Enterprising venture: the organised efforts of society and the third sector

1. Enterprising venture: the organised efforts of society and the third sector Mr Abdul Razzaq Joint Director of Public Health, Trafford

2. Maturity Model: Public Health Timeline 19th Century Towns were characterised by overcrowding, poor housing, bad water and disease 19th Century 1848 Public Health Act Smallpox vaccination Slum clearance, clean air and water 20th Century Free School Milk Act Beveridge – Welfare State 5th July 1948 - NHS 21st Century Ageing population Chronic diseases Rising costs 1 2 3 4 INTRODUCTION GROWTH MATURITY DECLINE

3. Our Health and Wellbeing Today • We are living longer than ever before with dramatic changes in the nature of health over the last 150 years • infectious diseases now account for only 2% of deaths • 4 in every 5 deaths occur after the age of 65 • clean air, water, and environmental protection • BUT: success brings new challenges • circulatory diseases account for 34% of deaths • cancers 27% and respiratory diseases 14% • rising prevalence of mental ill-health • persistence of long-term conditions • Lifestyles and behaviours influence our outcomes and inequalities • 21% of the adult population still smoke • 61% of adults are overweight or obese • Fewer than 40% of adults meet physical activity guidelines • 2.4 million adults regularly drink more than recommended

4. Fair Society: Healthy Lives: 6 Policy Objectives • Give every child the best start in life • Enable all children, young people and adults to maximise their capabilities and have control over their lives • Create fair employment and good work for all • Ensure healthy standard of living for all • Create and develop healthy and sustainable places and communities • Strengthen the role and impact of ill health prevention

5. Mobilising the Assets of the Third Sector • There are 900,000 voluntary sector organisations (by which we mean charities, social enterprises, housing associations, mutuals, research organisations, co-operatives and other non-profit organisations) in the UK, with a combined annual turnover of £157 billion, a workforce of 1,600,000, combined assets of £244 billion, and the capacity to mobiliseover a quarter of the population to volunteer formally at least once a month. • It has immense associative power: the ability to bring together coalitions for change, people from one profession or many, agencies across different silos within a locality, communities and the state. • The voluntary sector is, in effect, ‘organised civil society’, or organisedcommunity action. It is therefore a heterogeneous but hugely significant economic and social force, one which is at the heart of the current Government’s overarching ‘Big Society’ vision for Britain

6. Asset Models: Key Roles for the Third Sector Social attitues & public opinion Expertise Innovation & person centred Fairness and social value The third sector plays a particularly important role in giving voice to less well-served groups, and thereby reducing health inequalities. Chapter The voluntary sector brings unique expertise to population health policy-making, often having a depth of understanding of particular issues or areas Third sector plays an important role in designing and delivering frontline services, but also in delivering second-tier services (such as training) Third sector acts as a social force for improved health Improved population health Leadership and Collaboration Designing and delivering and supporting services Informing and shaping policy and stratgey Leadership, voice and advocacy Harnessing the Potential

7. Four Steps to Releasing the Potential The need to have an approach to evidence-gathering that is more collaborative, more cross sector and more person- and community-centred. Government formulates population health policy in a way that is: •more cross-governmental •more open and cross-sectoral, and less of a closed, bureaucratic process Stepping up to the mark Improving population health needs to be based on “the organised efforts of society”, and on genuine partnership between the state and the voluntary sector. It is recognised that it is not just Government that needs to change – the voluntary sector will need to step up to the mark as well. A new social market for population health A fully functioning market in which effective commissioners purchase the best services available from a variety of providers, but also a genuinely social market in which both commissioners and providers collaborate as well as competing Cross government, cross sectoral policy making Collaborative approach to evidence INTRODUCTION GROWTH MATURITY REINVENTION

8. SOCIAL MARKET FOR POPULATION HEALTH JOINING UP • commissioning of population health-related activity should be joined-up across Government LONG TERMISM • commissioning should be based on a long-term strategy of shifting resources from acute care to prevention and population health and longer term contracts STIMULATE DEMAND & SUPPLY SIDE Stimulate demand and supply • stimulate the growth of new providers in the market, and • ensure that the market is backed up by a new social finance architecture Joining Up Long Termism Your own footer Your Logo

9. STEPPING UP TO THE MARK & LEVELLING THE PLAYING FIELD GATHERING AND SHARING EVIDENCE • Many are highly adept at gathering information together for policy-making design of public services. • Some are less good at seeing information as an asset, less good at gathering data or convincing others. ENGAGING WITH POLICY MAKERS • Many voluntary sector organisations are highly adept at engaging with policymakers in order to bring about positive change for their beneficiaries – others not Selling services to commissioners Enggaing with policy makers SELLING SERVICES TO COMMISSIONERS Gathering & sharing evidence • Many voluntary organisations have become highly adept at selling their services to commissioners, demonstrating the business case for why a commissioner should invest in what they do.

10. Case Study: Green Gym • The BTCV Green Gym® is a scheme which inspires to improve both health and the environment at the same time. Experienced leaders guide you through a range of practical projects, giving you the opportunity to tackle physical jobs in the outdoors – improving your strength and stamina, boosting your practical skills and confidence and benefitting your local green spaces. • An independent evaluation by Oxford Brookes University has proven the mental and physical health benefits of Green Gym, and a separate evaluation based on NICE costing models has shown the service’s cost-effectiveness: over a four year period the Green Gym delivered 132 Quality Adjusted Life Years (QALY) at a cost of £4,031 per QALY. This is substantially less than the £30,000 ceiling usually applied by NICE in deciding cost-effectiveness. Over four years the Green Gym delivered savings to the health service of £1,359,453 (based on life cost averted savings).

11. Key Route for funding Route for accountability Public Health funding and commissioning Local communities Local Authorities GP Consortia Providers Department of Health including Public Health England NHS Commissioning Board

12. Public Health Outcomes Framework: alignment with the NHS AND Adult Social Care – Missing Link to the Third Sector? Public Health Adult Social Care and Public Health: Maintaining good health and wellbeing. Preventing avoidable ill health or injury, including through reablement or intermediate care services and early intervention. NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants. Awareness and early detection of major conditions Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeat emergency admissions. Supporting carers and involving in care planning. Adult Social Care NHS ASC, NHS and Public Health: The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches.

13. But: Marmot on Public Health Challenges in Current Climate • Giving local communities control is challenging when they face budget cuts of 20-25%; • “responsibility deals” • Evidence from history suggests that public health advances – clean water, reduction of air pollution, healthier working conditions, reduction in drink-driving – have come to greater degree from action by local and central government than by voluntary agreements with industry. • While the Public Health White Paper picked up five of the six domains of recommendations from the Marmot Review it was silent on ensuring a healthy standard of living for all. • It is still possible to make progress and measure using indicators.

14. Public Sector Reinvention: Role of the Third Sector 19th Century Poor health and living conditions 20thCentury Introduction of the Welfare State and the NHS 20th Century Scientific and technological advancemnets 21st Century Reinvention as an alternative scenario to decline REINVENTION 1 5 4 2 3 INTRODUCTION GROWTH MATURITY DECLINE