broxbourne scrutiny public health update april 2017
TRANSCRIPT
www.hertsdirect.org
Public Health Update and next steps11th April 2017
Prof Jim McManus, Director of Public Health,
Hertfordshire County Council
Scrutiny Committee, Broxbourne Borough Council
www.hertfordshire.gov.uk
A word of thanks
• I wont cover the significant work going on locally led by Broxbourne members and Officers, I’m assuming you’re aware of this
• But I do want to say a heartfelt thank you for what you do
www.hertfordshire.gov.uk
Some of what HCC PH do for Hertfordshire • 142 workstreams ranging from health protection to
health improvement
• 40 staff on commissioning and technical/specialist side
• £50m budget reducing to £46
• 35,000 hours of school nursing a year
• 8000 hours of health visiting a week
• 60,000 people using sexual health services
• 15,000 children weight measured every year
• 96% of children get hearing and eye screening
• Immunising children and young people
www.hertfordshire.gov.uk
Layers of what we do
CommissioningProvided by NHS, Schools, Third Sector, GPs, Private SectorLargest HealthWalks programme in UK
Drugs and Alcohol, Sexual Health, Child Measurement, School Nursing, Health Visiting, Health Improvement, Preventive Work, Contraception, Smoking Cessation, HIV Testing
Assurance, Safeguarding•HCV Infected healthcare worker•Rare disease outbreaks•TB Control Board•Infection control in care and nursing homes•Child Death Overview Panel•Health Visitors and MASH
Cancer ScreeningMentally Disordered OffendersDiabetes ScreeningVaccinations, ImmunisationsHealth Protection,NHS Resilience, novel diseases
Advice Licensing, Pathways for CareScientific Issues NHS Spend and Commissioning
“System Leadership” JSNA, PNA, Specific ReviewsCAMHS ReviewStrategic Prevention Workstream
Partnerships. PH Board Partnership with Districts and other key partners
www.hertfordshire.gov.uk
Some current projects
• JSNA
• Get Active
• Mental Health
• Suicide and Self Harm
• One You
• Service redesign
• Safe and Well checks
• National Diabetes Prevention Programme
• Physical Activity and Health
www.hertfordshire.gov.uk
Big Strategic Issues for us all
• Sport Strategy
• NHS STP
• Strategic Shift to Prevention
• Finances
• Demographic Growth in Demand
• Continuing Health Challenges
• Air Quality
www.hertfordshire.gov.uk
Recent Wins
• Smoking prevalence reducing in most areas
• 2 Social enterprises getting people off drugs and into employment
• 650 workplace mental health advocates
• Suicide rate reducing and one of lowest in England
• Infection control in care homes
• 85% of injecting drug users protected against Hepatitis B
• HIV late diagnosis going down for five years (slowly)
• Mental Health Champions
www.hertfordshire.gov.uk
Recent Wins
• Year of Mental Health
• Air Quality Equipment funded by PH
• £0.4m spent on making leisure services disabled accessible
• CAMHS Review and £2m CAMHS investment from DH
• £160k from DoE for School Mental Health
• £2.5m from Sport England across County
• New, effective Health Improvement interventions
• Reducing suicides
www.hertfordshire.gov.uk
Health Protection
• A multi agency Health Protection Committee comprising Districts, Boroughs, County and Public Health England meets.
• partnership working across the local government family
www.hertfordshire.gov.uk
The problems• Early and avoidable disability and disease
• Early avoidable death
• Smoking prevalence uneven
• Obesity rising in adults, flattening in children in most places, rising in some
• Alcohol related disease on the increase
• Preventable cost to public health
• Multiple needs, worklessnessThe Tartan Rug and local profiles give much more info on this
www.hertfordshire.gov.uk
History and Funding• 2012 – PCT total Child Obesity budget £20,000 (yes £20k) (not
including NCMP); 2013 healthy weight into Health and Wellbeing Strategy
• 2015• Child Healthy Weight – £499k (Excluding NCMP)
• Beat the Streets £100k
• School Nurses £4.02m
• PH funding to School Catering £100k
• Full time nutritionist in School Catering £60k
• Cycling Training and Support in Schools £60k
• Planning and Environment workstreams
• Major physical activity programmes
• Disabled Access to physical Activity £250k
• Two district councils with major focus on Child Obesity and Stevenage
• Share of £1m District Council Partnership Funding
www.hertfordshire.gov.uk
Adult weight management schemes
• 10,359 residents referred to the programme so far: • free access to one course• for people who are obese
• Evaluation: (5,000+ people)• 62% completed the 12 week
programme – above national standards
• ⅔ completers lose 5%+ of body weight – a significant benefit to their health
www.hertfordshire.gov.uk
Men’s Weight Management • “Shape Up” with Watford FC
– Male focused, to increase uptake, following evidence
– Good results – • 3361 donuts “lost” by first cohort
• 206 men started, ¾ complete
• Half of completers benefit significantly
– Potential for external funding
www.hertfordshire.gov.uk
Public Health
• £54m budget reducing to £46m
• Growing need
– Demographic pressures sexual health
• Burden of avoidable ill health growing
• Burden of avoidable disability growing
www.hertfordshire.gov.uk
Strategic Challenges
1. Delivering core public health must dos for less
2. Service Redesign (Children)
3. Preventing cost and adverse outcome (Falls going up in some areas)
4. Levering whole system redesign and prevention using everyone’s resources to save money and improve outcomes
5. Using PH skills within this to best advantage for the system
6. Using PH budget within this to best advantage for the system
www.hertfordshire.gov.uk
Strategic Priorities
• Shift to prevention by everyone esp primary and secondary care
• Physical activity as part of this
• Mental health and resilience – social prescribing
• Redesign mandated services to cost less but but keep outcomes
• Better outcomes through integration?
www.hertfordshire.gov.uk
One You
• One You aims to help people recognise that they have the power to change and provides them with practical advice to make it easier to do so.
• As part of the campaign, people are being encouraged to take an online quiz to see how healthy they are: www.hertsdirect.org/oneyou
www.hertfordshire.gov.uk
One You Day 7 July
• The way in which you can contribute is entirely up to you, but could include:
• promoting the campaign visually with posters and leaflets
• If you require more information or would like to request some materials please contact Gemma McKelvey in comms [email protected] or 01992 555567 (25567)
www.hertfordshire.gov.uk
What is Prevention?
• The avoidance, whether permanent or temporary, of need for public service or an adverse event/hazard or exposure leading to need for public service
– SHORT TERM (eg up to 24 months)– MEDIUM TERM (eg 2-5years)– LONGER TERM (eg 5 years plus)
• Prevention is NOT rationing or restricting eligibility
© Copyright, 2017 Hertfordshire County Council Public Health
www.hertfordshire.gov.uk
Levels of Prevention• three levels. Preventative activities may be delivered by any
agency.
• Primary Prevention – ‘prevent’ or stop harm or need for service arising in first place – physical activity, recycling
• Secondary Prevention – ‘reverse’ harm or need for service – rehabilitation
• Tertiary Prevention – ‘reduce’ or mitigate harm/need for service – an Anti Social Behaviour Order? A wheelchair for a diabetic foot amputation
© Copyright, 2017 Hertfordshire County Council Public Health
www.hertfordshire.gov.uk
Prevention Pyramid – Adults(with thanks to Jeanelle de Gruchy, DPH Haringey)
www.hertfordshire.gov.uk
Prevention Pyramid – Children(with thanks to Jeanelle de Gruchy, DPH Haringey)
www.hertfordshire.gov.uk
Mainstreaming Prevention
Herts & West Essex Governance Structure v4
Healthier Population
needing fewer specialist
resources
www.hertfordshire.gov.uk
Prioritising Prevention – the Decision Cycle
What population?
What issue/need?
What outcomes do we want?
Which interventions fit
best?
How do we know it’s working?(Evaluation)
1. Service cost and demand
2. Needs (JSNA)
Define the outcomes clearly so you can really assess
feasibility
1. Financial Assessment2. Evidence Assessment
3. Logic mode where evidence silent
1. Financial Assessment2. Outcome Assessment
Questions to ask Tools for HCC
www.hertfordshire.gov.uk
Mainstreaming Prevention
Herts & West Essex Governance Structure v4
Healthier Population
needing fewer specialist
resources
www.hertfordshire.gov.uk
Developing Work
• Herts, Haringey, Sheffield and Kirlees forming a “prevention led council” learning set
• ADPH and LGA working on a national narrative for prevention
www.hertfordshire.gov.uk
Levels of Prevention
• three levels. Preventative activities may be delivered by any agency.
• Primary Prevention – ‘prevent’ or stop harm or need for service arising in first place
• Secondary Prevention – ‘reverse’ harm or need for service
• Tertiary Prevention – ‘reduce’ or mitigate harm/need for service
www.hertfordshire.gov.uk
Reducing the need and spend curve: Preventing avoidable spend in public service
Volume of spend
Severity
Existing curve
The Achievable curve?
Reduce or delay need here
Highest cost. Reduce and delayNeed here
Intervene here before needescalates
www.hertfordshire.gov.uk
HCC Strategy for prevention
• Identify those areas which will generate best returns (demand management or activity reduction) first and work on them
• Assess if this is primary, secondary or tertiary using the decision cycle
• Assess feasibility
• Implement
• Provide a basis for decisions for investment or disinvestment
www.hertfordshire.gov.uk
Prioritising Prevention – the Decision Cycle
What population?
What issue/need?
What outcomes do we want?
Which interventions fit
best?
How do we know it’s working?(Evaluation)
1. Service cost and demand
2. Needs (JSNA)
Define the outcomes clearly so you can really assess
feasibility
1. Financial Assessment2. Evidence Assessment
3. Logic mode where evidence silent
1. Financial Assessment2. Outcome Assessment
Questions to ask Tools for HCC