1. Learning from the past…… looking to the future The Director of Public Health’s Annual Report 2013 Wendy Meredith

2. Background to report 1972 Public Health moves from Council into the NHS 2012 Health and Social Care Act Comparison of then and now Future working

3. Looking Back…1972 “The outlook for people born in the last 20 years and who will experience this affluence for the whole of their lives must be a cause of great concern unless it is balanced by advances in medicine allowing earlier detection and treatment of this condition [CVD]” “It is extremely disappointing that a potentially preventable condition could appear in such numbers in the community”. “Many teachers whilst prepared to give simple factual health education talks, have felt anxious about dealing with more personal topics in the field of sex education, relationships and the abuse of drugs”. New technology in the form of an Answerphone service was established in April 1972 to increase clinic attendances. Dr. Ross reflected that having received 21,800 calls this was “fulfilling a much needed service in the town”. “These two nurses visit patients on discharge from hospital giving them full support in an effort to decrease the possibility of the elderly person having to be readmitted to hospital and also to give them the confidence to continue to live in the community”. “These two nurses visit patients on discharge from hospital giving them full support in an effort to decrease the possibility of the elderly person having to be readmitted to hospital and also to give them the confidence to continue to live in the community”.

4. Demographics and Health Need Bolton Population 276,800 24.2% increase in births between 2002 and 2012 15% of population over 65 years

5. Demographics and Health Need continued……. Coronary Heart Disease Stroke Respiratory disease Lung (& other) cancer Obesity & associated conditions Alcohol Mental Health

6. Recommendations Ensure JSNA develops as a vital resource to support health and social care and wider public service reform Engage with local commissioners to identify how Boltons Health Matters can be improved to better meet their needs Enhance and develop the Children and Young People’s element of the JSNA Develop a systematic approach to gathering, interpretation and presentation of data Undertake needs and asset assessments which focus holistically on cohorts of people.

7. Integrated Health and Wellbeing Services Significant advances in preventative healthcare in the last 40 years Demand for services continues to outstrip available resources Positive outcomes and good patient experience depend upon services working together A life course approach to commissioning and developing services to ensure prevention is embedded in the practice of all

8. Recommendations Ensure the effective delivery of the Early Years model, prepare for the implementation of the new model for Health Visiting and the Council’s new commissioning responsibilities Re-design the Healthy Child Programme for school age children focusing on the most vulnerable groups Further strengthen and expand the provision of services to improve mental health and wellbeing and ensure that key cohorts in the population get the service they need. Further develop opportunities within primary care to help people stay well by systematically addressing individuals’ health and social care needs. Further develop and implement the Bolton Integrated Health and Social Care model to expand and improve multi-disciplinary care across the borough

9. Health Protection Deaths from infectious diseases have reduced dramatically since 1972 Increased vaccination and development of robust screening programmes STIs remain a challenge, emergence of HIV and importance of early diagnosis Good hand hygiene remains a simple but effective tool in controlling the spread of infection

10. Recommendations Improve engagement with communities to increase vaccination uptake rates Target work to increase flu vaccination uptake in pregnant women and front line health and social care staff and increase pneumococcal immunisation uptake, especially in women. Increase activity to ensure that those communities most at risk of developing TB have improved,work needs to continue to reduce the stigma associated with the disease and to better enable individuals who have tuberculosis to successfully complete treatment. Continue to focus on sexual health improvement, good sex and relationships education and improved access to sexual health services Increase awareness of infection prevention and control interventions

11. Health Improvement Health behaviours influenced by more than knowledge Affluent more likely to adopt healthier behaviours Action at population, community and individual level to enhance outcomes Use of social media and new technologies Shift to the concept of “wellbeing” Health as “everybody’s business”

12. Recommendations Explore further the potential of social media in supporting the achievement of health improvement outcomes (whilst being aware that not everyone has digital access). Evaluate and learn from pilot programmes and initiatives such as Farnworth Healthy Weight in order to ensure best use of limited resources. Continue to identify and improve health outcomes for vulnerable groups including Black and Minority Ethnic and new and emerging communities. Continue to target and develop actions to improve the quality of private sector housing particularly the private rented sector.

13. Moving Forward Ensuring delivery of our statutory duties Assurance in respect of the health protection of Bolton’s population Improving life chances for children: Early Years new delivery model Linking health and education: commissioning 5-19 children’s health and wellbeing service Tackling long term conditions: further develop early recognition and swift referral Integrating health and social care: Staying Well Developing an Asset based approach to community development Developing use of new technologies and social media to improve health

14. …. and finally “Much has changed in the last 40 years since Dr Ross’s day. The NHS has experienced many reorganisations. The transfer of public health responsibilities back to where they belong in local government offers the greatest opportunity to improve the health of Bolton people in the next 40 years – public health has come home” Wendy Meredith, Director of Public Health’s Annual Report 2013

15. Driving the partnership – Tackling health Equalities Vision Steering Group September 2014

16. Health Inequalities – Key Issues People living in the poorest neighbourhoods in England will on average die seven years earlier than people living in the richest neighbourhoods and spend more of their lives with disability It is estimated that the annual cost of health inequalities is between £36 billion to £40 billion through lost taxes, welfare payments and costs to the NHS Action on health inequalities requires action across all the social determinants of health, including education, occupation, income, home and community

17. The Data – Comparison of Bolton with the rest of England Life expectancy in Bolton is 1.7 years less than the rest of England Bolton has the widest “internal” inequality gap of our peers (between most and least deprived neighbourhoods) 12.1 years for men 9.2 years for women

18. Wider determinants of health

19. Health Inequalities are preventable – National recommendations (Marmot) 1. Give every child the best start in life 2. Enable all children, young people and adults to maximise their capabilities and have control over their lives 3. Create fair employment and good work for all 4. Ensure healthy standard of living for all 5. Create and develop healthy and sustainable places and communities 6. Strengthen the role and impact of ill-health prevention.

20. Our current strategy in Bolton The Health & Wellbeing Strategy A life course strategy from starting well to end of life Progress and priorities: Keeping children healthy (Early Years PSR pilot work; Developing Well Sub Group of the Children’s trust) Healthy adults at work (Borough Skills agenda and Working Well pilot) Community support for our older people (Health & Social Care integration) Key partnership contributions: housing; Skills and anti-poverty strategy

21. Discussion - What more can we do? What more we can the voluntary and community sector across the spectrum of health determinants? Specifically: –Creating fair employment and good work? –Ensuring healthy standard of living for all? –Creating and developing healthy and sustainable places and communities? How do we take this forward?