1. Councils at the Heart of Health Reforms Ian Gray CIEH, Chris Shaw Sheffield City Council & Sandra Whiles Blaby District Council

2. Today's Menu A bit about : the challenges the reforms our potential the outcomes frameworks our offer ladders of intervention group work

3. A Few Challenges Health inequalities – people, places and power An ageing population Families with complex needs Youth unemployment System changes Limited resources

4. What's Going On? Reform To improve or change for the better To give up a bad habit Re-form To form anew

5. NHS Commissioning Board Clinical Commissioning Groups (CCGs) Public Health (PH) England Local Government The New Health System Health Protection Agency National Treatment Agency Regional PH teams PH Observatories Cancer registries Most commissioning of healthcare services locally Health and Wellbeing Board Public health: improvement, protection, care Joint Strategic Needs Assessment (JSNA) (with CCGs) Joint commissioning Local Healthwatch Primary care: GPs, Dentists, Pharmacists, Optometrists Specialised commissioning Prison health Immunisation Public Health 0-5yrs

6. A Moment in Time? Central strategic leadership to give a context for local action Locally led - councillors and GPs A new vision for Public Health – “wellness” should be central to all we do” Outcomes frameworks to energise and motivate Dedicated resources for Public Health to promote a strategic approach to prevention

7. A Few Things to Keep us Busy? Setting up new structures quickly which engage, influence and deliver Big challenges with limited solutions or resources Learning new skills Professional worries Building new relationships Establishing a sustainable performing culture

8. Special Relationships & Structures Health &Wellbeing Board Clinical Commissioning Groups Local authority Health Champions Local Health & Well Being Forums Local Councils and the Community Local Health watch Businesses Third sector

9. Health and Wellbeing? Not being ill and feeling okay about life? What makes folk feel okay about life? (salutogenesis )

10. Planning Housing Environmental Health Sport and Leisure Waste …and all the contacts the council has with the public

11. What Will be Different in the Future? Do we? Give Pooh Bear a tablet Take him into hospital to bandage his head Fit a stair lift Install telecare equipment to support Pooh Bear's independence Change our policies to increase the number of accessible homes

12. Are You a Chadwick or a Snow or Doesn't it Matter?

13. A Leicestershire Approach A wider strategic approach to deliver better outcomes in our place – around issue and place Visible leadership around culture and healthy challenge Pragmatic doing - not waiting for permission Risk management

14. Leicestershire's Partnership Structures – Simplified!

15. What Levers Can We Use? Make the JSNAs and H&WBB strategies useful Integrated commissioning Use the outcomes frameworks as a performance management tool Evidence of what works Shared commitment to make the difference Reputation

16. The Outcome Frameworks Public Health The NHS Adult Social care What about children?

17. Public Health Outcomes' Framework “To improve the nations health and wellbeing and improve the health of the poorest fast” Outcome 1 :Increased healthy life expectancy Outcome 2 : Reduced differences in life expectancy and healthy life expectancy between communities

18. Public Health Outcomes Framework Improving the wider determinants of health Health improvement Health protection Healthcare public health and preventing premature mortality

19. NHS Outcome Framework Preventing people from dying prematurely Enhancing quality of life for people with long- term conditions Helping people to recover from episodes of ill health or following injury Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm

20. Adult Social Care Outcome Framework Enhancing quality of life for people with care and support needs Delaying and reducing the need for care and support Ensuring that people have a positive experience of care and support Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm

21. Every Child Matters Be healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic well-being

22. Public Health, Environmental Health:-So What? Chris Shaw Director of Health Improvement Sheffield City Council

23. We Get It, So What?

24. Learning from History PH in local government was led by medical men for much of 19 th and 20 th centuries People working for them, engineers, inspectors of nuisances, HVs MoH, powerful influences on the work undertaken MoH constrained - what council was willing to pay for and what it believed would be effective Webster - MoHs did not act collectively esp on poverty Up to 1974 responsible for sanitation, prevention, housing, waste, health services for women and children, school health, etc Since 1974, attention dwindled, some arguing why should we do it, it’s the NHS job?

25. Local Government – The Public Health Service 25% Health Care System 15% Genes 10% Physical Environment 50% Social & Economic Environment An individuals life circumstances contribute more to health improvement than health care services Local government is best placed to change life circumstances and improve health Estimated Health Impact of ‘Determinants Of Health’ on Population Health Status Source: Canadian Institute for a Advanced Research

26. Double Vision? Faculty of Public Health, CIEH – spot the difference ‘Leading, inspiring and delivering a safer, cleaner and healthier world.’ ‘The world’s population achieves and maintains its fullest potential for health and wellbeing’

27. Wave Theory Public health has delivered in waves over the decades – from the classic water and sanitation of 1800s, to scientific advances into 1950, the post war welfare developments (including the NHS) and risk factor and lifestyle issues from 1960 to now# This combination of reforms and a change in the health ‘concerns of the generation present a massive opportunity for redefining a relationship which has always existed but changed with progress in other fields #Afternow – Phil Hanlon Glasgow University

28. The EHO View of the World

29. LA Services to PH Solutions

30. What Are You Selling? activityDPH Comments Current regulatoryThat would happen anyway Current CampaignsShow me the evidence of impact Community focussed activityHow is that better than ours? New investmentWhat should I stop doing?

31. Observations CCG’s have too much to do, you will do well to engage them or GP’s, you have too much to do too. Everyone wants a place on Health and Wellbeing Boards DPH’s are not inclined to change their ‘commissioning’ plans Members will be on your side. PH practitioners do not know as much as you about communities. PH evidence isn’t all its cracked up to be. EH will have to rethink its role and relationships if it is to be involved, Institute can help. Think health concerns – long term conditions, mental health, older people Think Political concerns- Inequality, vulnerable communities, strategic priorities

32. Ideas Health and safety- local accident data, Lofstedt, different intervention, Food – what are the PH threats? Food strategy, salt, transfats, Combine Protection with Improvement Housing- vulnerable communities, private rented, fuel poverty, Cat 1 hazards Wellbeing + resilience – opportunity?

33. We get it, so what –next ?

35. Ladder of Interventions

36. So What Do We Have to Offer? Group work