1. Iechyd Cyhoeddus yng Ngogledd Cymru / Public Health in North Wales
13 Mehefin / June 2011
Cyflwynydd / Presenter: Andrew Jones
Cyfarwyddwr Gweithredol Iechyd Cyhoeddus / Executive Director of Public Health
Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board
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2. Trosolwg Overview North Wales / BCU Health Board
Service Delivery Model - North Wales Public Health team
Public Health Priorities/Our Healthy Future
LHB
LAs and other partners
Key Achievements
Next Steps
Gogledd Cymru / Bwrdd Iechyd PBC
Model Darparu Gwasanaeth – tîm Iechyd Cyhoeddus Gogledd Cymru
Blaenoriaethau Iechyd Cyhoeddus/ Ein Dyfodol Iach
Bwrdd Iechyd Lleol
ALlau a phartneriaid eraill
Cyraeddiadau Allweddol
Camau Nesaf

3. Role of the DPH
LHB – public health executive leadership, advocacy and action
LA – executive leadership, interagency partnership for population health improvement
Public Health Wales – specialist input
Unified Public Health System and Leadership Team

4. "the labour of such officer will do much to remove the ignorance which has permitted such evils to arise, to arouse the apathy which allows their continuance, and to overcome the opposition which impedes their removal. Such officers would show the fearful amount of suffering disease and death produced for want of means for bringing pure water into the town, and for taking foul water out of it. They would prove that the losses occasioned by avoidable sickness and its consequences reduce a well paid population to poverty“
P H Holland, 1853

5. North Wales Profile North Wales Demographics
Variation in health outcome
North
Wales
Total population
678,500
2,980,000
Life expectancy at birth: males
77.2 years
76.8
Life expectancy at birth: females
81.5 years
81.2
% population from ethnic
minority background (2001)
1.0%
2.1%
Total number of births
7,570
34,572
Total number of deaths
7,448
32,148
% lower super output areas in
most deprived 5th of Wales
12%
20%
Source: Public Health Wales

6. Betsi Cadwaladr University Health Board
Largest in Wales - 18,000 staff, £2.1 billion budget, 3 District General Hospitals, 121 GP practices
Clinically led : 11 Clinical Programme Groups, 14 primary and community ‘localities’
Key relationships with:
Chiefs of Staff (senior team, ‘operations’ and nursing)
Other corporate support (finance, planning and performance)
Partnership with 6 local authorities, North Wales Police and North Wales Fire and Rescue

7. Bringing People and Services Together across North Wales
Strategic Aim
based on 5 themes: Making it Safe, Making it Better, Making it Sound, Making it Work, Making it Happen
To provide a “world class” health service in North Wales that:
Improves the health and wellbeing of the population
Provides an excellent experience no matter who, or where, or what language
Reduces the cost of health provision per capita

8. Practicing Public Health Organisation
IMPROVING THE HEALTH OF OUR POPULATION
WHAT PEOPLE WHO USE OUR SERVICES EXPERIENCE
THE COST OF DELIVERING SERVICES
Puts the TRIPLE AIM
at the centre
Focused on population health
OUTCOMES

9. This means Focused upon improving population health outcomes
Services are designed to meet need
Continuous quality improvement, reduction in waste, harm and variation
More care provided outside of an acute hospital setting through primary and community health and social services
Emphasis on independence and supported living at home or in communities
Complex care delivered in centres of excellence
No longer will healthcare be measured in terms of beds and buildings but rather services and health outcomes

10. Clinical Programme Groups (CPGs)

11. Local Public Health Team Service Delivery Model
Single local Public Health team (consultants and practitioners) – based on agreed Public Health Wales principles
Full engagement – all local staff (including feedback from project board and consultation on local DPH proposals)
Support to HB and LAs – concept of primary purpose and special interest
Agreed fewer number of priority areas - linked to national programmes
Implemented 1 April 2011

12. Public Health – BCU Health Board (1)
Our Healthy Future embedded into 5 year plan and core business
Public Health Wales support to a clinical leadership model
Clinical Programme Groups/Individual Chiefs of staff taking champion roles for Public Health priorities - including performance

13. Public Health – BCU Health Board (2)
Corporate governance – reports to Board and committees on key PH issues, health improvement, health protection, screening
DPH part of corporate business: finance, partnership, organisational and workforce development, scrutiny
Engagement with primary care and localities

14. BCUHB Localities

15. Public Health System: Bringing it all together(1)
Health Protection: immunisation, communicable disease/environmental hazard, hospital associated infection
Screening: national programme delivery, transformation of services e.g. cytology, emergency surgery
Public Health Wales Observatory – Service reviews, population profiles

16. Public Health System: Bringing it all together (2)
WCISU – investigation, service transformation
Safeguarding
Academic collaboration
Communications – all of the above!

17. Local Government DPH and specific team support to each LA
Individual and collective engagement e.g.
North Wales leadership group (chief executives)
Area Planning Board (substance misuse)
LA representative on LHB Management team
Health Social Care and Well-being, Children and Young People Partnerships
Agreed key priorities for collective action (outcome focused using Results Based Accountability model)
Ongoing development

18. Academic Focus Research, teaching and training 5 Specalist trainees
Influence of BCU academic strategy
Joint working with Universities, Bangor and Glyndwr
Health Economics
Adding to evidence base e.g. CHARISMA ( housing, health, child poverty)
Transformational research?

19. Workforce Development
Staff learning from transition – CPGs etc
Local team development – who we are, what we have and what we don’t
Journal club – local learning and challenge
Leadership for transformation – learning alongside HB colleagues
Developing the ‘virtual’ Public Health team – Nursing, clinicians, LA staff
Learning from others – collaboration with Liverpool PCT (& North West England)

20. Key Achievements: Health Improvement
Local ‘Our Healthy Future’ (Local Public Health Strategic Framework)
Outcome focused approach linked to 5 year strategic plan and annual quality framework
Whole system approach
HB clinical leadership – strategic and operational
Agreed action plans for tobacco & alcohol
‘Upstream’ embedded into service transformation

21. Key Achievements: Health Services Quality (1)
Major service reviews/transformation
DPH: Exec Chair of Emergency General Surgery Review
Needs assessment and literature review for Unscheduled care, Maternal and child health, Emergency surgery, Orthopaedics, Endoscopy, Haematology (local and Observatory support)
Cytology (screening input)
Joint Review of Microbiology Services

22. Key Achievements: Health Services Quality (2)
Development of primary and community care
Localities
Primary care engagement
Support to policy development and review – Individual Patient Commissioning

23. Key Achievements: Health Protection
Response to swine flu and winter pressures
Hanson Cement Investigation – community concern
Support to consultation on development of new nuclear power station – inclusion of formal Health Impact Assessment in application process
Economic regeneration – ‘Energy Island’

24. Community Engagement Being contactable Making contact
Sharing good practice
Sustainable communities
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25. Key Achievements: Communications
Working relations with central team
Examples of best practice in individual and multi-agency response
Support to HB communications team
Development of a model for the future

26. Key Achievements: Health Intelligence
Population profile on general health
Variation in surgical procedures (local and national)
Interim DPH annual report – population need
Detailed needs assessments and literature reviews e.g. on maternity and child health

27. Cyfarwyddwr Gweithredol Iechyd Cyhoeddus Adroddiad Blynyddol Executive Director of Public Health Annual Report .
Bydd yr adroddiad nesaf yn canolbwyntio ar y Blynyddoedd Cynnar ac yn cael ei gyhoeddi ym mis Gorffennaf 2011.
The next report will focus on the Early Years and will be published in July 2011

28. What should be done and what is being done in Wales?
Introduce self
Maternal & child health Consultant lead in NW
Support CPG & Review
Discuss regional work on early years & link to this national work
Reproductive and Early Years
What should be done and what is being done in Wales?
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Siobhan Jones

29. High profile
Thousands back campaign for maternity services in North Wales Oct by Owen R Hughes, Daily Post
An internet campaign to save maternity services and children’s wards at North Wales’ three main hospitals has already attracted 11,500 supporters.
Ysbyty Glan Clwyd doctors protest against maternity service cuts Oct by Alex Hickey, Daily Post
GPs maternity concern over North Wales NHS shake-up Sep by Tom Bodden, Daily Post
Parents’ fears on North Wales maternity review Dec by Eva Ketley, Daily Post

30. Whole System – Whole pathway

31. Next steps Year 2 of a 5 year plan
Implementing the new Service Delivery Model
Major project on programme budgeting – prioritisation, population outcome and cost
Implementing NHS service transformation
Delivery of agreed OHF actions (outcome, evidence base)
Contribute to Health Impact Assessment of Wylfa B and related developments
Public Health Wales – formalising local arrangements for DPH support - ‘whole team’
Reporting to Public Health Wales Board
Making clear links between ‘local’ and ‘national’ priority work
Realising the benefits of the Unified Public Health System

33. "the labour of such a unified public health system will do much to remove the ignorance which has permitted such evils to arise, to arouse the apathy which allows their continuance, and to overcome the opposition which impedes their removal. Such a unified public health system would show the fearful amount of suffering disease and death produced for want of bringing early years services and life skills into the town and supporting sustainable local communities within and around it. They would prove that the losses occasioned by avoidable sickness and its consequences reduce a well resourced population to poverty“
P H Wales 2011
Adapted from P H Holland 1853