Organised to Improve Population Health Outcomes
Staffordshire Public Health
Public Health/NHS Reforms
~ local action, central support
South Staffordshire District Council
MasterClass, 6 July 2012
Dr Aliko Ahmed
Director of Public Health, Staffordshire
Health and social care spend (£ millions)
Current PH Challenges in Staffordshire
People - proud to live in Staffordshire,
but believe public services are “not good”
Staffordshire Public health Challenges
35%
90
80
30%
25%
Percentage
60
20%
50
15%
40
30
10%
20
5%
10
0%
0
Cannock
Chase
East
Staffordshire
Smoking
Lichfield
Obesity
NewcastleSouth
under-Lyme Staffordshire
Binge drinking
Teenage pregnancy
Stafford
Staffordshire
Moorlands
Tamworth
Premature CVD mortality
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)
Rate per 100,000 population
70
Who said health is NHS problem?..
Estimated health
impact on the
health and
wellbeing of an
individual
25%
50%
Illness Care
System
Social & economic
environment
15%
10%
Genetic
endowment
Physical
Environment
Source: Canadian Institute for Advanced Research
Health of the Public (Public health) is everyone’s
business:
“diseases emerge as part of a process – of sickness, poor
lifestyle choices and opportunities including the
environment in which humans live and work”
Preventing ill health
Poor life
chances
 Unemployment
 Poor housing
 Poor Education
Unhealthy
lifestyles
Smoking
Alcohol/drugs
Obesity
Crime/disorder
Prolonging life and quality of care
Early onset
of disease
 Diabetes
 Hypertension etc
Severe
disease
 CHD
COPD
Heart Failure
Death
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
NHS Reforms – New Leadership and Decision Making
Clinical
Commissioning
Groups
NHS
commissioning
board
Public
Health
Provider
Why is PH moving to LA?
- effective ways of addressing the challenges
• Population focus
• democratically accountable stewards of local populations’ well
being
• Shapers of place
• ability to shape services to meet local population needs
– better citizens insight (wellbeing) and engagement
• Influence on social determinants of health
• levers for promoting health & well being ~ conditions of living
(born, grow, live and work) – county and districts services
• ability to tackle health inequalities – working across all
services and business of the local government
The New Public Health System
leadership role for local authorities
new roles and
responsibilities
supported by a new integrated public health
service, Public Health England
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
clear priorities
public health as a clear priority for Government,
backed by ring fenced resources
WHAT: Who does what in the new Public Health System?
Local Authorities
• Duty to improve health
• Brings together holistic approach to health
and wellbeing
• Employ DPH
• Commission PH using Ring fenced PH
budget
• Mandated PH services
• Mandated Core offer to the NHS,
including PH advice on health services
CCGs/NHS CB
PHE Units
Health and Wellbeing
Board
• Commissioning healthcare
• Commissioning some public health
services
• Functions in development – mainly
to protect the health of the
population
Coordinates local strategy through
• JSNA
• JSHWS
• Review of commissioning plans
Making it happen
Staffordshire Public Health
Improving health outcomes via local
action, central support
Staffordshire priority outcome:
people to live longer, healthier and fulfilling lives
Birth
Death
Health/Wellbeing
Disability/Disease
THE PUBLIC HEALTH OUTCOMES FRAMEWORK
Vision: To improve the health and wellbeing of all Staffordshire people, and improve the health of the
poorest fastest
Mission: Increased healthy life-expectancy of people and reduced differences in life expectancy
between communities i.e. enabling people to live longer, healthier and more fulfilling lives
Domains
Outcome domain 1:
Outcome domain 2:
Outcome domain 3:
Outcome domain 4:
Improving the Wider
Determinants of Health
Health Improvement
Health Protection
Population Health-care &
Preventing Premature
Mortality
Objective:
Objective:
Objective:
Objective:
Improvements
against wider factors
which affect health
and wellbeing and
health inequalities
e.g housing,
planning, transport,
employment
People are enabled
to live healthy
lifestyles, make
healthy choices and
reduce health
inequalities
The population’s
health is protected
from major incidents
and other threats,
whilst reducing
health inequalities
Reduced numbers
of people living with
preventable ill health
and people dying
prematurely, whilst
reducing the gap
between
communities.
Facilitation &
Influence
Accountable
Support/Advice &
Challenge
Support/Advice &
Challenge
Staffordshire County Council’s new Public
Health Responsibilities
New duty to improve the health of the population:
• Leading on commissioning of PH services
•
specified mandated and non-mandate services of HimP and
lifestyle behaviour change
• Mandated specialist advice and support (Integration for
better population health outcomes)
•
providing population healthcare advice to the NHS/CCGs
•
working with CCGs to integrate care pathways
•
working with HWB to integrate commissioning approaches
• Public Health Protection
•
duty to ensure plans in place to protect health - EPR
• Leading on Partnerships for reducing health inequalities
Staffordshire Public Health is Changing:
Rationale for Change
• Changes in organisation responsibilities
• transfer of PH to SCC
» getting existing 3 PH teams in a single team
• Transformational in the SCC
• focus on outcomes
• opportunities for integrated approaches across service areas
• Changes in partnership landscape
• emerging CCGs and their responsibilities
• roles of Districts/borough councils in wellbeing and
community action
“need for consultation to define fit for purpose”
7/5/2012
PH Commissioning Partnership (Locality)
Subtitle
Central PH Team
Administrative
Support Officer /
Office Manager
PH Commissioning Leads
(SE Locality- SES & ES
CCGs)
PH Commissioning Leads
PH Commissioning Leads
(North Locality - NS CCG)
District PH
Development
Officer
(NuL DC)
District PH
Development
Officer
(SM DC)
(SW Locality – SS, CC & SP
CCGs)
District PH
Development
Officer (S BC)
District PH
Development
Officer (SS DC)
District PH
Development
Officer (C DC)
District PH
Development
Officer (ES DC)
District PH
Development
Officer (L DC)
District PH
Development
Officer
(T BC)
Making it happen
Staffordshire Public Health
Improving health outcomes via local action,
central support
How District Councils can impact on
Health and Wellbeing of People??
Strategic Role – District Councils:
Impact of Poor Housing on ill-Health
Impact of Poor Housing on ill-Health:
accidental deaths and injuries in UK
Source: Good Housing Leads To Good Health: A toolkit for environmental health practitioners
Strategic Role: Excess Winter Deaths
Newcastle-under-Lyme
England
Staffordshire Moorlands
35%
Excess winter mortality index (percentage)
West Midlands
Staffordshire
Stafford
Staffordshire Moorlands
Lichfield
Newcastle-under-Lyme
South Staffordshire
East Staffordshire
30%
25%
20%
15%
10%
5%
Cannock Chase
0%
Tamworth
0%
5%
10%
15%
20%
25%
Excess winter mortality index (percentage)
30%
35%
Three year rolling average
Tamworth
England
Housing – at the core of health and well being:
cohesive society
• Robert Taylor Homes,
Chicago
• 28 identical high-rise
buildings along a 3-mile
corridor
• Some with nearby
vegetation, others without
• Residents randomly
assigned to apartments
20
21
22
Impact of Poor Housing on ill-Health:
Mental Health - Strength of community
very
no trees
trees
quite
somewhat
a little
not at all
Acknowledge
Each Other
Help
Each Other
23
Impact of Poor Housing on ill-Health:
Mental Health - Aggressive behaviour against partner
.6
.5
.4
Proportion
Yes
.3
.2
.1
0
Hit with
something
Hit with
fist
Beat them
up
Used gun
or knife
24
Impact of Poor Housing on ill-Health:
Mental Health - Aggressive behaviour against partner
1.6
no trees
1.4
trees
Mean Values
1.2
1
0.8
0.6
0.4
0.2
0
Psychological
Aggression
Mild Violence Severe Violence
Aggressive and Violent Behavior
25
Summary Points
• Public Health is everyone’s business
• new focus on wellbeing, prevention in addition to treatments
• Opportunities
• embedding public health approaches into Council’s business
• new and enhanced partnership environment
» Health and Wellbeing Boards ~ local and County
• innovative and creative commissioning options/actions
• strengthening/building relationships
» PH commissioning partnerships
• Shared leadership
• across Staffordshire
• across districts
• across CCGs
~ and most importantly across Communities
“the source of real discovery is not looking for
new things all the time, but looking with new
eyes”
~ Proust
“The time is always right to do what is right”
~ Martin Luther King Jr.
Thank You