Better Health- Better Wales The Health Improvement in Wales 1998-2010

1. Better Health- Better WalesThe Health Improvement in Wales 1998-2010 Susan Mably Consultant in Public Health

2. Outline of Presentation • Starting out- Better Health- Better Wales • Fundamental principles/ approaches • Proliferation of policies and Initiatives • Consolidation of local government plans • Monitoring progress? • Full Circle - 2010 and beyond….

3. Better Health- Better Wales (1998) “Despite recent improvements, the health of people in Wales is poor compared with that in the majority of European countries and in other parts of the UK. Within Wales a significant proportion of the population remain deeply disadvantaged in terms of expectation of life and health-related quality of life, and there are wide variations between those with the poorest health and those with the best.” “The NHS in Wales is being restructured in order to enable it to be more responsive to local needs, in particular through the creation of Local Health Groups (LHG) with commissioning responsibilities for primary as well as community and hospital-based services, and strengthened requirements for co-operation with Local Authorities and other organisations.” (Better Health- Better Wales, 1998)

4. preventing disease and substantially improving the health and well-being of people in Wales; bringing the level of those with the poorest health up to level of those with the best health; improving the health and well-being of children; encouraging individual responsibility for health; improving the health and safety of people at work Better Health- Better Wales (1998) Objective: to provide a comprehensive, multi-disciplinary Framework for national and local action which will contribute to:

5. Better Health- Better Wales

6. Fundamental principles/ approaches • Health and Well-being- broad definition Health > health care • Healthcare services are only part of the picture • Twin track approaches • Delivery through partnership • Health in all policies • Health Impact Assessment • Central direction/ local implementation

10. Better Health Better Wales (1998) - health inequalities acknowledged and described Improving Health In Wales: A Plan for the NHS and its Partners (2001) - NHS to improve performance , to contribute significantly to health improvement and to tackle inequalities in health - NHS re-organisation, to 22 Local Health Groups/ Boards Targeting Poor Health (2001)dual strategy of: - action within the NHS, including NHS resource allocation favouring those most in need - wider strategic action Review of Health and Social Care in Wales (2003) - notes inequalities and action being taken in other policy areas Designed for Life (2005) - commitment to reducing, and where possible eliminating, inequalities in health - health inequalities strategy to be published by 2010 One Wales (2008) - recognises the need to work harder to improve the well-being of all vulnerable and disadvantaged in Wales Our Healthy Future (2010) Public Health Strategic Framework – 2020 Policy Development

11. Health gain targets 2002-2012

12. Examples of Health Gain Targets Child poverty milestones and targets • Designed to measure progress eradicating child poverty by 2020 across 5 themes including health • Progress since baseline assessed in 2008 • Little or no change on health indicators • infant mortality • low birth weight • under 16 teenage conceptions • 5 year olds with dental caries • child pedestrian injuries (5-14 year olds)

13. Evaluation • Variable • Local action subject to scrutiny • through local authority and • partnerships • some structured evaluation • of national policies

14. Facilitating partnerships e.g. Local Health Alliances Health alliances will develop local strategies for health promotion etc. link with, and provide the public health input to Local Health Groups assist in the establishment and implementation of the Health Improvement Programme ensure that health remains high on the corporate/ local agenda. (Better Health- Better Wales, 1998) e.g. Communities First Welsh Assembly Government’s flagship programme to improve the living conditions and prospects for people in the most disadvantaged communities (around 150) • Long term programme (at least) 10 years • Local people themselves decide what is intended and are helped to make it happen

15. Facilitating partnerships Health, Social Care and Well being (HSCWB) Strategies Local authorities and local health boards required to formulate and implement HSCWB Strategies, in partnership with NHS Trusts and the voluntary sector. (Built in most cases on the foundations of Local Health Alliances; these now relate to new NHS structures in Wales) Local Service Boards Address key issues where services (including Health services) need to work better together across sectoral or organisational boundaries to integrate services and respond to citizen’s needs. Collective action to: • Improve the quality of life • joined-up service delivery for citizens • leadership to ensure that difficult issues across public services are confidently managed not avoided or ignored • integration, co-ordination and co-operation between local, regional and national public sector organisations; 􀂃

16. Health Challenge Wales

17. Making Sense at the Local level In 2008/2009, the 32 statutory plans required of local authorities were reduced to 4 high level plans Community Strategy Health, Social Care and Wellbeing Strategy Children and Young People Plan Local Development Plan

18. 2010 and Beyond…….. ‘Health inequalities remain significant in Wales…… we have to recognise that our problems are serious and deep-seated’ (Chief Medical Officer for Wales, Annual Report 2007)

19. Our Healthy Future • 4 Main ambitions • 7 Themes to help achieve these ambitions • Objectives/ actions across these themes (currently in development)

20. Our Healthy Future 4 Main ambitions for 2020

21. Set out clearly the Nation’s ambitions for better health and well being Help to harness all of the strategic activity of the Welsh Assembly Government and set it into a public health context Provide a vision to which all sectors in Welsh society will be asked to contribute 7 themes Socio-economic, cultural and environmental conditions Children and young people Healthy eating, food and fitness Health-related behaviours and risk Limiting long-term health conditions Mental health and well-being Strengthening local public health delivery Our Healthy Future

22. Summary • BHBW marked key moment- recognising that health is everyone’s business • Set within the context of devolved government and emerging policy agenda • Partnerships for change • Drive for improvements in health care services- quality, access • Proliferation of projects/ initiatives across agenda- sustainability issues • Variable evaluation/ monitoring; low profile of targets

23. Summary • Generally, recognised that health has improved but inequalities remain • New strategic framework emerging- reflects Today’s position but true to the philosophy • 5 Year NHS Plan- workstream for Prevention and Promotion; focus on reducing spending • Impact of new Government in Westminster- potential tensions???