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The 6 Steps Making Herts County Council a Public Health Organization

Corporate Policy and Performance Workshop on Public Health October 8th 2013

Jim McManus

Director of Public Health

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Our success so far

• Our healthy workplace work shows we can a)improve health, b) reduce sickness absence in our workforce and c) save the taxpayer money. ..see end of this slideshow for more

• So we have the ability to be a strong public health organization

• Here’s how...

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The Six Steps to being a Public Health Organization

1. Leadership commited to Public Health

2. Understand our Public Health Challenges

3. Identify what each area can do

4. Identify what Public Health Tools and Skills we can use

5. Consider every area of the business systematically

6. Make us an example of healthy employer and service provider

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1.Leadership

• Exec Member• Cabinet Panel• HWBB• Partnerships• But what about officers across County?

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1. Leadership Our Public Health Strategy

OUR PURPOSEto work together to improve the health and wellbeing of the people of

Hertfordshire, based on best practice and best evidence

OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well

against Hertfordshire

Priority 5: We understand what’s needed and we do what works

Priority 6: We make public health everybody’s business and work together

HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for

our County)

ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)

WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION

(our strategic priorities: what we achieve for our County)

Priority 1: Our Population lives Longer, Healthier Lives

Priority 2: Our Population Starts Life Healthy and Stays Healthy

Priority 3: We narrow the gap in life expectancy and health between most and least healthy

Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)

BuildingBlocks For the Public Health Family

Strong Leadership

Capable, Skilled People

Co-production with citizens

Effective Partnerships

Evidence and Knowledge Driven

Plan and Deliver for Localism

Whole System Approaches

Making better use of behavioural sciences at individual, interpersonal, community and service levels

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2. UNDERSTAND OUR PUBLIC HEALTH CHALLENGES

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Hertfordshire

• 1.1m People in 37 Settlements• 10 Districts• 1 County Council• 2 NHS CCGs• 8 NHS Trusts• 1400+ vol orgs• Urban/Rural mix

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Our Burden of Disease

• – Non-Communicable Diseases

– Over 60% of deaths due to lifestyle and behaviour

– Smoking

– Lack of effective primary and secondary prevention across system

– Knowing what works

– Poorest fare worst (smoking, diabetes, heart disease)

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Learning the lessons from theNational Audit Office 2010not on course!

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Interface of PH, health inequalities & social care• NHS gone from infectious disease focus in 1948 to LTCs, cancer and

mental health in 21st century • 1 in every 7 GP appointments for LTCs*• 50% of adults with a mental health problem had a MH, behavioural or

emotional problem before the age of 14 yrs• MH biggest spend of NHS than any other health condition• Social determinants AND quality and accessibility of health & social care• Old model of health and social care – deliver to, not with…co-production,

co-creating health, shared decision-making …• Personal budgets… for social care (and health ??)• Shift from one size fits all

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The Big Strategic Challenges for Hertfordshire

Health Improvement

Health Protection

Service Quality

Imms

Vaccs

TB

HCAI

Environment

• Non Communicable Disease

• Public Mental Health

• Development

• Ageing

Health Care QualityPublic Service Outcomes

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3. IDENTIFY WHAT WE EACH CAN DO

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Conceptualising wider determinants

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%Poor sexual health

5%

Health Behaviours 30%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%Community Safety 5%

Socioeconomic Factors 40%

Access to care 10%

Quality of care 10%

Clinical Care 20%

Environmental Quality 5%

Built Environment 5%

Built Environment 10%

Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status

While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

Contributors to overall health outcomes

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Questions for you to answer

1. Where do we touch people where we can build resilience, motivation and opportunity to be healthy?

2. Where do we touch people in a way which mitigates against better health?

3. What do I want to know about evidence-based practice tools which will help me do my core role better?

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Systems thinking on wider determinantsA framework for you to use

The wider determinants of Health and Local Government functions (Must adopt a Lifecourse approach!)

The Lives people lead and whether LA functions help or hinder healthy lifestyles (policy, service quality, access, behavioural economics, behavioural sciences)

The services people access such as primary care (high quality, easy access, good follow up, behavioural and lifestyle pathways wrap around)

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An example from housing

• Warm, decent homes is a public health strategy

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4. IDENTIFY WHAT TOOLS AND SKILLS WE CAN USE

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Some Tools

• Needs Assessment• Evidence Based Practice• Evaluation• Whole Systems Thinking on Public Health• The 3 Domains Model

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5. CONSIDER EVERY AREA OF THE BUSINESS SYSTEMATICALLY

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Making Herts County Council a Public Health Organisation• Every service understands and owns a public

health role• We skill and motivate people to self-manage

their health and wellbeing• We focus on the person and co-ordinate around

them• Physical, Social, Psychological and Spiritual are

all part of the dynamics of health• Mindset of staff,volunteers, carers and users

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Healthier Herts: A Public Health Strategy for Hertfordshire

OUR PURPOSEto work together to improve the health and wellbeing of the people of

Hertfordshire, based on best practice and best evidence

OUR VISION:A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy and happy lives. We compare well with England and every area in Hertfordshire compares well

against Hertfordshire

Priority 5: We understand what’s needed and we do what works

Priority 6: We make public health everybody’s business and work together

HOW WE WILL WORK TOGETHER(our strategic priorities: how we do it for

our County)

ThePublicHealthOutcomesFramework(the nationalPHOF willHelp us measureOur success)

WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT POPULATION

(our strategic priorities: what we achieve for our County)

Priority 1: Our Population lives Longer, Healthier Lives

Priority 2: Our Population Starts Life Healthy and Stays Healthy

Priority 3: We narrow the gap in life expectancy and health between most and least healthy

Priority 4: We protect our communities from harm (chemical, biological, radiological and environmental)

BuildingBlocks For the Public Health Family

Strong Leadership

Capable, Skilled People

Co-production with citizens

Effective Partnerships

Evidence and Knowledge Driven

Plan and Deliver for Localism

Whole System Approaches

Making better use of behavioural sciences at individual, interpersonal, community and service levels

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The Strategy Pyramid2

Mission Vision: Where we want

to get to

Strategy: How we want to get to the vision

Implementation Plans : What we need to do in each area of the business and for each topic

Individual Plans: My personal objectives and must dos

Mission:

Why ? Where/What do we want to be?

Why do we Exist ?

How we want to get there?

What we need to do!

What I need to do!

Values, what’s important to us ? {

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County of Opportunity- Questions to ask

• The conditions for everyone to be healthy, from conception to end of life

• The conditions for the poorest and worst off to be healthier

• Intervene early• Public services which put this at the core of their

business• People thriving and prosperous

• Healthy workforce, prosperous County

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Health Improvement

Health Protection

Commissioning priorities, Evidence, acting when evidence is silent, making it work, supporting implementation

Ensuring we have the right frameworks in place

Long term, medium term, short term impacts

Let’s assume you run a day centre.....

FALLS PREVENTION?

Service Quality andImprovement

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What Outcomes can I contribute to?

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The public health mindset means working across different dimensions of time and responsibility

•Think through what we can do short term

•Start work on the medium term

•Set the policy framework for the long term

•Build this understanding among partners

•Get started and realise

•County, District, Parish, NHS, Business and Community Sector working together

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HERTFORDSHIRE LOCAL PUBLIC HEALTH MODEL (For Place or for People Settings)Development of a local plan for each area and agency between partners with use of existing

community networks

2. WORK ON THE COMMON RISK FACTORS FOR BIG KILLERS

Neighbourhood interventions forDiet, Physical Activity, Smoking,

Alcohol,

3a. IMPROVE LOCAL NEIGHBOURHOOD QUALITY

Physical Environment, Green Space, Crime/ASB. INCREASE SOCIAL CONTACT BETWEEN NEIGHBOURS

4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMESImmunisation, Screening, This may differ from area to area depending on

issues

1. Complete a Basic health profile – identification of health issues salient for the neighbourhood or service user group by checking the basic basic profile from JSNA or other source

5. Skilling people for their own health– develop and deliver basic personal health skills training. (Physical and mental health)

So…towards a modelexplicitly designed to be as easy as possible for non-health specialists can implement it

3b. IMPROVE SALIENT HEALTH OUTCOMESAddress issues specific to your population e.g. Coping and resilience for carers

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6. Make us an example of a healthy employer

• Smokefree policy• Healthy Herts – employee wellbeing programe• Show Leadership across County• StepJockey

• CREATE A

MOVEMENT

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Healthy Employer - what we’re doing

1. Smokefree policy – already in place for employees, moving to next stage

2. Healthy Herts –nominated for two awards, saved money, reduced sickness absence

1. Next stage is sorting the food culture!

3. Counselling and wellbeing offer

4. Leadership – setting up workplace health offer and seminars with employers

5. Stepjockey – took part in the trial, now rolling it out across candidate buildings. Increased stair use by 29% from baseline

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The Six Steps...what are you going to do?

1. Leadership commited to Public Health

2. Understand our Public Health Challenges

3. Identify what each area can do

4. Identify what Public Health Tools and Skills we can use

5. Consider every area of the business systematically

6. Make us an example of healthy employer and service provider