28th January 2011 Joint Dph Workshop Leeds
-
Upload
jim-mcmanus -
Category
Documents
-
view
186 -
download
0
description
Transcript of 28th January 2011 Joint Dph Workshop Leeds
![Page 1: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/1.jpg)
The Joint Director of Public Health: Opportunities and challenges in a changing landscape
Jim McManusJoint Director of Public Health, Birmingham City Council
New Species or Oddity?A DPH in Local Government
![Page 2: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/2.jpg)
Wendy thought the new multiple accountabilities for Directors of Public Health could get a bit fraught
![Page 3: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/3.jpg)
Local Government Public Health
IS• A portfolio of activities• part of a Matrix• About doing our Core
Business in a Healthy Way• About complex and
strategic working• About partnership• About People, and Places,
and Exposures
IS NOT• A replacement for the NHS
or good primary care• Going to improve life
expectancy tomorrow• Lacking in Evidence• Lacking in Implementation• Always Short Term• About shifting all energy
from NHS to Local Authority services
![Page 4: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/4.jpg)
Health Improvement
Health Protection
Service Public Health
Commissioning priorities, Evidence, making it work, supporting implementation
Ensuring we have the right frameworks in place
Long term, medium term, short term, matrix
![Page 5: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/5.jpg)
Context
• Birmingham’s support for the White Paper
• Desire to do things differently
• View of members and GPs that public health isn’t working optimally
• PH refreshing and reshaping its vision
![Page 6: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/6.jpg)
Some History• Public Health Acts 1836 and 36 subsequently• Public Health into NHS in 1974• LA Public Health Movement since• Environmental Health• Promotion of Health 1984 Act• Range of Public Health Functions endured in LA:
– Communicable disease– Social care– Housing– Waste disposal, sewage, waste collection
• Marmott !
![Page 7: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/7.jpg)
The Vision as I see it
1. Public health at heart of strategic role for LA
2. JSNA - Commissioning
3. Opportunities for health improvement short, medium and long term
4. The big prize is not the 20%
1. In the LA, but not focused solely on the LA
2. Get this right for primary care
3. Take to heart the NAO criticisms
![Page 8: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/8.jpg)
The new public health duties
Coming into Las where….• Money has been removed
and services cut. Whole landscape changed
• There’s a ring-fenced budget and everybody wants some of it
• Public health is not a known or necessarily trusted quantity (just how joint is your joint DPH?)
Implications
• DsPH need a lot of preparation
• Identify value and priorities with clear business case linked to core authority priorities
• Identify what you can add to LA core agenda and what outcomes
• Identify other outcomes too
![Page 9: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/9.jpg)
So what does it mean?
The Core Business
• Doing the core business of the Local Authority in a way which– improves the health of the
population– Reduces inequalities in
health caused or acted on by social determinants
The Ringfenced Budget
• Opportunities but need to be seen in the context of the core business
• The DPH is “MORETHAN” the 20% of the 4%
![Page 10: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/10.jpg)
Financial Issues for Councils
• Go bust very quickly indeed (tarrif services?)• Create parish/town councils and function transfer • Cut, cut, cut – deny people services – 33% less?• Change your model – targeted services for those
with greatest need, preventive and universal for others– Spread risk and co-produce/outsource
• Ringfencing of public health budgets in this context will be seen as a mixed blessing
![Page 11: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/11.jpg)
The Opportunities
• Public health delivering outcomes• A balanced public health function• Wider networks and systems approaches• Interface between GPs and Social care to
save both sides of the system money• Behavioural solutions to thorny and
expensive problems
![Page 12: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/12.jpg)
Our Burdens of Disease
Primary Secondary Tertiary
![Page 13: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/13.jpg)
The Challenge
• We are doing tertiary prevention first because of where we are epidemiologically
• Understand which levers pull short, medium and long term
Short Term – primary careEXPOSURESLIFESTYLE
Medium to Long Term – LA and other playersEXPOSURES. PLACES. LIVES
Time
![Page 14: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/14.jpg)
Domains of Public Health
Health Improvement
Health Protection
Service Public Health
Where does this go and when will it stop being entirely NHS focused?
Diverse accountabilities
What about the PH role in Commissioning?
![Page 15: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/15.jpg)
So what is our approach since 2008/9?
• Policy Commitment– The Council Plan
• An assessment of work and priorities across the council
• Each service area playing its part
• Corporate areas playing their part
• Scrutiny of Delivery
![Page 16: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/16.jpg)
Each Service Area Playing its Part
• Regulatory services – workplace health and also nutrition through food outlets serving food to people in low paid/deprived areas (the healthy food sales awards)and work on young people and tobacco/alcohol
• Housing and Health• Adult Social Care and Health including our strong work on
prevention and integration between health and social care• Childrens’ JSNA and helping to reshape commissioning and the
work they are doing on emotional development• Worklessness and health, work just starting• The Core Strategy including clear commitments on health
![Page 17: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/17.jpg)
Corporate Area Playing its Part
• Shaping the Place to reduce risk and exposure – Protective Factors (Good Housing, Good
Education, Good Economy, Decent Public Realm)
– Vulnerability Factors • Be Healthy as a Key Priority (for our CORE
business)• Health of our staff as a key part of a corporate
strategy for our human resources
![Page 18: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/18.jpg)
Don’t wait for change or direction…move now
Life Expectancy by WardStill there whatever the back office system
![Page 19: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/19.jpg)
Birmingham Approach to theWhite Paper
• Shadow HWBB• GP Engagement• Public Health
Strategy• Transitional
Programmes• Shared Leadership
across City• develop HWBB
• Public Engagement• Member and GP
shared learning • Prediction &
Prevention– Falls prevention in
social care– Telecare
![Page 20: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/20.jpg)
The Accountability Challenge for the DPH
• Either everyone wants you or you wonder which Lion will bite you first…
• At least some of that is down to the System, and some of it is down to the DPH
![Page 21: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/21.jpg)
The DPH – Focus for Action orPorcupine?
Elected Members
HWBB
SoS / CMO / DH / A-Z
LA CMT
NPHS
Staff Team ?
GP Consortia
PROVIDERS
![Page 22: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/22.jpg)
Issues for us to work out
System
• Clarity of governance• Boundaries• Deliverables• Outcomes Framework• Early Wins with HWBB• Systems Working, Matrix
Working• Pressure Valves• Complexity
Person• Capacity v DASS/DCS• Partnership Oriented• Strengths• Support• Boundaries• Working with elected members• Working with GPs• Resilience• The myth of independence• Political Restriction
![Page 23: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/23.jpg)
Some Golden Rules
• Position – Council Plan, Directorate Plans, HI Plan
• A good time to refresh outcomes, strategies and delivery – keep momentum and morale
• Phased Positions
• Formation/Learning/Preparation
– Members– GPs– DsPH– LA Directors – PH Staff
![Page 24: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/24.jpg)
Birmingham Policy Framework
• Council’s Big Three includes Behaviour Change by Services AND Citizens
• The Council Plan – Be Healthy
• The Prevention Framework and Prevention Strategy for Birmingham
• The Public Health Strategy 2011
![Page 25: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/25.jpg)
Models for new services
• Provide
• Outsource
• Commission
• Matrix
• Network
• Mixed Economy
• Stimulate Social Enterprise
![Page 26: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/26.jpg)
Embrace the vision and the opportunities for Public Health
From “independent” advocate
(was that ever really true) to
Officer working with members
and GPs
![Page 27: 28th January 2011 Joint Dph Workshop Leeds](https://reader036.fdocuments.us/reader036/viewer/2022062419/558cec41d8b42a46028b45a1/html5/thumbnails/27.jpg)
Thank you!A copy of a supporting paper “some thoughts on the DPH transition” is in your pack