1. Jim McManus Joint Director of Public Health Birmingham City Council

2. Prevent, Enable, Personalise, Realise some tentative experience from Birmingham COSLA Annual Conference 2012 Jim McManus Joint Director of Public Health Birmingham City Council 16 th February 2012 Delivering Success:

3. Public Service Reform – Big Tasks 1.Localism Act 2.Elected Mayors??? Errr... 3.NHS Reforms – public health, clinical commissioning groups, NHS Commissioning Board, Health and Wellbeing Boards 4.Police and Crime Commissioners 5.Open Public Services White Paper 6.Spending Review 7.Social Care Funding

4. Big Asks Do better with a lot less And by the way your population is still getting older, needier and growing And you will have a 25% increase in dementia And immigration will bring costly TB and CVD Oh, and you’ll have more folk with learning disabilities And they all have to have personal budgets

5. The basic message – complex relationships, big tasks Life circumstances Good outcome Bad outcome Behaviours The arrows include public services and access

6. The basic message – interventions = big asks Life circumstances Good Health Ill Health Behaviours

7. Birmingham Change Prevent, Enable, Personalise, Realise Major Change – reducing buildings, reducing costs, outsourcing, mutuals New single contract (50,000 people) New operating model for children – universal, targeted, special and complex New Operating Model for adult social care – prevent, enable, personalise Benefits realisation Radical new ways of doing things

8. New Ways of Working Not just rely upon commissioning Working with wide range of civil society partners Shared leadership of Health and Well-Being Board Support from HealthWatch Using new powers and new resources to create healthier communities

9. The Big Ask: What success looks like... £37million Range of targeted/ Flexible Services Support to service user /Citizens Number of those receiving preventive services Prediction and Prevention Self management Supported to stay in their Home Customer Satisfaction Increased Improved flexibility Increased Increased through joint interventions Increased through community resources People supported to manage LTC

10. Why does service change matter?

11. Life Expectancy against Core Cities MaleFemale England 78.382.3 Sheffield 77.881.5 Leeds 77.782.0 Bristol 77.281.9 Birmingham 76.481.3 Newcastle 76.281.0 Nottingham 75.280.3 Liverpool 74.579.2 Manchester 74.079.1 4 th out of 8 Male 5 th out of 8 female

12. Life Expectancy by Ward

14. Gaps in school readiness at 3 and 5 years by family income: UK Average percentile score Waldfogel & Washbrook 2008

15. National Audit Office 2010 not on course!

16. And what has got us there? Barriers to reform Focus, or lack of it Starting with a promising intervention, then making sure it is doomed to fail by tinkering about Scientific Grounding and Understanding of Need (or lack thereof) Partnerships – obsessed with structure and governance Poor integration of joint commissioning Cultures...Aaarrrghhh!!!!! Deficit – We know more than you

17. Not getting value of Intelligence in achieving Better Outcomes... Does anyone actually Really do all this? What did we achieve? Keeping on Track Prioritisation Best Buys/Best Dos Need

18. Writ across all Programmes 1.Telecare £14 million 2.Intelligence and Information Programme 3.Predicting need in social care 4.Data sharing with GPs 5.Diverting people from social care and hospital 6.Targeting young people to reduce risk 7.Worklessness 8.Decent Housing 9.Preventing Extremism 10.Enablement 11.Public Health Transition

19. Critical Success Criteria – Fire Service Falls Assessment Telecare Assessment JSNA and data sharing Population density of fire and need Sharing populations Well constructed outcomes based agreements

20. Health and Care: Our Burdens of Disease mean Prevention is wrong way round PrimarySecondary Tertiary

21. The Big Ask: What success looks like... £37million Range of targeted/ Flexible Services Support to service user /Citizens Number of those receiving preventive services Prediction and Prevention Self management Supported to stay in their Home Customer Satisfaction Increased Improved flexibility Increased Increased through joint interventions Increased through community resources People supported to manage LTC

22. Whole System plus focused action The example of health inequalities

23. The Conceptual Framework Reduce health inequalities and improve health and well-being for all. Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. A. Give every child the best start in life. C. Create fair employment and good work for all. B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 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. Equality and health equity in all policies. Effective evidence-based delivery systems. Policy objectives Policy mechanisms

24. The Golden Thread Need, OutcomesPriorities, Interventions

25. Health Inequalities : What we know Edinburgh World Congress of Epidemiology 2011 Non Communicable Diseases Impoverished understanding of behavioural sciences in some public health programmes Multiple Tracks. Public policy action in all of them

26. Policy History...Zzzzz Black Report 1982 (UK) Ottawa Charter 1986 (World) Health of the Nation 1984 (England & Wales) Our Healthier Nation 1998 (England & Wales) Healthier Wales 2000 (Wales) Choosing Health 2005 (England) WHO Commission on Social Determinants 2009 Marmot Review of Health Inequalities 2010

27. 2008

28. 2007

29. The upshot of all this is that whatever framework you use..... It’s the same problem!

30. The Big Tasks Short term challenge of tertiary prevention Medium term problem of keeping the ill well Short term problem of stopping avoidable events Long term problem of changing determinants of health, health expectations, behaviour and culture

31. The Big Tasks The Ask Short term challenge of tertiary prevention Medium term problem of keeping the ill well Short term problem of stopping avoidable events Long term problem of changing determinants of health, health expectations, behaviour and culture Who Social Care, NHS, Housing NHS, Social Care, Housing, Leisure NHS, Leisure Local government par excellence

32. Birmingham’s use of Marmot ActivitiesFramework 1. Adopt the Outcomes Starting well Developing well Living well Working well Ageing well 2. Add an outcome “dying well” 3.Cut our JSNA and Strategy across the Lifespan 4. Use as “golden thread” For Health Inequalities Action For JSNA For Health and Wellbeing Strategy For Integration As a lifecourse approach to human ecology

33. Examples of Marmot in practice LGBT MENTAL HEALTHPREVENTION Lifecourse approach using Marmot Early development Mental health problems onset Tasks for each lifestage Community and Public Sector tasks Interdependencies Use of Marmot Framework across lifecourse Tasks for adult social care and older adult social care elucidated Incorporation into third sector contracts with third sector Preventive workstream

34. Examples Start WellDevelop WellAge Well Adults & Communities High priority parents in touch with A & C TransitionOlder Peoples’ offer from prevention to very high need Homes & Neighbourhoods Overcrowding and infant mortality Decent Homes StandardAccess, Trips, Falls, Extreme Weather, Adaptability, DevelopmentBack to work packages Digital inclusion Back to work packages for parents Digital Inclusion Volunteering and work packages Digital Inclusion NHSInfant Mortality Conception Frail Elderly

35. Demonstrated The role of public health sciences in public service can be significant The role of behavioural sciences in public service reform can be significant Public health disciplines can be applied across public service reform

36. Thank You! Jim.mcmanus@birmingham.gov.uk