Optimising health outcomes using a place- based approach Prof Aliko Ahmed Healthwatch Showcase Event 10 November 2015
'If this were the time or the place to uphold a paradox, I am half inclined to state that Norfolk is one of the most beautiful of counties.' - Virginia Woolf 'People are proud of it, they like it, and it is a county in which one feels at home.' - Sir Nikolaus Pevsner 2
'You can always tell a Norfolk man, but you can't tell him much.' --- Sidney Grapes 'Do Different - Norfolk motto 3
Public Health England East of England Well begun is half done - Aristotle Established on 1 st April 2013 bringing together public health specialists from over 70 organisations into a single health service, employing 5,000 staff. Our mission To protect and improve the nation s health and to address inequalities, working with national and local government, the NHS, industry, academia, the public and the voluntary and community sector. National Works transparently, proactively providing government, local government, the NHS, MPs, industry, public health professionals and the public with evidence-based professional, scientific and delivery expertise and advice Local Influencing and supporting local authorities in delivery public health services Providing evidence and knowledge on local health needs, alongside practical and professional advice on what to do to improve the nation s health 4
WHY we do what we do = Outcomes Healthy Children Healthy Adults Healthy Ageing Health Protection Health Improvement Healthcare & Quality Knowledge & Intelligence Effective delivery of Services Outputs Better Outcomes Healthier People and Places
Outcomes that matters to Communities: Healthy People and Places Staffordshire Lifecourse Model@SCC2015
Current National Context Many of the contextual challenges continue (e.g. population change, health risks and health inequalities) but a number of significant new issues are emerging: Financial position Local government Tough SR settlement: Local authorities need to deliver savings. NHS need to reduce activity growth and tackle deficits. Opportunities for revenue generation or new sources of funds (e.g. SIB)?Devolution? of power to local systems Changing funding context (local funds rather than central grants). Importance of self reliance and community assets Central government NHS Science & Technology Commitment to childhood obesity and prevention Focus on reducing welfare spending and on work and health Lower growth/efficiency challenge Making the 5YFV real Fundamental service change Deficit Science Hub/ next generation sequencing Big data, data linkages and transparency Digital delivery Behavioural science links System Reinvigoration of system leadership and management Developing new levers and performance management 7
PHE and Local Areas : Norfolk PHE s focus is about supporting local priorities: PHE Norfolk Central government Local government NHS Obesity and sugar reformulation Welfare reform and health and work Protecting the nation Securing local delivery and system delivery Returns of investment information Place based solutions Building on assets and communities An agreed set of products that add value to LA decision making Delivering Five Year Forward View and deploying a prevention agenda Securing reductions in demand through shortterm and long term prevention activities (building on professional advice and available data) Engaging local authorities in a credible prevention agenda A clear agreed contribution to NHS management e.g. specialised commissioning?devolution? Integration Obesity Best Start Dementia Inequalities Public Engaging and supporting people to change behaviours 8
Norfolk Health & Wellbeing Norfolk Health & Wellbeing Board Priorities Promoting social and emotional wellbeing of pre-school children Reduce obesity Making Norfolk a better place for people with dementia Crosscutting goals Prevention Reducing inequalities Integration Norfolk?Devolution? Deal Health & Care Aspirations Outcome-based vision healthier and independent lives proactive rather than reactive prevention and early intervention Integrated systems focussing on the needs of residents seamless pathways for health Sustainable and efficient system optimising the Norfolk pound ***Local decision & accountability**** local control of resources and outcomes 9
the local e.g. Staffordshire
11 HWB Underpinning Principles A platform for integration integration for outcomes integration of systems focus on whole of the population good conception to good death (lifecourse) health & wellbeing well-being NOT health & social care alone Composition/Membership + Flexibility Local elected representatives CCGs representatives Director of Public Health Directors of Children s services and Adult social care Local Health Watch rep Flexibility in other members to reflect value and scope for better health
12 HWB Governance & Accountability Challenges HWB as a platform for influencing commissioning No decision-making powers Multiple accountabilities Individual organisational governance and priorities ~ NHS vs Las arbitration and penalties? Commissioning vs Provider interface Conflicts, co-production and engagement? Opportunity to Do Different Local accountability for health and care system the triads professional, public and democratic reps
13 Optimising Health Outcomes - Pillars of Local Accountabilities Democratic legitimacy Residents/Public (HealthWatch) acceptability Professionals credibility Executives feasibility
Success is a journey, not a destination - Ben Sweetland Be not afraid of growing slowly, be afraid of standing still THANK YOU - Chinese Proverb