1. Welcome and scene setting Councillor Olwen Hamer, Chris Dawes and Professor Zafar Iqbal

2. CARING CITY HEALTHY CITY Health Promotion, Improvement & Community Development Council, Public Health, Care System & Communities SUCCESSFUL – WORKING CITY Economy, Employment, Education, Housing, Security & Environment Council & Partners Care System NHS, Social Services, Third Sector & The Individual STOKE 2012 - 2020

3. Professor Zafar Iqbal Acting Director of Public Health

4. Why Now ? Eye of an economic storm Health of most vulnerable and poorest Evaluation of pioneering programmes Assets and community empowerment A City Council with a PH outlook Mandate for Change Opportunity for Refresh and Renew

5. Baby Born to affluent parents – will live 10 years longer than Mark Baby One of teenage conceptions. Will live 10 years less than Charles Aged 10 Enjoying a good life, lots of opportunity to play sport Aged 10 Growing up in poverty Aged 20 At university with 10 x A* at GCSE. Plays rugby and eats a healthy diet Aged 20 Left school with no qualifications, casual labourer, drinks, smokes and takes drugs Aged 45 Fit and healthy businessman, manages stress by playing squash Aged 45 Weighs 18 stone, has high cholesterol, type 2 diabetes Charles Mark Aged 60 Died from massive stroke Aged 60 Retired early to spend time with his grand- children and travel

7. Estimated impact on public’s health and well-being – role of the local authorities 50% Social & economic environment 15% Genetic endowment 10% Physical Environment 25% Illness Care System Source: Canadian Institute for Advanced Research

8. “ Health-related behaviour is all about resolutions to give up the things you do not want to give up and to do the things you do not want to do. You cannot do that; you cannot make the resolutions and stick to them, unless you are feeling on top of life”. ( Richard Wilkinson giving evidence to the House of Commons Health Select Committee, 2008)

9. “The Story So Far”

10. Infant mortality in SOT between 1973 and 2000 Office for National Statistics 2007

11. Interventions Scale – visible from space Intensity – improve the poorest fastest Local needs – local intelligence Ambitious - risks

14. Cobridge Community Health Centre The new three storey community health centre will bring together three local GP practices with a combined patient list of 11,000. The building will also include a wide range of health services including: District nursing, health visiting, school nursing Adult physiotherapy, podiatry, occupational therapy and speech therapy Integrated sexual health unit including Genito-urinary medicine (GUM), contraception and Chlamydia screening A pharmacy A chest clinic and other outpatient services Specialist out-patients clinics X-ray

15. Impact 15,000 health checks 5,000 more young people accessing sexual health 5,000 lifestyle programme Record numbers of smoking quitters 5,000 diabetics better blood sugar control Ambition to have 1000 community health champions

16. Percentage improvement in health indicators in SOT NHS Stoke-on-Trent 2012

17. 2011 Health2011 Health Profile for SOT (1) Profile for SOT (1) Association of Public Health Observatories 2011

18. Vision Inspirational and ambitious Galvanise/empower communities to raise aspirations Grounded in JSNA and evidence Shift treatment to early intervention to prevention Cover all influences : place, communities and services Root causes – Mandate For Change

19. The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.“ Michelangelo

20. Appreciative Inquiry Introduction and the principles of the approach Trevor Hopkins Asset Based Consulting

21. “Good organisations know how to preserve the core of what they do best. Preserving the right thing is key. Letting go of other things is the next step” David Cooperrider

22. Appreciate – Valuing, recognising the best in people or the world around us, affirming past and present strengths, successes and potentials Inquiry – The act of exploration or discovery or to ask questions and be open to seeing new potentials and possibilities. Definition

23. Principles Reflection – remembering times when our culture, values and identity made us proud. Affirmation - inquiring into those strengths and how we can use them to create the future Action – practical planning towards the future

24. First some background Traditional approaches to development: Identify problems and barriers to progress Maybe analyse why the problems exist Propose solutions Create an action plan Also …assign fault or blame Focus attention on what is missing, and the gaps Can sap energy and motivation

25. Characteristics Appreciative - AI looks for the ‘positive core’ of the organisation and seeks to use it as a foundation for future growth Applicable - AI is grounded in stories of what has actually taken place in the past and is therefore essentially practical. Provocative - AI invites people to take some risks in the way they imagine the future and redesign their organisation to bring it about. Collaborative - AI is a form of collaborative inquiry. It always involves the whole system or a representative cross-section of the whole system.

26. The Appreciative Approach Focuses on existing resources and capacity Identifies what is desirable Creates energy, interest and motivation

27. The appreciative cycle Define Discover Vision Design Deliver

28. Definition: “What would Stoke on Trent look like if it was a healthy city by 2020?”

29. Discover Appreciative interviews Discussions in pairs

30. Appreciative interviewing Can you tell a story of a time when you made a positive change to improve your own health and wellbeing? What do you believe is now the single most important thing that positively influences your own health and wellbeing? Now turning to your work; can you tell a story of how you involved others as equal partners in bringing about real and sustainable change? Imagine your community, your friends, your family, your colleagues and the wider community in Stoke on Trent telling stories about how you have worked together as equal partners to achieve your dreams of a healthy community. What would these stories be?

31. Sharing your stories

32. Vision The six Marmot Policy Objectives

33. Delivering Together on the Social Determinants of Health in Stoke on Trent Visioning event 5th March 2012 Dr Mike Grady. Principal Adviser Institute of Health Equity UCL

34. The CSDH – closing the gap in a generation The Marmot Review – Fair Society Healthy Lives Review of the Social Determinants of Health and the Health Divide in the WHO European Region

35. Male life expectancy at birth, local authorities 2008-10

36. Female life expectancy at birth, local authorities 2008-10

37. Life course PrenatalPre-schoolSchoolTrainingEmploymentRetirement Family building Prevention Early YearsSkills DevelopmentEmployment and Work Accumulation of positive and negative effects on health and wellbeing Healthy Standard of Living Sustainable communities and places Life course stages Areas of action 37

38. A.Give every child the best start in life B.Enable all children, young people and adults to maximise their capabilities and have control over their lives C.Create fair employment and good work for all D.Ensure healthy standard of living for all E.Create and develop healthy and sustainable places and communities F. Strengthen the role and impact of ill health prevention Strategic Drivers. Fair Society: Healthy Lives: 6 key Policy Objectives

39. Fair Society, Healthy Lives (Marmot Review) Health inequalities are not inevitable or immutable Health inequalities result from social inequalities - ‘causes of the causes’ – the social determinants Focusing solely on most disadvantaged will not be sufficient - need ‘proportionate universalism’ Reducing health inequalities vital to economy - cost of inaction

40. Local Government Complex, disparate and diverse systems of Local Government. Focus on needs of local population and place. Differing capacities to orchestrate action to address the social determinants of health. Whole System Leadership Increasing participation and empowering communities.

41. Health,Wellbeing and resilience Evidence participation and improving life skills ameliorates impact of health inequalities through developing social support networks. (Bynner and Parsons 2006) Learning and skill development impact positively and fosters community action. “ I have learned..I use my counselling skills with my family. I listen more and I know my daughter will say I am really proud of what you are doing,Mum “ (Jane) Social networks create the conditions in which people thrive “ I would say that people in the group have more confidence. At one poInt they would have been sat at home doing nothing,now they are out and are involved. Once you get there it ‘s amazing to see how far you can go.” (Joyce)

42. Creating conditions in which individuals and communities have control over their health and lives and participate fully in society

43. Vision What would things be like in Stoke if it was a healthy city in 2020......?

44. Break

45. Vision and outcomes Trevor Hopkins

46. Definitions Vision (Dream) Outcome Indicator Performance Measure

47. Vision Outlines what the organisation wants to be, or how it wants the world in which it operates to be (an "idealised" view of the world). It is a long-term view and concentrates on the future. It can be emotive and is a source of inspiration. For example, a charity working with the poor might have a vision which is "A World without Poverty."

48. Outcome “A condition of well-being for children, adults, families or communities” All babies born healthy All people enjoy good mental health All people live in safe communities All people enjoy a clean environment All people benefit from a prosperous economy Positive, jargon-free statements of well-being in plain language that people can understand “A condition of well-being for people in a place......”

49. Indicator A measure which helps quantify the achievement of an outcome. 16+ current smoking prevalence Incidences of self harm All age, all cause mortality rate Adults with learning disabilities in employment Rates of serious violent crime rate How would we recognise these outcomes in measurable terms if we tripped over them?

50. Performance Measure A measure to evaluate how well a programme, agency or service system is working. Three questions: How much did we do? (quantity) How well did we do it? (quality) Is anyone better off as a result? (quantity and quality of effect or customer/client outcomes) Performance measures tell us how well service providers are working as opposed to the impact on whole populations

51. From ends to means Population Accountability Outcomes “A condition of well-being for children, adults, families or communities” Indicators “A measure which helps quantify the achievement of an outcome” Ends Performance Accountability Performance Measures “ A measure to evaluate how well a programme, agency or service system is working” Means

52. Priorities What is most important to us?

53. Prioritisation Six coloured sticky dots each Move around the room Read what others have said If it helps, interact with other people Vote for your six most important outcomes If you feel particularly passionate or committed to one particular outcome you can sign up to this with your name and telephone number/email address

54. What next? Vision, outcomes and priorities from this session to be presented at the Health & Well-being Board for discussion and agreement A further workshop to be held (possibly in April/May) to take forward the ‘Design’ and ‘Delivery’ of the vision for health and well-being in Stoke by 2020. The ‘vision’, JSNA, annual report and strategic framework to be launched in June/July 2012

55. Closing Comments Blank box for Trevor to insert bullets of the key points from today’s session