Growth and Reform

The Public’s Health in Greater Manchester

Lesley JonesDirector of Public Health for Bury Council

The Public’s Health - Greater Manchester Opportunities

• Directors of Public Health want to use the opportunities presented by transition to work together and rethink improving the public’s health, to focus on the outcomes most important to Greater Manchester

• New opportunities for system change, building on longstanding tradition of collaborative working in Greater Manchester

• Establish a credible Sector-Led Improvement approach to secure improved Public Health outcomes.

• Review of GM public health activities post transition - alignment with Greater Manchester Strategy and Public Service Reform (PSR)

• Leadership of the Public Health system by Directors of Public Health with Public Health England.

• Recognition that commissioning responsibilities sit across the health system – so partnerships are key.

Public Health Commissioning from 1st April 2013National 1. NHS Commissioning Board10 Commissioning: specialist NHS services, including some mental health and acute care

within managed networks; screening; child public health for under-fives, including the Healthy Child Programme and health visitors (until 2015 when this responsibility will move to local authorities); immunisation, core pharmacy and primary ophthalmic services; and antenatal and newborn screening aspects of maternity services. Some of these functions may be commissioned sub-nationally.

Public Health England Greater Manchester Centre

Responsible for national public health campaigns and health protection nationally and locally and will host specialist expertise such as dental public health.

Sub-national/ regional

Local area teams of the NHS Commissioning Board

Commissioning primary care, including the GP contract. This includes mental health within the GP contract.

Greater Manchester Directors of Public Health Group/ Association of CCGs

May work together to increase the effectiveness of commissioning of public health and health services for key groups over a larger geographical area, such as looked-after children and disabled children.

Local Clinical commissioning groups Commissioning local child and adolescent mental healthcare (CAMHs), physical healthcare and maternity services. CCGs will commission urgent and emergency care.

Local authorities Commissioning child public health services, including the Healthy Child Programme for five to 18 year-olds, school nurses and the majority of other public health services, including: dental public health; tobacco, alcohol and drugs; public mental health; accidental injury prevention; and sexual health services. Local authorities will take over commissioning child public health for under-fives, including the Healthy Child Programme and health visitors, from 2015 onwards.

Schools Commissioning public health initiatives, such as mental wellbeing, key elements relating to special educational needs, and other school initiatives that local authorities do not commission.

Police and crime Commissioning drugs, alcohol and youth justice services.

Public Service Reform

Sector-Led Improvement

Strategic Framework

for the Public’s Health

GM knowledge used to change policy and

influence: Government

PHEDept. for Work and

PensionsDept. of Health

Improved outcomes Better use of resources

Protecting the Public’s Health

System change

Public Service Reform – Greater Manchester Opportunities

•Ambition is sustainable economic growth, where all residents contribute to and benefit from sustained prosperity. This is set out in the GMS and our Growth and Reform Plan.•GM PSR Programme is central to the delivery of this vision. Generating growth and jobs will not be sufficient to close the gap between tax and public spending.•Increasing independence and enabling people and their families to take advantage of economic growth across the wider city region.•The Autumn Statement has re-affirmed GM ambition: Multi-year budgets, Growth and Reform Deals. Propositions about sharing risk and reward, and new models of accountability

• Work for Health• New Early Years model – Public Health

nursing / health visitors/ Family Nurse Partnership

• Risk stratification - older people at risk of entering residential care- Individuals falling out of work due to ill health

• Direct support to Working Well (WPL)• GM IGMA Chapter and Mental Health

and Wellbeing Baseline Data• Developing community assets and

individual resilience• Strategic Framework for the Public’s

Health• Risk and reward – conversations with

PHE & Treasury on FNP

Growth and Reform Public Health

PATHFINDERS UPSCALING EVIDENCE-BASED INTERVENTION

INNOVATION PROTECTING THE PUBLIC’S HEALTH

Public Service Reform - Work for Health• A programme to enable system change within health services to

integrate work as part of a treatment plan• Piloted in 3 pathfinder sites: Stanley Road in Oldham, Farnworth

in Bolton and Worsley Mesnes in Wigan• Insight into the factors that influence health professionals and

individuals attitudes about working with a health condition• Social marketing activity - conversation between health

professionals and communities around work and health

Public Service Reform - Alcohol recovery from employment

• Individuals with alcohol dependency have difficulty sustaining employment

• Innovative use of technology / text messaging to maintain support and prevent relapse

• Data sharing protocol with the Working Well programme to allow monitoring of referrals including substance misuse treatment starts, waiting times and treatment outcomes

• Alcohol identified as key issue through Troubled Families PSR workstream

• Councils now have considerable power to influence decisions made on alcohol licensing, but the process can be difficult and resource intensive

• Evidence suggests that limiting availability through times of sale and outlet density can have a positive impact on levels of harm particularly violence and disorder

• Public Health England is working with partners across GM to produce a toolkit to support councils in being more active in their action on alcohol control through licensing, through improved intelligence, promoting a more consistent approach that leads to better enforcement

 

Public Service Reform - Greater Manchester Alcohol Strategy

Source: McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff(Millwood) 2002;21(2):78-93 cited We Can Do Better — Improving the Health of the American People Steven A. Schroeder, M.D.

The Public's Health - A Greater Manchester Strategic Framework

• GM ambitions to keep people in good health and reduce the impact of health conditions on their ability to fully participate in creating economic and social wellbeing

• 60% of early deaths can be prevented by thinking beyond traditional healthcare activities?

The Public's Health - A Greater Manchester Strategic Framework

•Strategic approach working across all sectors.

•The public’s health is the responsibility of all agencies and not solely the remit of one.

•Changing everyday practice to embed actions across the public sector needed to sustain and improve the public’s health.

Priority areas identified for action

1.Children and young people

2.Environment

3.Work, skills and income

4.Primary care

5.Mental wellbeing

6.Resilience – community and individual

• Areas of activity where potential to minimise risks to health and secure health improvement is the greatest for each priority area.

• Identification of areas where the scale of change requires reprioritising of current resources or changes to the way that services are commissioned.

• Demonstrate how lower cost early intervention activities are a serious alternative to expensive, sometimes ineffective later interventions and how this will reduce current and future cost pressures.

The Public's Health - A Greater Manchester Strategic Framework

Work, Skills and Income Greater Manchester Intelligence IGMA Public Health Chapter (Productive and Active Residents)

HIA Welfare Reform Bill (DWP) WPL Analysis and CBA Fit For Work Evaluation (University of Liverpool) Work for Health Insight – GPs and Allied Health Professionals Fuel Poverty Geographic Mapping

Local and National Policy Context Public Sector Reform, Troubled Families, Work and Skills, Complex Dependency GM Fuel Poverty Strategic Framework GM Work for Health (including Workplace Ageing Strategy and Recovery for Employment projects) JRF Longitudinal Study of Low Pay No Pay Cohort Childhood Poverty Reduction Strategies (various national documents on in work progression) GM Poverty Commission Financial Exclusion, Health and Employment (Glasgow City Council, Insight Collective and the Scottish

Government) Evaluation of CAB Provision in Primary Care (University of Sheffield CESR) Welfare Reform Bill/ Universal Credit – various impact assessments (i.e. Young Foundation Bedroom Tax

mapping 2012)Greater Manchester - Collaboration Opportunities

This should set out the contribution of the PHS to tackling worklessness and unemployment, with clear links to the GMS.

Actions in this area should focus around keeping people in work, stopping people falling out of work and helping them get back into work. The principle of “Good Work “ needs to be embedded in practices in this area.

The PHS should help facilitate better engagement between health providers and work programme providers.

Further work is required to promote better understanding of the link between unemployment and health conditions type of job and recognition that the type of work that some people can do is affected by their health.

High Level OutcomesWhat we will seek to achieve by working together and how we will measure success

Collaborative ActionsA small number of actions that (a) Have evidence on impact on the strategic outcomes (b) can be delivered at scale

Strategic PrioritiesThe high level changes required at Greater Manchester level to achieve the outcomes

Next steps for the Public’s Health

• Publication of the Greater Manchester Strategic Framework for the Public’s Health – November 2014

• Transition of 0-5 years Public Health services – October 2015

• Development of Greater Manchester Alcohol Strategy

• Ongoing review of alignment with Greater Manchester Strategy and PSR