Putting Prevention and Health Promotion into Practice in EU Regions North West England

1. Putting Prevention and Health Promotion into Practice in EU RegionsNorth West England Dominic Harrison Deputy Regional Director for Public Health Department of Health

2. Issues Paradigm Shifts – Public Sector, NHS, Regions, Performance Management systems. NHS Reform The Darzi Review of NHS World Class Commissioning Future Scenario Testing Wider Health Strategy Local Area Agreements/ Multi Area Agreements Investment for Health / Health Inequalities Health and well-being as economic development

3. Paradigm Shifts For the public sector From “detect and manage to predict and prevent” From “How do we best make use of health sector resources to secure health outcomes” to “How do we best mobilise all public sector investment (on this footprint) to secure the shared aspirations of this community (across all sectoral outcomes)” From “public as consumer to public as co-producer” For the NHS From a focus on “effective management of service delivery” to effective commissioning of health outcomes. From “commissioning services to commissioning outcomes” For Regions From “how do we command and control this system to deliver health outcomes” to “how do we assure this system functions to deliver outcomes”. For Performance Assessment From “How well does this institution deliver its own target” to “how well does this partnership deliver all agreed targets. (CAA)

4. Local Area Agreements Agreement between Central and local government for 3 years following Comprehensive Spending Review 35 targets agreed (out of a national indicator set of about 198) Negotiated by regions with Local Strategic Partnerships LSPs at local level Signed off by all Ministers with rewards for delivery.

5. This diagram has appeared in a number of publications. It demonstrates how local and national priorities meet in the LAA. From the top – the local process building on the SCS, consultation with stakeholders to achieve clarity on local priorities. At the same time central govt is looking at how to implement its PSAs through the national indicator set. GOs – have a view on the knowledge of localities which they bring to the negotiating table. The consequence of negotiations is the LAA. The ultimate purpose of LAAs is better outcomes for local people.This diagram has appeared in a number of publications. It demonstrates how local and national priorities meet in the LAA. From the top – the local process building on the SCS, consultation with stakeholders to achieve clarity on local priorities. At the same time central govt is looking at how to implement its PSAs through the national indicator set. GOs – have a view on the knowledge of localities which they bring to the negotiating table. The consequence of negotiations is the LAA. The ultimate purpose of LAAs is better outcomes for local people.

6. Local Area Agreements The new framework is built around a new set of relationships and processes that span central government Departments, Government Offices in the regions, local authorities and their partners – as well as sector-led improvement agencies and the inspectorates. Changing cultures and behaviours will be at least as important as improving processes for prioritisation and performance management. The principal interactions are: 1. Local partnerships agree local priorities, contained in the Sustainable Community Strategy, with the involvement of the local community 2. Central government agrees national priorities, contained in the new National Indicator Set 3. Government Offices negotiate LAAs containing up to 35 targets to improve the outcomes that central and local government agree are the top priorities for the local area as well as MAAs. 4. Local partnerships deliver LAAs and MAAs, with robust local performance management and regular reports on progress against all national indicators 5. Robust local performance management is combined with inspection with the new Comprehensive Area Assessment acting as a catalyst to drive improvement 6.Sector-led improvement agencies deliver capacity building and support, backed by a ladder of intervention to address under-performance The new framework is built around a new set of relationships and processes that span central government Departments, Government Offices in the regions, local authorities and their partners – as well as sector-led improvement agencies and the inspectorates. Changing cultures and behaviours will be at least as important as improving processes for prioritisation and performance management. The principal interactions are: 1. Local partnerships agree local priorities, contained in the Sustainable Community Strategy, with the involvement of the local community 2. Central government agrees national priorities, contained in the new National Indicator Set 3. Government Offices negotiate LAAs containing up to 35 targets to improve the outcomes that central and local government agree are the top priorities for the local area as well as MAAs. 4. Local partnerships deliver LAAs and MAAs, with robust local performance management and regular reports on progress against all national indicators 5. Robust local performance management is combined with inspection with the new Comprehensive Area Assessment acting as a catalyst to drive improvement 6.Sector-led improvement agencies deliver capacity building and support, backed by a ladder of intervention to address under-performance

7. MAAs

8. The NHS journey

9. New National /Regional NHS Strategy

14. 10 PublicTouchstones

15. PCTs have to improve the present whilst simultaneously preparing for the future Improving the Present: PCTs have to manage the health care ‘machine’ more effectively. Preparing for the Future: PCTs also have to lead their local health ‘system’ NHS has to get smarter at enabling prevention and foster health in different environments

17. PCTs as local leaders of the NHS The World Class Commissioning vision is to create self improving health commissioning organisations, responsive to the needs and aspirations of citizens, drawing on the best of public, private and third sector provision. Focused on, and held accountable for delivering outcomes for local people Freed from top-down ‘push’

22. Bob Horn, a scholar at Stanford University, sums up the present situation in this icon – which he calls the ‘Medusa’s head’, or the ‘can of worms’.   [The following passage may be dropped: Bob has been working on how to tackle information overload since the early 1960s. His conviction is that visual language will become more prominent as we try to communicate complexity across national boundaries. His book ‘Visual Language: global communication in the 21st century’ is highly recommended… Instinctively we know that it is images that communicate across cultures (see the earthrise photo, or the twin towers). Visual language is the tight integration of words, shapes and images to bring out the intrinsic properties of all three, and to help us communicate and understand complexity. I will come back to this when we talk about global branding.] Just take a quick look at some of the language on these arrows… This is a world of powerful trends and forces, all pulling in different directions. Yet we are now able to conceive of this intuitively as a single model, a whole system. Bob Horn, a scholar at Stanford University, sums up the present situation in this icon – which he calls the ‘Medusa’s head’, or the ‘can of worms’.   [The following passage may be dropped: Bob has been working on how to tackle information overload since the early 1960s. His conviction is that visual language will become more prominent as we try to communicate complexity across national boundaries. His book ‘Visual Language: global communication in the 21st century’ is highly recommended… Instinctively we know that it is images that communicate across cultures (see the earthrise photo, or the twin towers). Visual language is the tight integration of words, shapes and images to bring out the intrinsic properties of all three, and to help us communicate and understand complexity. I will come back to this when we talk about global branding.] Just take a quick look at some of the language on these arrows… This is a world of powerful trends and forces, all pulling in different directions. Yet we are now able to conceive of this intuitively as a single model, a whole system.

24. Male Life Expectancy Gaps

25. Components of the Male Gap

26. Health and productivity costs of alcohol misuse are around £4 billion.

27. A new attempt to make an impact on health in the North West

28. “Coalitions for better health” - Darzi “Social movement for health” - DH Social movements and large scale change in the NHS – Helen Bevan Public empowerment - Darzi

30. We are the culture We need to consider how our actions and decisions as leaders, parents, and role models establish and reinforce cultural norms

31. A movement of “leaders” From the public sector, businesses, faith groups, community groups and among the public People willing to commit themselves and their organisations and networks to action to change cultural norms