Iechyd Cyhoeddus yng Ngogledd Cymru / Public Health in North Wales

1. Iechyd Cyhoeddus yng Ngogledd Cymru / Public Health in North Wales 13 Mehefin / June 2011 Cyflwynydd / Presenter: Andrew Jones Cyfarwyddwr Gweithredol Iechyd Cyhoeddus / Executive Director of Public Health Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board Insert name of presentation on Master Slide

2. Gogledd Cymru / Bwrdd Iechyd PBC Model Darparu Gwasanaeth – tîm Iechyd Cyhoeddus Gogledd Cymru Blaenoriaethau Iechyd Cyhoeddus/ Ein Dyfodol Iach Bwrdd Iechyd Lleol ALlau a phartneriaid eraill Cyraeddiadau Allweddol Camau Nesaf North Wales / BCU Health Board Service Delivery Model - North Wales Public Health team Public Health Priorities/Our Healthy Future LHB LAs and other partners Key Achievements Next Steps TrosolwgOverview

3. Role of the DPH • LHB – public health executive leadership, advocacy and action • LA – executive leadership, interagency partnership for population health improvement • Public Health Wales – specialist input • Unified Public Health System and Leadership Team

4. "the labour of such officer will do much to remove the ignorance which has permitted such evils to arise, to arouse the apathy which allows their continuance, and to overcome the opposition which impedes their removal. Such officers would showthe fearful amount of suffering disease and death produced for want of means for bringing pure water into the town, and for taking foul water out of it. They would prove that the losses occasioned by avoidable sickness and its consequences reduce a well paid population to poverty“ P H Holland, 1853

5. North Wales Profile North Wales Demographics Variation in health outcome Source: Public Health Wales

6. Largest in Wales - 18,000 staff, £2.1 billion budget, 3 District General Hospitals, 121 GP practices Clinically led : 11 Clinical Programme Groups, 14 primary and community ‘localities’ Key relationships with: Chiefs of Staff (senior team, ‘operations’ and nursing) Other corporate support (finance, planning and performance) Partnership with 6 local authorities, North Wales Police and North Wales Fire and Rescue Betsi Cadwaladr University Health Board

7. Bringing People and Services Together across North Wales • Strategic Aim • based on 5 themes: Making it Safe, Making it Better, Making it Sound, Making it Work, Making it Happen • To provide a “world class” health service in North Wales that: • Improves the health and wellbeing of the population • Provides an excellent experience no matter who, or where, or what language • Reduces the cost of health provision per capita

8. Practicing Public Health Organisation IMPROVING THE HEALTH OF OUR POPULATION WHAT PEOPLE WHO USE OUR SERVICES EXPERIENCE THE COST OF DELIVERING SERVICES Puts the TRIPLE AIM at the centre Focused on population health OUTCOMES

9. This means • Focused upon improving population health outcomes • Services are designed to meet need • Continuous quality improvement, reduction in waste, harm and variation • More care provided outside of an acute hospital setting through primary and community health and social services • Emphasis on independence and supported living at home or in communities • Complex care delivered in centres of excellence • No longer will healthcare be measured in terms of beds and buildings but rather services and health outcomes

10. Clinical Programme Groups (CPGs)

11. Local Public Health TeamService Delivery Model • Single local Public Health team (consultants and practitioners) – based on agreed Public Health Wales principles • Full engagement – all local staff (including feedback from project board and consultation on local DPH proposals) • Support to HB and LAs – concept of primary purpose and special interest • Agreed fewer number of priority areas - linked to national programmes • Implemented 1 April 2011

12. Public Health – BCU Health Board (1) • Our Healthy Future embedded into 5 year plan and core business • Public Health Wales support to a clinical leadership model • Clinical Programme Groups/Individual Chiefs of staff taking champion roles for Public Health priorities - including performance

13. Public Health – BCU Health Board (2) • Corporate governance – reports to Board and committees on key PH issues, health improvement, health protection, screening • DPH part of corporate business: finance, partnership, organisational and workforce development, scrutiny • Engagement with primary care and localities

14. BCUHB Localities

15. Public Health System:Bringing it all together(1) • Health Protection: immunisation, communicable disease/environmental hazard, hospital associated infection • Screening: national programme delivery, transformation of services e.g. cytology, emergency surgery • Public Health Wales Observatory – Service reviews, population profiles

16. Public Health System:Bringing it all together (2) • WCISU – investigation, service transformation • Safeguarding • Academic collaboration • Communications – all of the above!

17. Local Government • DPH and specific team support to each LA • Individual and collective engagement e.g. • North Wales leadership group (chief executives) • Area Planning Board (substance misuse) • LA representative on LHB Management team • Health Social Care and Well-being, Children and Young People Partnerships • Agreed key priorities for collective action (outcome focused using Results Based Accountability model) • Ongoing development

18. Academic Focus • Research, teaching and training • 5 Specalist trainees • Influence of BCU academic strategy • Joint working with Universities, Bangor and Glyndwr • Health Economics • Adding to evidence base e.g. CHARISMA ( housing, health, child poverty) • Transformational research?

19. Workforce Development • Staff learning from transition – CPGs etc • Local team development – who we are, what we have and what we don’t • Journal club – local learning and challenge • Leadership for transformation – learning alongside HB colleagues • Developing the ‘virtual’ Public Health team – Nursing, clinicians, LA staff • Learning from others – collaboration with Liverpool PCT (& North West England)

20. Key Achievements: Health Improvement • Local ‘Our Healthy Future’ (Local Public Health Strategic Framework) • Outcome focused approach linked to 5 year strategic plan and annual quality framework • Whole system approach • HB clinical leadership – strategic and operational • Agreed action plans for tobacco & alcohol • ‘Upstream’ embedded into service transformation

21. Key Achievements: Health Services Quality (1) • Major service reviews/transformation • DPH: Exec Chair of Emergency General Surgery Review • Needs assessment and literature review for Unscheduled care, Maternal and child health, Emergency surgery, Orthopaedics, Endoscopy, Haematology (local and Observatory support) • Cytology (screening input) • Joint Review of Microbiology Services

22. Key Achievements: Health Services Quality (2) • Development of primary and community care • Localities • Primary care engagement • Support to policy development and review – Individual Patient Commissioning

23. Key Achievements: Health Protection • Response to swine flu and winter pressures • Hanson Cement Investigation – community concern • Support to consultation on development of new nuclear power station – inclusion of formal Health Impact Assessment in application process • Economic regeneration – ‘Energy Island’

24. Community Engagement • Being contactable • Making contact • Sharing good practice • Sustainable communities Insert name of presentation on Master Slide

25. Key Achievements: Communications • Working relations with central team • Examples of best practice in individual and multi-agency response • Support to HB communications team • Development of a model for the future

26. Key Achievements: Health Intelligence • Population profile on general health • Variation in surgical procedures (local and national) • Interim DPH annual report – population need • Detailed needs assessments and literature reviews e.g. on maternity and child health

27. Cyfarwyddwr Gweithredol Iechyd Cyhoeddus Adroddiad Blynyddol Executive Director of Public Health Annual Report • Bydd yr adroddiad nesaf yn canolbwyntio ar y Blynyddoedd Cynnar ac yn cael ei gyhoeddi ym mis Gorffennaf 2011. • The next report will focus on the Early Years and will be published in July 2011 .

28. What should be done and what is being done in Wales? Reproductive and Early Years Insert name of presentation on Master Slide Siobhan Jones

29. High profile • Thousands back campaign for maternity services in North Wales Oct 19 2010 by Owen R Hughes, Daily Post • An internet campaign to save maternity services and children’s wards at North Wales’ three main hospitals has already attracted 11,500 supporters. • Ysbyty Glan Clwyd doctors protest against maternity service cuts Oct 12 2010 by Alex Hickey, Daily Post • GPs maternity concern over North Wales NHS shake-up Sep 30 2010 by Tom Bodden, Daily Post • Parents’ fears on North Wales maternity review Dec 6 2010 by Eva Ketley, Daily Post

30. Whole System – Whole pathway

31. Next steps • Year 2 of a 5 year plan • Implementing the new Service Delivery Model • Major project on programme budgeting – prioritisation, population outcome and cost • Implementing NHS service transformation • Delivery of agreed OHF actions (outcome, evidence base) • Contribute to Health Impact Assessment of Wylfa B and related developments • Public Health Wales – formalising local arrangements for DPH support - ‘whole team’ • Reporting to Public Health Wales Board • Making clear links between ‘local’ and ‘national’ priority work • Realising the benefits of the Unified Public Health System

33. "the labour of such a unified public health system will do much to remove the ignorance which has permitted such evils to arise, to arouse the apathy which allows their continuance, and to overcome the opposition which impedes their removal. Such a unified public health system would showthe fearful amount of suffering disease and death produced for want of bringing early years services and life skills into the town and supporting sustainable local communities within and around it. They would prove that the losses occasioned by avoidable sickness and its consequences reduce a well resourced population to poverty“ PH Wales 2011 Adapted from P H Holland 1853