1 / 22

Jim McManus Director of Public Health

Working with the new Public Health Arrangements Chartered Society of Physiotherapy 18 th September. Jim McManus Director of Public Health. What’s in a name?.

tyme
Download Presentation

Jim McManus Director of Public Health

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Working with the new Public Health ArrangementsChartered Society of Physiotherapy 18th September Jim McManus Director of Public Health

  2. What’s in a name? “the science and art of preventing disease, prolonging life and promoting, protecting and improving health through the organised efforts of society” Sir Donald Acheson, 1988 “Decency, Freedom from infection, Labour, Dignity” Sir Alfred Hill, President of the Society of Medical Officers of Health, 1866-1903

  3. The Public Health Revolutions • 1st – Poverty, Living Conditions (Up to 1900) • Improvement in incomes, reduction in deaths • 2nd –Communicable Diseases (Up to 1950s) • Now on average 6-11% of deaths in UK. Was 85% of deaths before 1900 • 3rd – Non-Communicable Diseases (Today) • Over 60% of deaths due to lifestyle and behaviour • Poorest fare worst (smoking, diabetes, heart disease)

  4. Contributors to overall health outcomesHave changed over time Health Behaviours 30% Socioeconomic Factors 40% Clinical Care 20% Built Environment 10% Smoking 10% Education 10% Access to care 10% Environmental Quality 5% Diet/Exercise 10% Employment 10% Quality of care 10% Built Environment 5% Income 10% Alcohol use 5% Poor sexual health 5% Family/Social Support 5% Community Safety 5% Source: Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute. Used in US to rank counties by health status While this is from a US context it does have significant resonance with UK Evidence, though I would want to increase the contribution of housing to health outcomes from a UK perspective.

  5. Policy History...Zzzzz Chadwick Aneurin Bevan Black Report 1982 (UK) Ottawa Charter 1986 (World) Health of the Nation 1984 (England & Wales) Our Healthier Nation 1998 (England & Wales) Healthier Wales 2000 (Wales) Choosing Health 2005 (England) WHO Commission on Social Determinants 2009 Marmot Review of Health Inequalities 2010

  6. The Technology that is Public Health

  7. The Domains of Public Health Then & Now Smoking Heart Disease Then & Now Sanitation Housing Health Improvement Health Protection Now Care which keeps People healthy and independent Service Quality Now Environment

  8. Key Point As the factors and services behind health in the UK improved, key public health contributions became mainstream parts of the local government day job (sanitation, housing, school meals) How do we work with the new day job?

  9. The Health and Social Care Act 2012 Specialist public health is multidisciplinary Most public health coming to LAs in 2013 / 2015 Some going to NHS Commissioning Board National Agency Public Health England Health and Wellbeing Boards

  10. HW Boards • Statute and guidance • Boards of commissioners • Provider and district engagement left open • Roadmap of JSNA to Commissioning Plans • Unlikely CSP or Physios will be given membership per se but each Board is different • Constitutional anomaly – officers as members

  11. Top Tips • Influence DPH and lead elected Members • Work with CCGs directly • Where can you add value? • Prevention • Long term conditions • Working age adults • Frail elderly • Expect JSNA and Strategy and Commissioning Plans to reflect your contribution rather than a seat on the Board • Provider Fora?

  12. Specialist / Wider Public Health Specialist High level of training in a technical public health function, largely defined by legislation or policy in West Application of technical and specialist skills to the three domains of public health Health Improvement Health Protection Service Quality

  13. Mechanisms Policy Mechanisms Marmot, JSNA, Health and Wellbeing Board Commissioning Mechanisms Applying specialist skills to commissioning Invest in the right things Delivery Mechanisms Mainstream public health – everyone provider or citizens understands their contribution

  14. Timeframes of impact/yield Primary Care CVD Events Self Care Vitamin D and TB Vitamin Supplements Rickets CVD Events Air Pollution Acute Bronchitis Admissions Respiratory Decent Homes Mental Health overcrowding educational attainment Education Life Expectancy Planning Healthier space use Changing culture of activity Jobs Mental Health Life Expectancy 0 1 5 10 15 20 Years

  15. Public Health Input into the Commissioning Cycle Triangle of critical influence – where public health should be most visible Needs Assessments Equity Auditing Evidence of Effectiveness Health Impact Assessment Check whether plans equate To evidence and need and Test for equity / inequity Plan Model whether need will Be met by proposed volume Community Engagement Review Need for Service and Effectiveness of existing services Contract/Deliver Monitor/ Evaluate Support in establishing meaningful indicators of delivery and outcome Public Health Input into the Commissioning Cycle. Can be throughout or can be on specific areas playing to the PH strengths Support and advise on Evaluation and conduct Bits of it if enough resource

  16. Investing in the Right Things Our Burden of Disease is not the right way round System Failure Primary Prevention Secondary Prevention Tertiary Prevention

  17. Health and Care: Our Burden of Disease is not the right way round The shift to prevention Tertiary Prevention Primary Prevention Secondary Prevention

  18. The Riches • Understanding key drivers of health and wellbeing, and interventions to improve population health • Structured ways of doing needs analysis • Decision analysis and helping with economic analyses of policy to help setting outcomes • Supporting the understanding of complex variables and their interaction in policy and decision making

  19. The Riches 2 • Resource allocation for policy and interventions • Understanding targeting action and interventions to bring most benefit • Understanding and manage the conflicts between population and individual concerns (equity) • Finding, assessing and applying evidence • Supporting effective commissioning using 1,2 and 3 above • Evaluation of commissioning against desired outcomes

  20. Seven Principles for a commissioning approach • Commission for the whole person’s lived experience (housing, volunteering, leisure, transport,) • See Potentials not Problems, assets as well as needs • Transformation of current system through staged redesign to preventive and early intervention • Subsidiarity and Access • Co-production • Behavioural Sciences • Pathwayed

  21. Making this lot work Burden of avoidable ill-health Demographic and growing demands Benefits to citizens Preventing service use Moves people into self-care We cannot afford the coming time bomb Justice and fairness are public health values The DPH’s concerns…

  22. https://www.wp.dh.gov.uk/healthandcare/files/2012/06/system-graphic.jpghttps://www.wp.dh.gov.uk/healthandcare/files/2012/06/system-graphic.jpg

More Related