How can Public Health best deliver
in Local Authorities
Mike Gogarty DPH Essex County Council
Today
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Genuine Question, I need your help in answering!
Defining the Opportunity
Financial challenge
Our journey in Essex~ easy wins, familiar ground, evidence
based practice?
Invest to save
Early Years
Place agenda
Next steps?
Essex County Council
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Essex County Council –some basics
• Responsible for Highways Economy, Environment, Some waste,
Children and Adult Social Care, Education ( but reducing role)
and public health (not screening, immunisation and much health
protection)
• Districts/ Boroughs deal with housing, environmental health and
leisure
• Run by Cabinet with elected Leader with Portfolio holders from
amongst 75 elected members each representing a geographical
“division”. Essex large majority Conservative councillors
• Managed by appointed officers including CEO, DoF, DASS and
DCS and DPH
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Defining the Opportunity
-Essex County Council has 1.4 million residents
-Commissioning authority
-Budget 1 billion ( plus similar in schools)
-Previous 5 PCTs ~now 5 CCGs
-12 Districts/Boroughs/City
-Most deprived Lower level super output area (LSOA)
NATIONALLY ( Jaywick)
-18 years difference life expectancy across electoral wards
-Elected body with strong links to local communities
-Variable relations with DC/BC/City partners
- Strong focus on economic growth
- Reduced grip on education
- Officers often have “social care” perspective rather than
population.
-prevention high on agenda
- while “people” services are 70% plus of spend, political focus
often on ”place” i.e. potholes!
-PH budget “ring fenced” and 50m for Essex
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ECC expenditure gap – the story to 2021
£95m gap closed via
TMII 2014/15 (includes
£7m of other
movements)
£105m gap anticipated
to be closed via
savings from 2015/16
onwards
£170m gap still to be
closed… plus any new
unfunded burdens
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*All values after 2017/18
are early indicative
estimates
• Original savings plan of £237m by 2016/17 could have been close to £370m by 2021
• The current view is that £28m is currently unmitigated by 2016/17 rising to £170m by 2021
Our Journey
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Could go either way
Get good press
Easy wins
Improve Public Health
Support Financial Challenge
Add value to corporate endeavour
We are VERY small beer! Visible to social care and
schools members but less to economy, environment and
highways
Improve Public Health and Support Corporate
Finance in Real Time!
• Variable historic PCT provision
• Some high areas inefficient spend and great procurement
team
• Enabled resource release while improving smoking,
obesity, sexual health services
• Evidence base around impact interventions on social care
costs is very sparse!
• Identify and Manage Atrial Fibrillation better
• Optimise health checks
• Roll out Senior health checks to 75-84
• Calculate reduction in strokes over time related to this and
impact on short/medium residential care provision
• Rather imprecise but well received
Improve Public Health and Support Corporate
Finance in Real Time!
• Win wins with CCGs
• We invest in evidence based alcohol and falls services
(historically patchy and suboptimal), They invest in Early
Supported Discharge and continence services.
• Leads to social care and health savings
• Based ESD savings on impact high levels ESD on
residential and nursing home admissions in one CCG
area.
• Annual Public Health Report focussed on evidence around
invest to save for health and social care.
Improve Public Health and Support Corporate
Finance in Real Time!
• Depression in older people ~ bit of a punt
• Optimal hypertension measurement
• Mental health and public health
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~ Social Prescription
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~Case management around Housing and benefits
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~Health trainer support for people with mental health
issues
• PH officers in DC/BC
Early Years
• Educational Attainment as driver future health
• Opportunity move 0-5 funding from NHS England to Local
Authorities
• Internal leadership issues
• Joined up approach
• Importance best start and school readiness
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Child Wellbeing and Educational Outcome
School readiness in Essex 2014
GLD
• 61% in Essex achieved
Good Level Development
in 2014 (60% England)
• Lowest district Braintree:
57%
• Highest district Maldon:
67%
• 43% receiving Free
School Meals (FSM) vs
64% no FSM
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80
70
60
50
40
30
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FSM GLD
Non FSM GLD
10
0
Total=16108 pupils
FSM=2225 (14%)
GLD2014 and FSM quintiles
75
70
School mean GLD
65
attainment levels
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- home and community factors 55
50
45
40
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meanGLD 2014
95CI_L
95CI_H
GLD2014 and IMD quintiles
75
70
65
60
55
50
45
40
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95CI_H
95CI_L
meanGLD
2014
15
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68.3
63.9
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69.4
63.8
3
66.5
61.2
4
63
57.3
5
58.8
53.8
66.1
66.6
63.8
60.2
56.3
1
68.6
65.8
71.3
2
65.9
63.8
68
3
63.7
60.9
66.5
4
58.3
55.7
61
5
56.7
54.3
59.1
Current Interventions: evidence
Preschool
EPPSE
- longitudinal study of preschool
education
- 3000 children, of which 300 did
not attend preschool
Higher attainment at GCSE
- attending preschool
- mother’s education level
- home learning environment
Home visiting
Family Nurse Partnership
- intensive home visiting
- teenage mothers
- prebirth – 2 yrs old
Implemented, Recommended by DH
Better cognitive development for low
resource mothers
(cost - £3000 per child)
MESCH – extended home visitng
No evidence of improvements in
child outcomes
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Parenting programmes
Triple P
- range of material for universal or
Range of trials, meta-analyses and
targeted approach
evaluations support:
- Age 2 onwards
- improved behaviour
- 8-10 weekly 2 hour sessions
- lower parenting stress
- reinforces positive relationships an - better parenting skills
behaviour
Incredible Years
- targeted parenting programme
- age 3-4 years
- 12 weekly 2 hour sessions
- reinforces positive behaviour
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Trial evidence:
- improved behaviour
- lower parenting stress
- better parenting skills
Impact of universal provision of Triple P
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Proposed model to reduce educational inequalities
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Intensive home visiting and Family Solutions
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Targeted Triple P and outreach support for high risk
families
- additional outreach can increase attendance
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Triple P offer in areas of high deprivation
- using predefined criteria for access
- maternal education
- FSM eligbility criteria
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Additional Free early years eligible 2 yr olds
- ensure quality
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Universal free pre school for 3-5 yr olds
- quality of provision
Estimated cost of Triple P to FSM eligible
(approx 2500= £3million
Increasing
Need
The Place Agenda
• Unfamiliar to NHS rooted officers
• A key reason government put PH in Local Authorities so need to
explore
• Covers transport, environment, economy, housing ( a bit), waste,
highways. Strong link to DC/BC agendas
• Some issues and conflicts eg air pollution, active transport,
speed restrictions, street lighting
• Joint Annual Public Health Report this year with place looking at
synergies but frankly no huge opportunities
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How can we influence stakeholders?
• NHS/CCGs ~ mandates PH support ( usually via named
aligned consultant)
• Adult social care~ engagement LA officers and members,
big prevention agenda, struggling for effective solutions
• Children’s social care ~ as above but less demographic
pressure
• Education~ harder as no direct links. Use 0-19
commissioning opportunity around healthy schools, school
nurses. HV, children’s centres
• DC/BC lead on environmental health, housing, leisure~
need dedicated officer links
• Police and Crime Commissioner~ dedicated officer
support focus on DA, offenders, probation
• Job Centre plus
• THE BIGGY~ Strengthening Communities and
Empowering Individuals
THE BIGGY~ Strengthening Communities and
Empowering Individuals
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Possible 28,000 voluntary sector organisations is Essex
How do we optimise their impact?
Evidence base for HOW to promote Strong Communities
Evidence base of IMPACT of strong communities
Role CVS, faith sector, parish councils
Use employees eg volunteering, MECC ( Making Every Contact
Count)
• Lots of cooks in county council!
• Bespoke support for very vulnerable eg Reach Out door
knocking, health check outreach, ECTU (Essex County
Traveller’s Unit)
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HELP!!!! Next Steps
• What more can we do?
• What easy PH stuff have we missed?
• Can we deliver more invest to save?
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