Public Health, Thrive Plymouth and Evaluation Robert Nelder, Consultant in Public Health, Plymouth City Council Claire Turbutt, Advanced Public Health Practitioner, Plymouth City Council February 2017

Outline Introductions The Office of the Director of Public Health (ODPH) explained Public health responsibilities and priorities Thrive Plymouth: background Thrive Plymouth: the story so far Thrive Plymouth: year three focus and case studies Evaluation work to-date Potential opportunities…..

The ODPH explained Plymouth’s Public Health Team used to be part of the Primary Care Trust (PCT) PCT’s were abolished on 31 March 2013 (as part of the Health and Social Care Act 2012) with their work taken over by Clinical Commissioning Groups Public Health became the responsibility of (unitary and top tier) Local Authorities on 1st April 2013 Plymouth’s Public Health Team ‘transitioned’ to Plymouth City Council The Public Health Team became part of the Council’s ‘People’ Direcorate ODPH was chosen as the Team’s name to give it an identity within the People Directorate

The ODPH explained From April 2013 to March 2014, series of acting/interim DsPH Stop/pause/reflect at same time as Fairness Commission Executive Director of Public Health appointed April 2014 Brought together Public Health, Public Protection (formerly part of the Council’s ‘Place’ Directorate) and Civil Protection (formerly part of the Chief Executive’s Department) ODPH became a Directorate within the Council (made up of three teams) instead of a single Team (Public Health) with a strange name ODPH is made up of three professions and managed day-to-day under four consultant-led multi-disciplinary teams

Public health responsibilities and priorities Mandated responsibilities: Appropriate access to sexual health services Ensuring there are plans in place to protect the health of the population, including immunisation and screening plans Ensuring NHS commissioners receive the public health advice they need (‘core offer’) The National Child Measurement Programme (NCMP) NHS Health Check assessment

Public health responsibilities and priorities Local authorities are responsible for: Tobacco control and smoking cessation services Alcohol and drug misuse services Public health services for children and young people The National Child Measurement Programme Interventions to tackle obesity such as community lifestyle and weight management services Locally-led nutrition initiatives Increasing levels of physical activity in the local population NHS Health Check assessments Public mental health services Dental public health services Accidental injury prevention Population level interventions to reduce and prevent birth defects

Public health responsibilities and priorities Behavioural and lifestyle campaigns to prevent cancer and long-term conditions Local initiatives on workplace health Supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as immunisation and screening programmes Comprehensive sexual health services Local initiatives to reduce excess deaths as a result of seasonal mortality The local authority role in dealing with health protection incidents, outbreaks and emergencies Public health aspects of promotion of community safety, violence prevention and response Public health aspects of local initiatives to tackle social exclusion Local initiatives that reduce public health impacts of environmental risks.

Thrive Plymouth: background In January 2014 at a Budget Scrutiny meeting, the following recommendation was agreed: “An action plan addressing the revised approach to health inequalities across the city is brought to the Caring Scrutiny Panel within six months by the incoming Director of Public Health.” There was an opportunity to define and agree a clear approach to addressing health inequalities in the city

Thrive Plymouth: background

Thrive Plymouth: background The 4-4-54 concept is based on the original work of the Oxford Health Alliance (OxHA) who developed 3four50 3four50 was implemented in San Diego A Plymouth-specific version of this approach has been developed to address health inequalities in the city. The framework for addressing health inequalities in Plymouth is known as 4-4-54

Thrive Plymouth: background Poor diet, lack of exercise, tobacco use and excess alcohol consumption are risk factors for coronary heart disease, stroke, cancers and respiratory problems which together contribute to 54% of deaths in Plymouth Changing these four behaviours would help prevent four diseases and reduce the number of deaths due to chronic diseases It’s a conversation starter

Thrive Plymouth: background

Thrive Plymouth: the story so far Thrive Plymouth was launched on 10 November 2014 at an event held in the Council House. The focus of year one was on workforce wellbeing The positive impact that employment can have on health is well documented - employee health is critical to company culture and output Evidence that having a healthy workforce can reduce sickness absence, lower staff turnover and boost productivity Opportunities for messages to be shared with families and friends Introduced the concept of the ‘offer’ and the ‘ask’

Thrive Plymouth: the story so far Thrive Plymouth was the focus of the 2014-15 Director of Public Health Annual Report Entitled ‘Positive choices for better health in a growing city’, it was published in July 2015 The focus is on positive choices (eating a healthy diet, leading an active lifestyle, drinking sensibly and not smoking tobacco) and the contexts in which these choices are made and influenced Included a dashboard that shows details of all the data included in the report and the key measures that will be used to monitor changes in health and wellbeing in the city over the next 10 years An ‘Easy Read’ version of the report was also produced which allowed the creation of some extra health resources for the city’s people with learning difficulties

Thrive Plymouth: the story so far Year two was launched in November 2015. The focus for year two was schools and educational settings Over 140 people attended the launch event, including colleagues from 41 of the city’s schools. A series of locality events were held where Public Health Team members and colleagues from the Healthy Child Quality Mark met with schools A network was developed to bring together schools, public health professionals and wider stakeholders, to deliver improved health outcomes in education settings, share best practice, and support development of the evidence base There are now 50 schools who have achieved the HCQM bronze award, 15 with the silver and six with the gold

Year 3 so far Good afternoon, I hope you enjoyed our new animation. We will be using this to spread the word about Thrive Plymouth.

One You - A genuine revolution in the way adult health is addressed

A focus on behaviour

Local engagement and participation in Plymouth

PHE is using Plymouth’s engagement with the One You launch as a national case study

Offer and Ask

Year 3 case studies Good afternoon, I hope you enjoyed our new animation. We will be using this to spread the word about Thrive Plymouth.

Livewell SW rebranding as One You Plymouth

PCH case study

Plymouth Hospitals Trust Thrive Group Opening the wellbeing centre Back to Netball Health checks for staff Plymotion advice

Plymouth Argyle engagement with Thrive Plymouth

Thrive Plymouth Network ONE YOU Active10 action plan Flash Report from: What would you like to do? What do you need? Who can give it to you? PLEDGE: What are you going to do and when?  

Thrive Plymouth: evaluation work to-date The Public Health Team is working with Plymouth University on the evaluation of Thrive Plymouth (years one and two) As well as this more formal evaluation, the Council’s Public Health Team holds and has access to comprehensive datasets that allow trends in inequalities and health and wellbeing status to be monitored over time The overall aim of the year one evaluation work to-date* has been to investigate how Thrive Plymouth improves the health and wellbeing of the population of Plymouth using workplace wellbeing (the year one focus) as an exemplar * Led by Katrina Bannigan and Clare Pettinger (School of Health Professions, Faculty of Health and Human Sciences)

Thrive Plymouth: evaluation work to-date Four recommendations (of the Y1 evaluation): Refine the logic model (particularly the bigger questions around delivering public health in a local authority context, mechanisms and outcomes) and translating this into an assessment framework Develop an action plan to implement the assessment framework for evaluating Thrive Plymouth Allow longer lead in times for assigning the theme for the ‘focus of the year’ to allow prospective evaluations to be planned, funding bids to be submitted and to capitalise on links with academic programmes Set up a public health forum as a network to facilitate the sharing of public health expertise, knowledge and skills across the city to support the evaluation of Thrive Plymouth

Thrive Plymouth: evaluation work to-date Year two evaluation** A systems approach to promoting health in schools: A case study exploring perceptions of school representatives and public health specialists The study aims to explore school representatives’ and Public Health staff perceptions of whether the Thrive Plymouth locality events helped promote a collective approach to health promotion. This will be done through an evaluation of the perceptions about the locality events, where Public Health Plymouth conducted 20-minute one-on-one sessions with school representatives to discuss schools’ health promotion projects. ** led by Sandiso Moyo (MSc in Healthcare Management, Leadership and Innovation)

Potential opportunities….. Related to Thrive Plymouth: Linkages between Thrive Plymouth years one and two Evaluation of year three (localising ‘One You’) Evaluation of year four (mental health and wellbeing) Effectiveness of the ‘offer and ask’ approach Related to wider public health: Dataset inventory