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Public Health Review. Susan Webb Deputy Director of Public Health. Process. Scope, functions map, principles, Stakeholder analysis. Principles. Multi disciplinary activity Prime responsibility for population health – protect, improve and to ensure equality of outcome
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Public Health Review Susan Webb Deputy Director of Public Health
Process Scope, functions map, principles, Stakeholder analysis
Principles • Multi disciplinary activity • Prime responsibility for population health – protect, improve and to ensure equality of outcome • Roles & responsibilities must clearly be understood but working within a shared framework • Located to influence • Activity underpinned by evidence and sound health intelligence • Team comprise practitioners and specialists who have up to date skills
Process Outcomes, gap analysis, key issues, GM, action to address, stocktake
Issues To address identified need develop a shared set of priorities Develop a single plan of action to address identified priorities Clarity about who does what and minimise duplication (health improvement) Clear single accountability structure Streamlined performance management arrangements Develop understanding of the pressures of working in different parts of the system Be more evidence informed Strengthen Governance arrangements Work together as a single Public Health function
National Outcomes: Wealthier & Fairer; Healthier; Safer & Stronger; Smarter; Greener Improved health and wellbeing Health of population is protected LONG-TERM HIGH LEVEL Health care services are first class Health inequalities are reduced Health of the population is protected from major emergencies & resilient to harm Factors which affect health and wellbeing / wider determinants are addressed by working with partners People are supported to live healthy lifestyles & make healthychoices INTERMEDIATE Number of people living with preventable ill health is reduced Less people die prematurely Health care services are improved quality, timely and delivered closer to home Outcomes related to service delivery Outputs SHORT-TERM: Processes Inputs
INTEGRATED ASSURANCE FRAMEWORK – REPORTING & ACCOUNTABILITY
NHS Grampian Board SSRC Clinical Governance Committee Performance Governance Committee Strategic Management Team CHP Committees OMT Grampian Public Health Network Sector Groups Public Health Management Team
Performance Issues No explicit linkage to national priorities Large number of unconnected ‘strategies’ Lack of outcomes focus No performance information Poor evaluation processes Difficulties in identifying impact
Health Improvement at a Glance…Strategies / Action Plans Health Improvement HI2 We want good health – the same as you MISSION STATEMENT “We want good health…the same as you”: A strategy to improve the health of children with learning difficulties and adults with a learning disability” (Children with learning difficulties and adults with learning disabilities will be valued as individuals alongside all other members of society) - this was on the scorecard AIM The health and wellbeing of the target group and carers will be improved through the development of sustainable and targeted health interventions. This will include information that address key health issues and improving access to services through effective engagement with service users themselves and those who are caring for them.
Objectives • Key health issues relevant to the target group (e.g. mental wellbeing, physical activity, healthy eating, oral health) will be addressed via the development and monitoring of health improvement lifestyle programmes by July 2011 • Carers and care support workers will have skills and knowledge through the development and implementation of a relevant training programme which will enable the target group to lead healthier, more independent lives by July 2011 • A training programme will be developed and made accessible for carers to enable them to better manage their own health and wellbeing by July 2011 • Pertinent care pathways that support the target group to access services will be identified, developed and disseminated throughout the multi-agency partnership. Three care pathways will be developed by July 2011 throughout year 2 of the Change fund project • A robust pan-Ayrshire communication system will be established that complements existing PFPI opportunities and supports implementation of local carers Information Strategy and Locality Carer Networks, to engage effectively with the target group, carers and staff, throughout the lifetime of the strategy by July 2011 • The health needs of the target group and relevant recommendations from national documents will be included in local strategies/policies and evidence of targeting will be monitored on an effective performance management system • Health Services will be improved and developed to meet the needs of the target group through better recording/monitoring practices and support to access services • Where possible and necessary develop existing respite resources to ensure that they are responsive and appropriate to the needs of the target group and that they are promoted appropriately through clear and accessible information Actions Actions Actions Actions Actions Actions Actions Actions
Objective 1 • Key health issues relevant to the target group (e.g. mental wellbeing, physical activity, healthy eating, oral health) will be addressed via the development and monitoring of health improvement lifestyle programmes by July 2011 • Actions • Develop a lifestyle programme with due consideration of specific topics e.g. oral health, active living and dietary needs • Agree methods to segment the target population to ensure effective targeting of work • Gather information from the individual needs assessments to agree health promotion priorities for individuals • Further develop information on cancer and cancer prevention for the target group • Produce accurate and accessible information on access to dental services for this target group • Develop a resource to manage mental wellbeing of target group • Investigate use of complementary therapies to improve mental wellbeing • Negotiations should take place with service providers to consider issues of equity in access to leisure opportunities • Work with Ayrshire Sports Ability (formally Ayrshire Special Games) to promote sport to the target group • Identify accessible skills based training for target group to make healthy food and positive food choices
High level Outcomes Intermediate Outcomes Short term Outcomes Reach Outputs Activities Inputs Logic Model : Life Circumstances We live longer, healthier lives We are better educated, more skilled and more successful We realised our full economic potential with better employment opp. We have tackled the significant inequalities in Scottish Society National indicators Increase the average score of adults on WEMWBS Scale by 2011 Increase proportion adults making 1+ visits to outdoors per week Decrease the proportion of people living in poverty - The income for the target group has been maximised Service providers have expanded and improved leisure opportunities Service providers have increased opportunities for life long learning Lifestyle programmes address the specific lifestyle needs Adults with Learning Disabilities Implementation plans propose actions to address life circumstances for the target group e.g. Single Outcome Agreements, Health Improvement Strategy Implementation Plan Implementation teams discuss and agree solutions to literacy and health literacy, lifestyle issues, mental wellbeing, co-morbidities, evidence based practice, national recommendations and undertake EDIA A clinical lead and support team are identified and undertake co-ordination and actions to achieve the aims of the strategy
High level outcomes Intermediate outcomes Short-term outcomes Reach Outputs Activities Inputs Multiple results chains We live longer, healthier lives We are better educated, more skilled and more successful We realised our full economic potential with better employment opp. We have tackled the significant inequalities in Scottish Society • Behaviour • Increased opportunities to improve knowledge and skills - increased participation in health improvement activities – improved physical and mental health • Social, economic and physical environment • Income for the target group is maximised • Specific learning needs of target group are addressed SU/carers know where and how to access benefits Service users and staff aware of opportunities and increased uptake Increased opportunities available for learning Lifestyle programme specific to needs of target group Target group more active Adults with LD Staff Adults with LD Adults with LD Carers Adults with LD Adults with LD Increased activities e.g. jabadao, dance Number of services and people up taking service Accessible user friendly system developed Increased choice of meaningful learning courses Distribution of resource pack Raise awareness of & create more opportunities for lifelong learning Develop system to maximize income Activities to promote physical & mental health Create equal access to leisure Raise awareness and benefits of activities Local Authority NHS/Service Providers Education/FE Change Fund Project Leisure
Process Service improvements & associated action, accountability framework, management, Performance framework.
Conclusions we have reached….. • To date we have focused on how we work together. • We have sought to remove organisational barriers. • We have defined what we need to deliver.
The Public Health Function • To protect and improve the population’s health and reduce health inequalities across Grampian by maintaining a critical mass of specialist public health skills to assist in the development, delivery and evaluation of policy and programmes to protect and promote health and deliver effective and efficient health care
Must Do’s • Identify and address the health needs of our population • Deliver statutory duties as laid out in the PH etc (Scotland) Act 2008 and Community Planning Legislation • Deliver HEAT targets including financial balance • Deliver national programmes and standards for which we receive funding • Deliver Governance Standards
Conclusions we have reached….. • To date we have focused on how we work together. • We have sought to remove organisational barriers. • We have defined what we need to deliver. • We have agreed to organise teams around the Faculty of Public Health domains to support staff development/critical mass of skills • We have considered how to organise health improvement staff
What we need from you • What is the most efficient way to organise ourselves to deliver health improvement? • Geographic & Grampian-wide specialist areas how do we work as one team? • What are the areas of duplication and gaps? • Have we missed any organisational barriers?
