From Strategy to delivery, a Public Health opportunity for the UK

1. From Strategy to delivery, a Public Health opportunity for the UK Vince Ion TrueBlue Consultancy & Honorary Lecturer at Sheffield Hallam University Consultancy

2. Transformation • The changing context of healthcare • A new focus for healthcare ‘provision’ • What sorts of skills and capabilities are needed? • How can learning support & promote change Consultancy

3. Change all over the world Consultancy

4. The Changing Nature of Healthcare • Increase in ‘out of hospitals care • Focus on chronic/long-term conditions • Promotion of healthy living • Public health concerns– flu pandemic, terrorism, avian flu etc • More ‘self-care’ • More voice, influence of patients, service users and the citizen • Health as core element of community development & social capital Consultancy

5. The Drive for Skills Consultancy

6. Towards ‘Risk Society’ (Beck) Ubiquitous Change Unreliability Uncertainty Risk Society Unpredictability Un-sustainability ‘Fuzzy’ Boundaries Choice Beyond Conventions, Rules & Structures Multiple & Contested Information & Knowledge Consultancy

7. Four key elements of contemporary Social & Political Policy E-learning Lifelong learning Citizens & Workers Choice Personalisation Consultancy

8. The Core Purposes of Learning According to the celebrated Jacques Delors Commission on Lifelong Learning, “The Treasure Within” • Learning to Know (learning to learn, general knowledge & understanding) • Learning to Do (skills, competence, practical ability in a variety of settings) • Learning to Live Together (tolerance, mutual understanding, interdependence) • Learning to Be (personal autonomy & responsibility, memory, aesthetics, ethics, communication & physical capacity) Consultancy

9. So is this the Future? Consultancy

10. NHS Next Stage Review Consultancy

11. Healthy Ambitions for Y&H Consultancy

12. UK based future Model for deliveryHealthy Ambitions • The model for delivering Healthy Ambitions is based on that developed by the Institute for Healthcare Improvement based on an analysis of high performing and high transforming health systems. It emphasizes 3 key ingredients for major change: • will – you need to create shared purpose about your objectives • ideas – you need to be specific about what you want to change and test out how you can make those changes • execution – you need project plans, with timescales and milestones, measurements and clear accountability. Consultancy

13. Our Principles for Delivery clarity of purpose: keep the objectives of the report – improving health and health care – at the forefront of all discussions collaborative production: design implementation programmes as much as possible with the NHS, local authorities and key stakeholders subsidiarity: ensure that where details of implementation can be determined locally, they should be Consultancy

14. Our Principles for Delivery • clinical ownership and leadership: build and sustain clinical engagement and leadership through all elements of implementation • system alignment: incorporate implementation into mainstream processes, and align our objectives to the goals of Healthy Ambitions Consultancy

15. Levels of delivery Regional Region wide consistency essential - local where possible Do itonce Need for regionalconsistency Direction regional – pace local Coordination/collaboration helps Need for difference by design Local Local delivery – SHA holds to local organisations to account, provides confirm and challenge Consultancy

16. Making it happen – the process Healthy Ambitions from pledge to practice Pathway Pledge Clinical Recommen-dations Levels of Delivery Local Priority Delivery Measure Oversight • Local monitoring • Pathway delivery board • Strategic Commissioning Board • PCT annual operating plans • Metrics • Dashboard • One key pledge • Detailed pathway recommendations • PCT strategic plans • WCC • Agreed with PCTs Consultancy

17. Making it happen – Staying Healthy Pathway Pledge Halt in the rise of obesity One key high-level pledge per pathway Pathway Recommendations e.g. Commissioning weight management services Detailed pathway recommendations Level of Delivery Localised commissioning Agreed with PCT CEs – local delivery wherever possible, sub-regional or regional where required Local Prioritisation PCT Strategic Plan Recommendations prioritised according to local circumstances. PCT Strategic Plans outline local delivery & are assured by the SHA Annual Operating Plan Annual Operating Plan Details of local initiatives, funding and timescales to deliver local priorities Metrics / Dashboard Obesity Prevalence Reception & Year 6 Children Pathway metrics developed and local trajectories agreed. Healthy Ambitions Dashboard shows progress against trajectories Oversight Staying Healthy PDB Local monitoring Pathway Delivery Board Strategic Commissioning Board Consultancy

18. Recommendations re obesity • Every local organisation (Primary Care Trust) should commission localised weight management services for their local population. To meet life expectancy targets these should focus on adults at mid-life • Brief interventions should be implemented consistently by a wide range of NHS settings and staff • Surgery for people who are morbidly obese. PCT should proactively collaborate on specification, services and common standards Consultancy

19. Recommendations: Obesity • Link with Gov initiative on child weight management • There should be systematic programme of local work to reduce the levels of obesity through the development of: • Food [policy and better food skills for adults • Transport and the built environment – making activity easier/ safer • More opportunities for active leisure • Local employment • Quality of school food, drink and activity programmes Consultancy

20. Staying Healthy Workforce approach Consultancy

21. Staying Healthy Pathway – levels of delivery Regional Making every Contact Count Conference Workforce Ambitions – March 09 Competence framework commissioned– Sheffield Hallam University Workforce strategies, job descriptions, new roles, development opportunities Local Consultancy

22. Healthy Ambitions for Y&H Consultancy

23. Consultancy

24. Healthy Cities Consultancy

25. What next to deliver • Regional need to develop public health competencies. Dec 2008 • Tender process Jan 2009 • Sheffield Hallam university chosen as provider Feb 2009 • Framework delivery May 2009 • Testing June-Aug 2009 • Final framework Oct 2009 Consultancy

26. What we are trying to do! Consultancy • Develop a competence framework for behaviour change interventions that can be used by: • Service and Education Commissioners: as a tool to support commissioning behaviour change services • Education providers: as a tool for developing targeted education and development • Individuals: as a tool to identify their existing competences and development needs.

27. The Challenge! Consultancy Foresight. (2007)

28. Why are we doing it? Consultancy EVERY CONTACT COUNTS

29. Who is Doing It? Consultancy Commissioner Policy Analyst Educationalists Behaviour Change experts Occupational Psychologist Public Health Specialist Developing New Roles

30. The Project Consultancy Approach Phase 1: Review of evidence base Phase 2: Construction of Framework Phase 3: Piloting & testing

31. The Project 2 Consultancy Deliverables: Evidence Digest for Commissioners of Services and Education Behaviour Change Competence Framework

32. The Evidence Base Consultancy Muliti-factoral and very complex Motivation is key Limited evidence of effectiveness Multi-stranded approaches What is the key ingredient?

33. Overview of the Framework Consultancy "Start Where the Person/Population Is" Identifies the main behaviour change approaches and interventions relevant to stage of change Identifies the generic competences and associated Knowledge and Skills Aimed at those people who undertake behaviour change in addition to their normal role, therefore levels of practice are not role specific

34. Start Where the Person /Population Is Consultancy Adapted from Prochaska & DiClemente (1983)

35. The Draft Framework • Evidence identifies basic competences common to all approaches, e.g., empathy, communication, empowerment • Levels of practice will be mapped against intensity of intervention required to move people through the stages of change. Consultancy

36. Next steps Translate evidence review into useable digest Continue development of competences and associated knowledge & skills Pilot testing Consultancy

37. References Towards a Risk Society The Treasure Within High Quality Care For All NHS Next Stage Review Healthy Ambitions Delivering Healthy Ambitions Beck.U. Sage London 1992 Delours Jack E.U. Commission on Life Long Learning http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085825 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085937 http://www.healthyambitions.co.uk/ http://www.healthyambitions.co.uk/DeliveringHealthyAmbitions/ Consultancy

38. References WorkforceAmbitions 2009 – 214 Commissioning and Behaviour Change – Kicking Bad Habits – Final Report (King’s Fund) Change for Life Tackling obesities-: Future Choices Stages and processes of self-change of smoking: Toward an integrative model of change http://www.yorksandhumber.nhs.uk/what_we_do/workforce_education_and_training/workforce_strategy World Class commissioning DH 2008 http://www.kingsfund.org.uk/publications/the_kings_fund_publications/kbh_final_report.html http://www.nhs.uk/change4life/Pages/default.aspx Butland B. UK Government 2007 Prochaska, James O.; DiClemente, Carlo C. Journal of Consulting and Clinical Psychology. Vol 51(3), Jun 1983, 390-395 Consultancy

39. How can you find out more? Vince Ion True Blue Consultancy& Honorary Lecturer at Sheffield Hallam University vince-ion@btconnect.com Tel 07796 888 573 Fax 01636 821 528 Consultancy