Leading better together – working with local government Martin Seymour Principal Consultant, Healthy Communities Programme

About the Healthy Communities Programme Helping local government to tackle health inequalities and improve the health of their communities

Healthy Communities Programme Peer support and peer reviews Healthy Communities benchmark The leadership academy Knowledge website Communities of Practice Valuing Health – the business case Community engagement and community asset mapping JSNA Partnerships Total Place and health Thematic and topical work, eg, coastal and rural health, childhood obesity The Communities for Health regional networks Strategic planning

Social Determinants of Health Developing a broader understanding of the impact that local authorities and their partners can have on heath inequalities

Strategic Review of Health Inequalities in England post 2010 – Key themes Reducing health inequalities is a matter of fairness and social justice – inequality is avoidable. Action is needed to tackle the social gradient in health – Proportionate universalism Action on health inequalities requires action across all the social determinants of health Reducing health inequalities is vital for the economy – cost of inaction A move beyond economic growth to well-being of society: sustainability and the fair distribution of health

Marmot review - delivery Taking a whole system approach – nationally, regionally and locally. Empowering people: securing local solutions. Creating the conditions in which people and communities take control Regional working - NW and London

"Public Health is delivered by a workforce most of whom do not have 'health' in their job title." “Securing Good health for the Whole Population” Wanless Feb 2004

A history lesson: local councils and health C19th – building the protective infrastructure and systems of regulation C20th – provision of hospitals, health and social care services to meet need C21st – helping people to change their behaviours and strengthening the social determinants for good health

The context for local government Policy documents Acheson report Tackling health inequalities: programme for action Choosing Health Fair Society, Healthy Lives Health service reviews Wanless Darzi Local government reviews LG Act Powers of well-being LG and public involvement in health act 2007 Lyons Report Place shaping

Local performance framework Local Strategic Partnerships Sustainable Community Strategies Local Area Agreements Comprehensive Area Assessments Joint Strategic Needs Assessments

Partnerships for health improvement

Evaluating partnerships Process issues Engagement of Senior managers in partnership Reorganisation impact Lack of financial and human resources Information sharing and best practice Coterminosity Need for quick wins Outcomes Health outcomes Monitoring and evaluation problems Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press

Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement

Immature Partnership Little added value Mature Partnership Showing Added value Gaining collaborative advantage for health improvement Maturing partnership Increasingly acting on social determinants of health Process factors External contextual factors A Theory of Maturing Partnerships for Health Improvement No shared vision Dominant partner Top down Project focussed Quick wins Funding constraints Grant giving Internal focus Individual ownership Health an NHS issue Medical Model Confidence in partners Shared identity Shared vision Joint ownership Alignment Joint posts Citizen engagement Accountability Holistic Health everyone's business. Addressing SDH Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.

Significant challenges to delivery Traditionally not seen as ‘core’ business – how can Fair Society, Healthy Lives reinforce the view that this is the core business of local government? How will Marmot be interpreted? Reduced resources – impact on public health budgets Accountability – who is responsible? Partnerships dependent on personalities rather than embedded in culture

…and opportunities Financial constraint – never let a good crisis…. Total Place - and parallel places Localism General power of competence for councils Big Society - “put more power and opportunity into people’s hands”.

Martin Seymour Healthy Communities Programme