Wigan: Healthy Lives, Healthy People

Dr. Kate Ardern MBChB MSc FFPHExecutive Director of Public Health for the Borough of Wigan

Strategic Drivers: Marmot ReviewStrategic Drivers: Marmot Review

The recent Marmot Review The recent Marmot Review Fair Society, Healthy LivesFair Society, Healthy Lives (DH, 2010) identifies 6 key policy areas to (DH, 2010) identifies 6 key policy areas to tackle Health Inequalities and the priority actions: tackle Health Inequalities and the priority actions: 

• Give every child the best start in lifeGive every child the best start in life

• Enable all children, young people and adults to maximise their capabilities and have control Enable all children, young people and adults to maximise their capabilities and have control over their livesover their lives

• Create fair employment and good work for allCreate fair employment and good work for all

• Ensure healthy standard of living for allEnsure healthy standard of living for all

• Create and develop healthy and sustainable places and communitiesCreate and develop healthy and sustainable places and communities

• Strengthen the role and impact of ill health preventionStrengthen the role and impact of ill health prevention

Cabinet Public Health sub-Committee

SoS

CLGDH

NHS Commissioning Board Public Health Service

NHS Healthcare System

Specialist & National care

Secondary & Tertiary Care

Primary & Community Care

Health & Wellbeing Board

Top Tier Local Authority

Responsibility for Health of Local Population

DPH

GP Commissioning

Public Health System

Health Improvement

Protection & Resilience

Prevention of ill health

Local Authority System

Social Care

Housing/Transport

Education

Economy

Third Sector

Big Society

Police/Fire

Public Health System

Wigan Health & Well-Being Board

• Wigan is in the cohort of ‘early implementers’ – aim is to transform the health and social care system with the LA and PBC working together as mutually respecting partners

• Local Authorities will take on the role of joining up the commissioning of local NHS services, social care and health improvement and will promote integration and partnership working

• Multi sector stakeholder event held on 2 March 2011 to ‘start the journey’

• Aim to have ‘shadow’ Board from April 2011

• Organisational development support is needed to capture key learning

Wigan partnership Health and Well- Being Priorities (6 Outcomes)

Health and Well - Being Board

Health and well-being services

Local Authority & Partners NHS

Social care (children and adults,Third sector Housing, transport, Big Society Leisure, Education, Partnerships, Economy, Social enterprises

Primary & Community

care

Secondary & Tertiary

care

Specialist & National

care

General population

Low level advice

& support

Support at home

Institutional care

Acute care

People choosing less dependent more cost-effective options

Increasing demand on services

NHS “flat cash” funding

£100 m gap in

funding

To foster the best possible health and well being

for every person in Wigan

Help lo

cal p

eople

take

resp

onsib

ility

for t

heir

healt

h

Target

resources

correctly Reach out a

cross

partnersh

ips

Harness local

knowledge , skills

and leadership

Peop

le

cent

red

Respect contributions & perspectives

Openness,

honesty,

integrity

Ownership & accountability

Best

quali

ty &

in

nova

tion

Co-

production

Incr

ease

aut

onom

y &

perc

eptio

n

Improve

accessibility of

services to support

independence

Reduce deaths & disability due to CVD & cancer

Redu

ce so

cial

exclu

sion

Care closer to home

Safeguarding, dignity & respectRaising and exceeding

public expectations of health and

well-being

To invest in a balanced

economy to focus on wellness

determinants of health and high quality health and social care

Stretching our ambition

and performance

to achieve world class

public health

Innovating and implementing

best practice to achieve best performance

against national

standards

Evidence, knowledge and skills

Productivity and evaluation

H&WBB

Beliefs Values Outcomes

Demand ManagementSystem RedesignStimulating the MarketOptimising the role of the Voluntary and Independent sectorsCommissioning of Health Improvement Services and ProgrammesService re-design to fully incorporate preventative interventionsPublic Health capacity and capability building

Locality workingOptimising the role of the Voluntary and Independent sectors

Develop the assets based approach to community empowerment

Building social capital

Developing co-productionPublic Health capacity and capability building – community health advocates

Public Health Annual Report

PH expert adviceAssurance that commissioning plans incorporate best quality & governance practice Assurance that CQUIN schedules reflect local & national priorities for health improvement, health protection & reducing health inequalities

Develop & implement a Joint Health & Well-being Strategy.

Influencing the wider determinants of health

Building the PH capacity of the wider workforce

Health promoting settings

Corporate social responsibilitySocial Impact Bonds

Screening Programme co-ordination

Environmental public health Communicable and Infectious Disease ControlImmunisation and VaccinationSafeguardingPH resilience and response to incidents and disasters

Research & DevelopmentJoint Strategic needs & Assets AssessmentEvaluation of services and programmesHealth Impact AssessmentHealth Equity AuditsIntegrating critically appraised evidence into programmes & servicesHealth Surveillance and AssessmentHealth Profiling

HEALTH AND WELL-BEING PROGRAMMES FOR CHANGE

Unleashing the Talents of Local People

System Reform

Achieving Best Quality

Health &Well-being Policy

Health Protection

Knowledge Management

HWBB Launch Event Feedback

• Liked the 'Big Conversation' style of event - want a follow up and soon!• High participation on the day and positive - even though the current economic

climate, public sector cuts are challenging. Talked openly about the 'tough stuff' and impacts.

• Participants want public representation/input into H&WBB - beyond a 'token rep from HealthWatch'

• A process for gathering public views needs to be formed that feeds into H&WBB and Commissioning priorities and that cuts across LA, PBC, Voluntary and Community Sectors

• Want to know about level of scrutiny and how this will work - educational opportunities here

• Creation of a Networked Board - want a diagram of where H&WBB sits• 'Root and branch' review of existing groups, terms of reference and how they

will fit with H&WBB• Communication plan needed for ongoing involvement of stakeholders and

influencing of key H&WB priorities

• Community engagement needs to move beyond consultation into empowerment, which will involve Community engagement needs to move beyond consultation into empowerment, which will involve the transfer of power and resources to communities themselvesthe transfer of power and resources to communities themselves

• Work towards integration of primary and community care services with statutory, voluntary and Work towards integration of primary and community care services with statutory, voluntary and independent sector neighbourhood services, providing a more holistic user-centred focus.independent sector neighbourhood services, providing a more holistic user-centred focus.

• Public health commissioning mechanisms to drive development of health improvement skills, Public health commissioning mechanisms to drive development of health improvement skills, resilience and leadership within local populations, making the concept of co-production of health resilience and leadership within local populations, making the concept of co-production of health between services and communities a realitybetween services and communities a reality

• Making strengthening the core economy of neighbourhood and family the central task of all public Making strengthening the core economy of neighbourhood and family the central task of all public servicesservices

• Using the power of Public Health Commissioning, locally coordinated eg through H & WBBs, to Using the power of Public Health Commissioning, locally coordinated eg through H & WBBs, to explore new models of integrated delivery. For example, develop forms of community-oriented primary explore new models of integrated delivery. For example, develop forms of community-oriented primary care appropriate to underserved communities with poor health outcomescare appropriate to underserved communities with poor health outcomes

• Bottom-up action plans to integrate services as part of the co-production approach with communities, Bottom-up action plans to integrate services as part of the co-production approach with communities, can provide the cornerstones of emerging strategic approaches to Community-based Budgets. can provide the cornerstones of emerging strategic approaches to Community-based Budgets.

Improving health• Health inequality – life expectancy, teenage pregnancy• Underlying conditions - poverty, housing, transport, worklessness, education,

aspirations & confidence• Lifestyles – obesity, tobacco, alcohol, physical activity, oral health, optimising

management of long term conditions & screening.

Protecting health• “New” health problems - Pandemic Flu, climate change• “Old” health problems – TB, food poisoning, imm & vacc, sexual health

Securing high quality health & wellbeing (including preventative population health& social care)

• integrated commissioning, plurality of providers• Integrated systems – e.g joint intelligence• Sustainable development /Corporate Employer• Public empowerment, patient focus• Quality and timeliness of diagnosis & care

Local Marmot Action Plan

• A ‘conscience’ for the new Health & Well-Being Board

• The 6 Marmot objectives provide the strategic framework

• Joint Strategic Needs & Assets Assessment highlights the health inequalities

• Priorities are being set in the context of an emerging policy agenda

• Plan includes health and well-being challenges throughout life - start well, develop well, live well, work well, age well

• Engaging local businesses through Food Sector and Well at Work

• Got cross sector commitment to understand and tackle causes of poor health locally

• CVD prevention partnership was established last year to raise the profile of CVD prevention work and specifically advocate for healthier policy and environments.

• Over the last 6 months, Heart of Wigan commissioned a piece of work examining the potential impact of local public policy on CVD across the borough based on the national consensus from a range of leading experts on the potential health impact of policy modification and to secure local consensus amongst senior decision makers on how receptive local conditions are to change or introduce related policy.

• The shortlist of 8 policies which had senior management support is now being taken out to community consultation to gather residents’ views.

• Heart of Wigan is also developing a CVD commissioning framework to guide future local investment in the area,

• 26% of the adult population of Wigan borough are smokers compared with 24% in England overall.

• The Health and Lifestyle Survey (2005/2006) suggests that younger residents are more likely to be current smokers than older residents and men are more likely to have smoked than women.

• Wigan South Township has one of the highest average smoking estimates of any Wigan’s townships at 34.5% and is higher than both the England and Wigan borough average.

• Estimates range from 26.4% to 47.4. The majority of areas in Wigan South Township have estimates that are among the highest in the borough.

• The area in the north of Wigan South Township has the highest smoking estimate of any area in Wigan borough.

47.4

38

30.5

30.4

26.4

5

10

15

20

25

30

35

40

45

50

Areas within Townships (MLSOAs)

Perc

en

tag

e o

f A

du

lts

(%) Smoking Highest Township Lowest Township Borough Average

Percentage of adults who smoke across Wigan Borough with areas in Wigan South Township highlighted

Smoking litter found beneath

this sign below!!!

Standing next to the sign on the left was this guy on the right!!!

Staff

Patients

Reception area at RAEI

The gutters

VisitorsParents/

Carers

• This programme contributes towards the QIPP agenda by adding value in a hospital setting through focusing on the prevention of ill health. The programme adopts the framework set out by the World Health Organisations’ Healthy Hospitals initiative by actively supporting and encouraging the health and wellbeing of patients, staff and visitors to ensure that the organization adopts a health promoting culture as routine practice.

• Good progress has been made in developing and delivering health improvement interventions around smoking, alcohol, healthy eating and breastfeeding as well as working towards improving staff health and wellbeing.

• A robust smoking cessation brief intervention programme has been rolled out on a trust wide scale and smokers are now actively targeted in the Pre Op Assessment clinic.

• An innovative training approach is currently being developed to ensure that every opportunity becomes a health improvement opportunity; this will ensure that staff receive the appropriate skills to initiate brief ‘health chats’ that will promote and protect health and wellbeing of patients & staff.

• Established in May 2010 to reduce tobacco related health inequalities; to reduce smoking prevalence Established in May 2010 to reduce tobacco related health inequalities; to reduce smoking prevalence across the borough by developing and delivering a local Tobacco Control Strategy and Action Plan. across the borough by developing and delivering a local Tobacco Control Strategy and Action Plan.

• Locally, the issues include: a high prevalence of smokers, especially within the more deprived areas, Locally, the issues include: a high prevalence of smokers, especially within the more deprived areas, illicit tobacco, and underage sales.illicit tobacco, and underage sales.

• Specific work streams include: reducing the supply of illicit tobacco, promoting smoke-fee homes Specific work streams include: reducing the supply of illicit tobacco, promoting smoke-fee homes and play areas, reducing the number of young people that start smoking, and assisting every smoker and play areas, reducing the number of young people that start smoking, and assisting every smoker to quit smoking, particularly from disadvantaged communities. The objectives are to strategically to quit smoking, particularly from disadvantaged communities. The objectives are to strategically plan and commission effective, evidenced based interventions for tobacco control. plan and commission effective, evidenced based interventions for tobacco control.

• 2 Cabinet members assist in Chairing the Alliance and there is clinical engagement on the Steering 2 Cabinet members assist in Chairing the Alliance and there is clinical engagement on the Steering Group from the Cardiology Consultant at WWL , the PEC Chairman.Group from the Cardiology Consultant at WWL , the PEC Chairman. Other partners are Other partners are Public Public Trading Standards , Ashton, Leigh & Wigan Community Health Care, Wrightington, Wigan & Leigh Trading Standards , Ashton, Leigh & Wigan Community Health Care, Wrightington, Wigan & Leigh NHS Foundation Trust, Environmental Health, Greater Manchester Police, Greater Manchester Fire & NHS Foundation Trust, Environmental Health, Greater Manchester Police, Greater Manchester Fire & Rescue Service, Children & Young People’s Service’s, Adult Services , Wigan & Leigh Housing, Rescue Service, Children & Young People’s Service’s, Adult Services , Wigan & Leigh Housing, HMRC, Community Engagement, Wigan & Leigh CVS, 5 Boroughs Partnership NHS Foundation HMRC, Community Engagement, Wigan & Leigh CVS, 5 Boroughs Partnership NHS Foundation Trust, Wigan Leisure & Culture Trust. Trust, Wigan Leisure & Culture Trust.

• The Public Health Directorate leads on commissioning a comprehensive portfolio of services and programmes to promote healthy weight. Our flagship programme is the Lose Weight Feel Great care pathway for managing excess weight in adults that was launched in January 2009.

• With services for overweight clients right through to bariatric surgery it has capacity to provide treatment for over 10,000 clients per annum across a range of services. It is one of the most comprehensive integrated pathways in the country and has significantly increased access to highly personalised advice and support services focused on achieving long term weight loss and maintenance.

• In the first 20 months of the programme, approvals for bariatric surgery have been reduced by 73% saving the PCT over £440000. Over 13,500 people have called the access hub for help and advice and nearly 11,000 people have been referred into services.

• Risk is the fragmentation of the commissioning budget may impact on this type of approach where currently the commissioning for all services related to obesity sits within Public Health.

• The ‘What Makes Wigan Work’ Worklessness Strategy for the Borough has seen Wigan be one of the top performing Boroughs in Greater Manchester at supporting people back into work e.g. reduction in Mental Health IB claimants.

• Achieved through the full allocation of Working Neighbourhoods Funds to the strategy and its implementation, strong partnerships, and responsive commissioning

• Maximising opportunities within the private sector and building public health capacity within the workforce

• Key business making huge strides in workplace health e.g. HJ Heinz ‘Full of Beans’ programme

Health and WorkHealth and Work

• This approach of developing the skills of frontline staff in basic behavioural change techniques This approach of developing the skills of frontline staff in basic behavioural change techniques specifically seeks to provide frontline staff with the skills, tools and confidence to embed specifically seeks to provide frontline staff with the skills, tools and confidence to embed prevention in their day-to-day work with clients. prevention in their day-to-day work with clients.

• Its based on the premise of making the most of the thousands of encounters that public sector, Its based on the premise of making the most of the thousands of encounters that public sector, voluntary and community organisations have with people every week and using these contacts voluntary and community organisations have with people every week and using these contacts as opportunities to raise health issues and signpost people to appropriate support services. as opportunities to raise health issues and signpost people to appropriate support services.

• Locally, Public Health is working with a wide range of organisations to develop staff skills and Locally, Public Health is working with a wide range of organisations to develop staff skills and confidence in raising health issues and signposting people to appropriate support and advice. confidence in raising health issues and signposting people to appropriate support and advice. Organisations committed to this programme include: Ashton, Leigh & Wigan Community Organisations committed to this programme include: Ashton, Leigh & Wigan Community Healthcare NHS Trust; Wrightington, Wigan & Leigh NHS Trust; Wigan Leisure & Culture Trust; Healthcare NHS Trust; Wrightington, Wigan & Leigh NHS Trust; Wigan Leisure & Culture Trust; Wigan Council; 5 Boroughs NHS Trust; and Groundwork. Essential Public Health is a 2 hour Wigan Council; 5 Boroughs NHS Trust; and Groundwork. Essential Public Health is a 2 hour training programme that is being used to provide staff with the practical skills and confidence to training programme that is being used to provide staff with the practical skills and confidence to deliver ‘health chats’.deliver ‘health chats’.

• The Royal Society of Public Health (RSPH) level 2 award in Understanding Health Improvement is being utilised in a The Royal Society of Public Health (RSPH) level 2 award in Understanding Health Improvement is being utilised in a number of ways:number of ways:

• Train the trainer within local public sector, community and voluntary organisations to build local training capacity.Train the trainer within local public sector, community and voluntary organisations to build local training capacity.• Training within local public sector, community and voluntary organisations to ensure that public health is better Training within local public sector, community and voluntary organisations to ensure that public health is better

understood and health messages being given out are as consistent as possible. Current plans include train the understood and health messages being given out are as consistent as possible. Current plans include train the trainer for teaching support staff in the level 2 programme so that it can be delivered to all 14+ pupils in the trainer for teaching support staff in the level 2 programme so that it can be delivered to all 14+ pupils in the borough .Training for Greater Manchester Fire Service community staff and active fire fighters.borough .Training for Greater Manchester Fire Service community staff and active fire fighters.

• Wigan has a large number of amateur sports teams, particularly focused on Rugby League. The volunteers who run Wigan has a large number of amateur sports teams, particularly focused on Rugby League. The volunteers who run these clubs are being trained in RSPH so that holistic messages are given to young people rather than a sole focus these clubs are being trained in RSPH so that holistic messages are given to young people rather than a sole focus on physical activity. This is supporting the borough’s Healthy Stadia programme and has led to Wigan having the on physical activity. This is supporting the borough’s Healthy Stadia programme and has led to Wigan having the first two amateur clubs in Europe to achieve Healthy Stadia status.first two amateur clubs in Europe to achieve Healthy Stadia status.

• Supporting staff health & wellbeing - Administrative staff in Public Health and wider PCT have successfully Supporting staff health & wellbeing - Administrative staff in Public Health and wider PCT have successfully completed the qualification and the qualification is starting to be delivered to staff in primary care settings.completed the qualification and the qualification is starting to be delivered to staff in primary care settings.

• Complex health and well-being challenges Complex health and well-being challenges

• Influencing resource decisions across organisations Influencing resource decisions across organisations

• Developing trust across organisational boundariesDeveloping trust across organisational boundaries

• Harnessing health and well-being leadership skills across local Harnessing health and well-being leadership skills across local people and all organisational sectors in the Borough.people and all organisational sectors in the Borough.