /drug misuse services • Obesity and community nutrition• Increasing levels of physical activity in the population• NHS Health Check • Public Mental Health Services• Dental Public Health • Injury prevention• Population – birth defects• Behaviour / lifestyle to prevent cancer& longterm conditions• Workplace health• Sexual health • Seasonal mortality• Community safety / social exclusion

Role of the Director of Public Health

• Leadership role within the local authority for the DPH and their team, to exercise these new functions:

• DPH should be the lead officer for health and championing health across the whole of the authority's business

• we expect there to be direct accountability between the director of public health and the local authority chief executive for the exercise of the local authority’s public health responsibilities

• DPH to be accountable to day to day operation of the PH budget

• the DPH should have direct access to elected members

• Produce an annual report

• Statutory member of Health and Wellbeing Board – and engaging across the health and wellbeing system.

PH Outcomes and Accountability Framework

Start Active Stay Active: Recommendations

Under 5s

• Physical activity should be encouraged from birth (floor based play, water based activity)

• 3 hours per day spread throughout the day• Minimise sedentary time (restrained or sitting – unless

sleeping)

5-18 years• From 1 hour to several hours moderate to vigorous spread

throughout the day• Vigorous at least 3 days per week, including activities that

strengthen muscle and bone• Minimise extended periods of sedentary time

19-65 years

• Active every day, at least 2½ hours per week moderate activity, bouts of 10 minutes or more

• Comparable benefit from 75 minutes vigorous activity spread throughout a week

• Exercise to improve muscle strength on at least 2 days each week

• Minimise extended periods of sedentary time

65 and over•Some activity is better than none, more provides greater benefit•Comparable benefit from 75 minutes vigorous activity spread throughout a week•Active every day, at least 2½ hours per week moderate activity, bouts of 10 minutes or more•Exercise to improve muscle strength on at least 2 days each week•If falls risk exercise to improve balance/coordination 2 days each week•Minimise extended periods of sedentary time

• Opportunities for people to be physically active exist in four major areas of an individuals day to day life:

1. At work, e.g. if a job involves manual labour.

2. For transport, e.g. walking or cycling to school, work or the shops.

3. In domestic duties at home, e.g. housework, DIY or gardening.

4. In leisure time, e.g. sports, exercise or recreational activities.

Working activity into daily life

Effective action – Staffordshire 1

Cycling towns

Workplace

Community

Primary CarePrimary care professionals can influence through regular assessment and advice/referral. They can promote activity and signpost to support services.

Investing in infrastructure and bike policies can increase cycling.

Employer’s policies, showers and facilities for cyclists and walkers.

Investments in parks, playgrounds, walking clubs, conservation schemes, support for sports clubs to improve facilities

Public/Staff willingness

Alternative space (Park and Ride Scheme) - DCs

Safe routes (cycle paths) - SCC

Effective action – Staffordshire 2

Cycling

“Real difficulties/challenges can be overcome, it is only the imaginary ones

that are unconquerable”

~Theodore N. Vail

Thank You