Jim McManus

1. Jim McManus Joint Director of Public Health Birmingham City Council

2. Delivering Success: Prevent, Enable, Personalise, Realise some tentative experience from BirminghamCOSLA Annual Conference 2012 Jim McManus Joint Director of Public Health Birmingham City Council 16th February 2012

3. Public Service Reform – Big Tasks • Localism Act • Elected Mayors??? Errr... • NHS Reforms – public health, clinical commissioning groups, NHS Commissioning Board, Health and Wellbeing Boards • Police and Crime Commissioners • Open Public Services White Paper • Spending Review • Social Care Funding

4. Big Asks • Do better with a lot less • And by the way your population is still getting older, needier and growing • And you will have a 25% increase in dementia • And immigration will bring costly TB and CVD • Oh, and you’ll have more folk with learning disabilities • And they all have to have personal budgets

5. The basic message – complex relationships, big tasks Good outcome Life circumstances Behaviours Bad outcome The arrows include public services and access

6. The basic message – interventions = big asks Good Health Life circumstances Behaviours Ill Health

7. Major Change – reducing buildings, reducing costs, outsourcing, mutuals New single contract (50,000 people) New operating model for children – universal, targeted, special and complex New Operating Model for adult social care – prevent, enable, personalise Benefits realisation Radical new ways of doing things Birmingham ChangePrevent, Enable, Personalise, Realise

8. New Ways of Working • Not just rely upon commissioning • Working with wide range of civil society partners • Shared leadership of Health and Well-Being Board • Support from HealthWatch • Using new powers and new resources to create healthier communities

9. The Big Ask: What success looks like... £37million Self management Range of targeted/ Flexible Services Support to service user /Citizens Increased People supported to manage LTC Improved flexibility Prediction and Prevention Increased through community resources Increased through joint interventions Increased Number of those receiving preventive services Customer Satisfaction Supported to stay in their Home

10. Why does service change matter?

11. 4th out of 8 Male 5th out of 8 female Life Expectancy against Core Cities

12. Life Expectancy by Ward

14. Gaps in school readiness at 3 and 5 years by family income: UK Average percentile score Waldfogel & Washbrook 2008

15. National Audit Office 2010not on course!

16. And what has got us there? Barriers to reform • Focus, or lack of it • Starting with a promising intervention, then making sure it is doomed to fail by tinkering about • Scientific Grounding and Understanding of Need (or lack thereof) • Partnerships – obsessed with structure and governance • Poor integration of joint commissioning • Cultures...Aaarrrghhh!!!!! • Deficit – We know more than you

17. Not getting value of Intelligence in achieving Better Outcomes... What did we achieve? Does anyone actually Really do all this? Keeping on Track Prioritisation Best Buys/Best Dos Need

18. Writ across all Programmes • Telecare £14 million • Intelligence and Information Programme • Predicting need in social care • Data sharing with GPs • Diverting people from social care and hospital • Targeting young people to reduce risk • Worklessness • Decent Housing • Preventing Extremism • Enablement • Public Health Transition

19. Critical Success Criteria – Fire Service • Falls Assessment • Telecare Assessment • JSNA and data sharing • Population density of fire and need • Sharing populations • Well constructed outcomes based agreements

20. Health and Care: Our Burdens of Disease mean Prevention is wrong way round Tertiary Primary Secondary

21. The Big Ask: What success looks like... £37million Self management Range of targeted/ Flexible Services Support to service user /Citizens Increased People supported to manage LTC Improved flexibility Prediction and Prevention Increased through community resources Increased through joint interventions Increased Number of those receiving preventive services Customer Satisfaction Supported to stay in their Home

22. Whole System plus focused action The example of health inequalities

23. The Conceptual Framework Reduce health inequalities and improve health and well-being for all. Create an enabling society that maximises individual and community potential. Ensure social justice, health and sustainability are at heart of policies. Policy objectives A. Give every child the best start in life. C. Create fair employment and good work for all. E. Create and develop healthy and sustainable places and communities. B. Enable all children, young people and adults to maximise their capabilities and have control over their lives. D. Ensure healthy standard of living for all. F. Strengthen the role and impact of ill health prevention. Policy mechanisms Equality and health equity in all policies. Effective evidence-based delivery systems.

24. The Golden Thread Need, Outcomes Priorities, Interventions

25. Health Inequalities : What we know • Edinburgh World Congress of Epidemiology 2011 • Non Communicable Diseases • Impoverished understanding of behavioural sciences in some public health programmes • Multiple Tracks. Public policy action in all of them

26. Policy History...Zzzzz • 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

27. 2008

28. 2007

29. The upshot of all this is that whatever framework you use..... It’s the same problem!

30. The Big Tasks • Short term challenge of tertiary prevention • Medium term problem of keeping the ill well • Short term problem of stopping avoidable events • Long term problem of changing determinants of health, health expectations, behaviour and culture

31. The Big Tasks The Ask Who • Short term challenge of tertiary prevention • Medium term problem of keeping the ill well • Short term problem of stopping avoidable events • Long term problem of changing determinants of health, health expectations, behaviour and culture • Social Care, NHS, Housing • NHS, Social Care, Housing, Leisure • NHS, Leisure • Local government par excellence

32. Framework Birmingham’s use of Marmot Activities • 1. Adopt the Outcomes • Starting well • Developing well • Living well • Working well • Ageing well • 2. Add an outcome “dying well” • 3.Cut our JSNA and Strategy across the Lifespan • 4. Use as “golden thread” • For Health Inequalities Action • For JSNA • For Health and Wellbeing Strategy • For Integration • As a lifecourse approach to human ecology

33. PREVENTION Examples of Marmot in practice • Lifecourse approach using Marmot • Early development • Mental health problems onset • Tasks for each lifestage • Community and Public Sector tasks • Interdependencies • Use of Marmot Framework across lifecourse • Tasks for adult social care and older adult social care elucidated • Incorporation into third sector contracts with third sector • Preventive workstream LGBT MENTAL HEALTH

34. Examples

35. Demonstrated • The role of public health sciences in public service can be significant • The role of behavioural sciences in public service reform can be significant • Public health disciplines can be applied across public service reform

36. Thank You! • Jim.mcmanus@birmingham.gov.uk