West Midlands

Sustainability and Transformation Planning – PART 2

22 February2016

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Sustainability & Transformation 2021: Taking a wider view of STP impact potential

PHE West Midlands CentreDr Helen Carter – Deputy Director Healthcare Public Health

22nd February 2016

Aims• To explore the wider potential and contribution that public health can make

across the triple aims

• To share with you the coordination of offer across the public health community in the West Midlands

This NHS planning cycle is a key opportunity to embed a focus on prevention across local health and care systems

The NHS planning guidance asks CCGs to work with local partners to produce multi-year and placed-based Sustainability and Transformation Plans (STPs). This will:

• enable local health and care systems to work together effectively to address local challenges, including those set out in the Five Year Forward View

• offer the opportunity to focus more effectively on preventing ill health and develop robust action plans to address the causes of key health and social care needs, which can reduce the local health and care bill whilst improving population health and wellbeing

The planning guidance encourages footprints to assess the contribution of prevention towards reducing overall healthcare demand and realising efficiency savings.

The planning process also incentivises a focus on prevention: compelling plans – which should include a prevention plan – will secure earliest funding from the Transformation Fund, as early as April 2017.

What do we mean by prevention?

• Primary prevention – taking action to address the causes of ill health and lifestyle risks or by targeting high-risk groups

• Secondary prevention – taking action to detect early stages of disease and intervene before full symptoms develop

The STP process is split in two: analysis of the ‘gaps’, and development of the action plan to address these gaps

Stage 1 - By 11 April:scale of challenge, priorities, governance

Stage 2 –from April:Develop STPs and submit for assurance

National guidance and support, events, workshops• Further guidance

(e.g. gap analysis)• ALBs lead/ support

on ‘gap analysis’• Development days• Programme of

workshops with experts

• Use online tools so local areas can share information and examples of emerging best practice

• Identify the scale of the challenge for each of the three gaps (via ‘gap analysis’)

• Set priorities to address each gap

• Establish the governance arrangements and processes needed to produce and implement STP

• Local partners to develop plans that will address identified challenges and how to close the three gaps over the next five years

• This will include a local prevention plan and a monitoring and evaluation plan (tbc – NHS England)

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‘Initial submission’ for 11 April

‘Final submission’ to RDs on 30 June

The NHS Shared Planning Guidance outlined key, national PH priorities that will need to be considered in each section

Care and quality gap• Out of hospital care• Cancer prevention• Mental health services• Dementia services• Learning disability• AMR• Maternity services• Mental health (incl CYP)• Workforce• Improving commissioning

Finance and efficiency gap

• What savings can be made from “moderating demand growth” e.g. through prevention?E.g. reducing alcohol consumption can potentially save money via: a) reduced A&E attendanceb) reduced alcohol related

illnesses (liver cirrhosis)c) reduced anti-social

behaviourd) reduced domestic violence

incidences

Public health has an important contribution to make across all three FYFV gaps.The NHS shared planning guidance referenced key public health areas of national interest – we outlined these below.

Health and wellbeing gap

• Preventable causes of ill health (incl. consumption of alcohol, tobacco)

• Diet and obesity• Diabetes• Workforce health• Patient activation and self-

care

Local areas will want to consider these and any other specific locality needs.

A compelling plan will set actions to address a balance of national priorities and local needs, based on evidence

What makes a STP a ‘compelling plan’?

SMART goals with clear actions that address priorities identified via the ‘gap analysis’

Include a prevention plan with steps to realise savings potential

Include a plan to monitor and evaluate delivery of SMART goals

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SMART goals to address evidence-based priorities

• Set SMART objectives and actions

Which must be based on:

• Stage 1 ‘gap analysis’ – the process local areas will go through to identify local priorities. This will build on evidence available, e.g. from JSNAs and national intelligence tools

• A demonstrable understanding of national priorities

• Further details to be published w/c 29th Feb

Prevention plan• Outline of leading preventable

health and care issues in local areas

• System actions to tackle these –reducing risky behaviour (e.g. unhealthy diet and obesity, alcohol and smoking); intervening ‘earlier’ and in a more integrated fashion (e.g. ‘crisis’ care teams in hospitals; housing; schools; workplace)

• Include assessment of when and how potential ‘cost’ savings would accrue, and where (i.e. which organisations benefit)

Monitoring and evaluation• Embed monitoring and evaluation

from the start

• Commit resource upfront towards monitoring progress each year over the FYFV period

Which should be based on/ include:

• Review of existing metrics and datasets, and monitoring programmes

• Define a baseline and track annual ‘cost savings’ from baseline

• More broadly, trackable metrics should range from input, process, output, outcome and health/spend

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Are you seeking data relating to healthcare?

Is there a health profile relating to what you are seeking on the PHE Fingertips platform?

Have you tried the PHE Data and Knowledge Gateway?

Are you looking for data relating to infectious disease rates or vaccine coverage?

Have you checked local sources of data such as the JSNA?

JSNAs are a rich source of local data. Many local areas also have their own observatory sites which provide a range of health data.

Fingertips is an online platform for publishing data developed by PHE. The PHOF and an increasing number of profiles are delivered via this platform, link.

The PHE Data and Knowledge Gateway brings together non-communicable health profiles and data resources across PHE, some 110 in total, link.

PHE health protection resources have a dedicated portal with information on a range of common diseases as well as on vaccine uptake, link.

NHS England collects and publishes a range of data relating to healthcare activity, performance and outcomes, link.

This site will include key data that NHS England uses to conduct its core business, link.

We set out key sources of intelligence that local areas will find useful to carry out the health and care ‘gap analysis’

Have you looked at the NHS England Data Catalogue?

Are you interested in understanding how local services compare to elsewhere?

NHS Right Care publishes a range of resources designed to help commissioners and providers understand variation in health and healthcare and aims to maximise value from the health system, link.

Have you looked at ONS or HSCIC?

The Health and Social Care Information Centre (HSCIC) and ONS collect, analyse and present a range of data, including on population (births, deaths and census), the economy and health, link.

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Public Health in the West Midlands offer• Awash with data-but what does this mean-value add from the PH community

• Discussions with WM Association of Directors of Public Health

• Coordinated through WM healthcare public health network-meeting 14th

March 2016

• Draw upon our resource in WM public health information analysis's group (WMPHIG)

• Principle-’do once and do for all’

• Strong links to national PHE Knowledge and Intelligence Team

The task: what costs can be avoided?• Identify what is costing a lot in both health and social care – and what is 

likely to happen with these in the next 5 years 

‐ What is currently being done to tackle these issues? 

‐ What else could be done to address these issues and at what cost? 

‐ How much public money could be saved by tackling the root causes?

• Health system leaders are asked to identify how these issues, these costs can be avoided. 

• Also what would help engage local government – thinking of social care, child welfare, productivity, housing and air quality.

Public Health England’s contribution: identifying cost‐effective prevention opportunities 

UK Burden of Disease

Prevention’s potential contribution • Cancer Research UK have estimated that 42% of cancers in the UK are

preventable

• 80% of NHS spending on diabetes is incurred in treating potentially avoidable complications

• In more than 90% of cases, the risk of a first heart attack is related to at least one of nine potentially modifiable risk factors

• Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment

• It is estimated that if Atrial Fibrillation was adequately treated, around 7,000 strokes would be prevented and 2,100 lives saved every year

• The National Audit Office suggest that 47% of type 2 diabetes cases in England can be attributed to obesity

• Despite reductions in levels of smoking 17% of deaths in adults over 35 are attributable to smoking

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Approaches: all have a role in prevention

Lifestyle change: • Information, social marketing, Make Every Contact Count (MECC)• Promoting health choices with prompts and nudges• Reducing access to harmful stuff through voluntary schemes and

regulation

Cultural shift:• What we talk about, what we care about• Who feels responsibility – schools, workplace, housing • Changing attitudes e.g. safeguarding Advocacy and political action

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Troubled Families & Economic Impact

Rachel Jones, Chief Superintendent – West Midlands Police

Sarah Middleton, Chief Executive – Black Country Consortium Limited

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WMCA SEP Vision & Objectives

Sarah Middleton 

Sarah_middleton@blackcountryconsortium.co.uk

January 2016

Chief Executive Black Country Consortium Ltd

Our Vision for PEOPLE

Home to 4.5m people +500,000 additional residents

Raised Education & Skills135,000

fewer people with no quals

176,000more people with degrees

Internationally Recognised  

#UK top place to do Business

Healthier & Wealthier –Salaries13% Above

UK average 

More & Better Homesc1.9mhomes

High Quality Local Transit –more people accessing jobs

Premier Business 

Locations – High Quality 

Employment Land 

Additional c1,600 ha

World Class Connectivity ‐49 minutes to 

London

Our Vision for PLACE

High Value Manufacturing 

Capital –Largest 

Concentration jobs in UK

Thriving Business Base ‐

150,000 Businesses

GVA per head outperforming 

national average 

Fiscal neutral –eradication 

£3.9bn Income vs Exp.

Our Vision for BUSINESS

Transformational & Enabling Sectors

Our Approach

Vision Led

Our Approach

Vision Led

Vision Led

Vision Led

Vision Led

Vision Led

DELIVERING OUR AMBITIONS ‐ JOBS

AMBITION + 504,000 JOBS of which an additional +49,000 via WMCA

20302.4MJobs 

2015 1.9MJobs 

5 yearly ambitions 

DELIVERING OUR AMBITIONS ‐ GVA

GVA PER HEAD EXCEEDING NATIONAL 

AVERAGE BY 2026

Measured in constant ‘real’ prices

2030£153BN

2015 £77BN

AMBITION + £75BN GVA of which an additional +£7bn via WMCA

Public Service Reform

Programme Areas

BusinessPeoplePlace

Outcomes

£3.9bn reduction of the Income and Expenditure gap

Strategic Priorities

e.g. HVM Capital

Productivity

WMCA SEP Framework

WMCA Income & Expenditure

£30.7

£34.6

£28

£29

£30

£31

£32

£33

£34

£35

Income Expenditure

Billion

s

GAP

: ‐£3.9bn

WMCA Income & Expenditure

£7.91 £7.61

£15.16

£9.95

£7.63

£17.02

 £‐

 £2

 £4

 £6

 £8

 £10

 £12

 £14

 £16

 £18

BCLEP CWLEP GBSLEP

Billion

s

Income Expenditure

WMCA Income & Expenditure

Labour47%      

(£14.3bn)

Consumption25% 

(£7.6bn)

Other10% 

(£3.2bn)

Land & Property10% 

(£3.1bn)

Capital8% 

(£2.6bn)

Note: Figures  will vary slightly from overall totals due to rounding

0% 10% 20% 30% 40% 50%

Social protection

Health

Education

Economic Affairs

Public Order and Safety

Housing and community amenities

Environmental protection

Recreation, culture and religion

General Public Services

Defence

£15.6bn

£15.6bn

£7.9bn

£1.9bn

£1.6bn

£0.5bn

£0.4bn

£0.4bn

£0.3bn

£0.004bn

INCOME EXPENDITURE

Rachel Jones and Dave Twyford

Creating Safe and Healthy Futures

Craig’s Story

Purpose Process People

Empowerment

Outcome Focus 

Cost‐effectiveness

New Delivery Models 

Experimentation

Whole person/family

Digitalisation 

Principles and enablers

Big Ticket Programme“Improving Life Chances”

TroubledIndividuals

YouthJustice

MentalHealthSkills

Process

WMCA approach to public service reform

Business case “filter”

Pilot testing + evaluation

Impact(worth doing?)

Feasibility(likely to succeed?)

Coho

rt

Curren

t cost

PSR Outcomes

Cost/ben

efits

Econ

omic

Asset b

uilding

Source

Eviden

ce

Advantage

Adaptability

Trialability

Complexity

Scale up Discard / adapt

Cost‐benefit evaluation model

Craig’s Story

Violence in the West Midlands

226,125 Violent offences90.2% Resident within the West Midlands 

48,980 Attendances at Emergency Departments12,792 Admissions

5.1% Sustained serious or fatal injuries43.4% Victims are aged between 10‐24 years old

Economic Cost = £890 Million per yearWe need a different approach!

38Violence Affecting Local Residents across the West Midlands Force Area

“Help, I can’t cope?”

Sorry, not us please try over

there?

Referral to another agency

2614

Assessment

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Multi-Agency Meeting

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Total Number of Agencies / Services

Product Selection

12 opportunities missed

Help things are getting worse

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16/31

Ownership?

Adverse Childhood Experiences (ACEs)

Stressful events occurring during childhood that directly affect a child or affect the environment in which they live

Child maltreatment

Physical abuse

Sexual abuse

Psychological abuse

Physical neglect

Emotional neglect

Family environment, e.g.

Parental separation/divorce

Substance abuse

Mental illness

Incarceration

Domestic violence

ACE Study Felitti et al, 1998; Anda et al, 2006, slide with thanks to Karen Hughes, John Moore’s University

Smoking (current)

by 16%

Heroin/crack use(lifetime)

by 59%

Violence victimisation 

(past year)

by 51%

Violence perpetration 

(past year)

by 52%

Binge drinking (current)

by 15%

Unintended teen pregnancy

by 38%

Early sex (before age 16)

by 33%

Cannabis use (lifetime)

by 33%

Poor diet(current)

by 14%

Incarceration (lifetime)

by 53%

Preventing ACEs in future generations could reduce levels of:

slide with thanks to Karen Hughes, John Moore’s University

Year 1 Year 5 Year 10

NHS £39 £751 £1,148

Social Services £4 £13 £23

Education £26 £135 £186

Criminal Justice £14 £1,139 £1,849

Voluntary Sector 0 £4 £8

Victim costs (crime) £30 £3,164 £4,912

Other crime costs £12 £1,295 £2,038

Total payoffs £125 £6,501 £10,164

Cost of intervention £132 £132 £132

Net cost/pay offs ‐£7 £6,369 £10,032

School based social and emotional learning programmes to prevent conduct problems in childhood 

Cumulative payoffs per child (£s)  (Knapp et al, 2011)

Multi‐Agency Muddle

Craig

Primary Care 

ServicesSocial Services

Housing Association

Education Services

Mental Health Services

Drug & Alcohol Services

Sexual Assault Referral Centre

Police Services

Probation Services

Prison Services

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Components of success

CollaborationsRelationshipsAspirationInformationGovernance

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Panel Questions

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