Challenges and Opportunities:
A Public Health Perspective
17th October 2011
Social Services Research Group Seminar
Jim McManus
Joint Director of Public Health
The Context
• Local Government
– Sector Led Improvement
– Strategic Role (health, public health,
HWBB)
– Big Society, Localism, Open Public
Services
• Public Health and NHS
• Opportunities and Freedoms?
The Challenge for Sector Led
Improvement
• Helping LAs make optimal decisions – did
Public Health ever help the NHS do that?
• Distributed nature of evidence based
practice in Local Govt
• Evidence and its role in the political
decision making process
• Critiques of the problems with evidence
based practice
Synopsis – The Issues
Questions
• Where does Public
Health fit in the new
Sector-Led Improvement
Agenda?
• Does Public Health have
anything to say on the
improvement agenda for
social care?
My Suggested Answer
• A role in identifying
priorities and ways of
evidencing whether we
meet them,
• A definite role in
improving and innovating
in social care for our
communities, much
under-developed in public
health hitherto
Synopsis 2 – Achieving Change
Suggested Answer
• A role in identifying
•
priorities and ways of
evidencing whether we
meet them,
• A definite role in
improving and innovating
•
in social care for our
communities, much
under-developed in public
health hitherto
This needs
Mutual understanding of
priority setting and outcome
setting, and evidencing
– DPH can’t lead this unless s/he
understands LA
– A distributed leadership task
Needs mutual confluence
between public health and
social care professionals and
research communities
Synopsis 3 - Birmingham
Suggested Answer
• A role in identifying
priorities and ways of
evidencing whether we
meet them,
• A definite role in
improving and innovating
in social care for our
communities, much
under-developed in public
health hitherto
Birmingham doing…
• JSNA and Corporate I
and A Board informs
Council priorities
• A social care programme
for public health from
telecare and winter
deaths to prevention
Government Intention –
Public Health
• Directors of Public Health in Local Government
• Transition of Staff
• Remit across Health Improvement, Health Protection,
Advice for Commissioners
• JSNA and Health and Wellbeing Strategy
• Public Health England
• Outcome Frameworks
• But given timescales there is a need for us to
start doing and shaping things towards this
Example - National Audit Office 2010
not on course for HI
The domains of public health and where it
touches Sector –led Improvement
Health
Improvement
Health
Protection
Service
Quality and
Improvement
Long term, medium term,
short term impacts
Commissioning
priorities, Evidence,
acting when evidence is
silent, making it work,
supporting
implementation
Interface -FALLS
PREVENTION
Ensuring we have the right
frameworks in place. Major
challenges
Four Quick Wins or Challenges
1. Common approaches to the problem of
evidence, especially where there isn’t
any
2. Identifying outcomes together
3. Integrated approach to improvement
4. Pick some thorny issues
Timeframes of impact/yield and Sector-led Improvement
Primary Care
Primary
Care
Vitamin Supplements
Air Pollution
Decent Homes
Air Pollution
Decent Homes
Reducing Worklessness
Education
Planning Frameworks and Core Strategies
0
1
5
Years
10
15
The Challenge
• Helping LAs make optimal decisions – did
we ever help the NHS do that?
• Distributed nature of evidence based
practice in Local Govt
• Evidence and its role in the political
decision making process
• Critiques of the problems with evidence
based practice
The limits of evidence based
practice
• The limits of evidence – where evidence is
silent
• The current hierarchy of evidence –
biomedical not social scientific
• The role of evidence in the political process
• Contested space – everyone who can have
an opinion on it does, and not always helpful
• What does this say about elected members?
Birmingham Approach
Identify where evidence does and doesn’t have something
useful to say
Where it does
• Search, Sift and Appraise
• Devise and implement a
process stakeholders can
work with for this
• Identify clear priorities
and strength of evidence
• Doing this on Children,
Corporate, Housing,
Social Care
Where it doesn’t
• Identify “best bets”
• Create a methodology to
identify outcomes and
assess whether they
have been met
• Commission directly the
modelling to make
business cases
Public Health yield across the lifespan
Housing
• Evidence review group – identifying key
interventions
• Evidence review paper for Members
and Officers – 8 pages
• Summits, Workshops, Briefings
• Action Plan created
• Review
Systems thinking in health interventions
Getting everyone on the same systems page
The wider determinants of Health and Local
Government functions
The Lives people lead and whether LA functions
help or hinder healthy lifestyles
The services people access such as primary
care
Implications
•
•
•
•
•
Selecting Outcomes
Prioritising interventions by timescale
Evidence for differing interventions
System wide approaches
Need to understand and work with
complexity
Public Health Outcomes Framework
– alignment with the NHS
AND Adult Social Care
Adult Social Care and Public
Health:
Maintaining good health
and wellbeing.
Preventing avoidable ill
health or injury, including
through reablement or
intermediate care services
and early intervention.
Adult Social
Care
NHS and Public Health:
Preventing ill health
and lifestyle diseases
and tackling their
determinants.
Awareness and early detection of
major conditions
Adult Social Care and NHS:
Supported discharge from
NHS to social care.
Impact of reablement or
intermediate care services
on reducing repeat
NHS emergency admissions.
Supporting carers and
involving in care planning.
ASC, NHS and Public Health:
The focus of Joint Strategic Needs Assessment: shared local
health and wellbeing issues for joint approaches.
Which Framework? Marmot and the Lifespan?
What does Marmot offer?
• Provides high level outcomes which can unify across
frameworks and agencies
• Evidence based
• Enables us to track progress
• An aid to the 4Es duty
• Clear Hierarchy of Outcomes, Priorities and Interventions
• Clearer success and clearer failure
• Lancs, Leics, Lincs and Rotherham already used Marmot for
JSNA
• Yorkshire’s Big Opportunity Report
Worked Example
Marmot – Best Start in life
Children – all 5
NHS – 2 Domains
Public Health – 2 Domains
Indicator Measures could be common
and shared across some outcomes
Case Study
Regulatory Services and Marmot Outcomes
• Trading Standards – A,E,,D
• Environmental Health (inc pest control and animal
Welfare) – A,B,C,D,E,F
• Licensing – D,E,F
Skills
• Holistic approach to solving problems
• Education skills
• Enforcement skills
• Established partnership working
• Local contact – over 7000 businesses visits and over 20,000 homes
visited per year
Some ongoing projects
by their Marmot Outcomes
• B
– Health Tums – changing attitudes of young people inspiring a lifetime of
healthier eating
– Preparing young people for work with knowledge of health and safety
• D
– Doorstep crime – mental health wellbeing
– Health choices – promote healthy eating and healthy lifestyles (educating
catering businesses)
– Low emissions in cites - promote uptake of low emissions technologies to
reduce oxides of nitrogen
– Preventing scalding in residential homes
• E
– Illicit tobacco – counterfeit, smuggled, novel tobacco
– Cosmetic safety – heavy metals in produces esp around young people
• F
– Shisha – compliance and health choice messages
– Illicit tobacco – counterfeit, smuggled, novel tobacco
An integrated obesity strategy
(truncated due to space)
Area of
Work and
timescale
to deliver
visible
results
Primary
Prevention
Secondar
Tertiary
Prevention
y
Prevention
Current
Performanc
e
Planning 
Timescale
2-15 years
Planning restrictions on hot food
takeaways to ensure vibrant town
centres and diverse food choice

This is not
really a role for
planning
Poorly
performing
Leisure

and Sport
Timescale
1-5 years
Getting people more active as a
routine part of their week

Integrated care
pathway
covering all
agencies
Be Active and Be
Active + offered.
Sports Partnership
also engaged.
Thank you!
Jim.mcmanus@birmingham.gov.uk
http://jimmcmanus.wordpress.com