Nine local authorities covering a population of 2.4 million people

1. Whole system working in Cheshire and MerseysideMelanie Sirotkin –Centre Director, PHEFiona Johnstone –Director of Public Health, Policy & Performance, Wirral Counciland Chair of Champs

2. Nine local authorities covering a population of 2.4 million people

3. Cheshire and Merseyside System Cheshire & Merseyside Public Health England Centre Voluntary & Independent Sector Health & Wellbeing Board • 2 x NHS England Area Teams • 12 x CCGs 9 Local Authorities – supported by CHAMPs Network

4. What’s it like out there? – Wider determinants • Deprivation – 5/9 authorities in the most deprived quintile. Child poverty and older people in deprivation is worse than the England average. • Unemployment - higher than England average in 6/9 authorities (2011/12). • Income - average weekly pay is lower than the England average in 8/9 authorities. Index of Deprivation, 2010, %, Cheshire & Merseyside (comparing to England average)

5. Life expectancy in both males and females is lower in most (8/9) local authorities. • Higher preventable mortality (liver disease, CVD, cancer) • Similar or better – health check offer but poorer health check take up. • Rates of low birth weight better than or similar to. • Lower breast feeding rates. • Teenage conceptions lower or similar in 6/9 authorities. • Excess weight in 10-11 year olds worse than or similar to (most authorities). • Similar levels of physical activity. • Similar or less smoking in routine and manual groups. • Successful completion of drug treatment (opiate and non opiates –similar or better) • Good coverage MMR, HPV and flu (at risk). • Higher rates of injuries due to falls. • Emergency re-admissions within 30days of discharge from hospital is worse than England average What’s it like out there? (PHOF)* *Compared to England average

6. Health & Care Indicators Health and care indicators, 2011, %, Cheshire & Merseyside (comparing to England average)

7. What’s it like out there – North West mental health and wellbeing survey - key findings • All nine local authority areas within Cheshire and Merseyside (C&M) participated in the 2012/13 North West survey. • The WEMWBS scores varied in significance for the 9 local authorities with 2 showing an improvement between 2012/13 and 2009. • Overall 15.3% of respondents had ‘low’ mental wellbeing, 64.1% had ‘moderate’ and 20.6% had ‘high’ mental wellbeing. This varied widely across the nine local areas. • The mean life satisfaction score for Cheshire and Merseyside was significantly higher than the North West mean. • Source: North West Mental Health and Wellbeing Survey 2012/13

8. What’s it like out there? • Strong traditions of music, arts, culture and sport rich heritage – castles, parks, historic building • Vibrant voluntary sector – Change up consortium in Greater Merseyside working with 18 organisations and investing in voluntary, community and faith groups

9. Top 5 priorities from the Local Health and Wellbeing Board Strategies • Mental Wellbeing • Children • Alcohol • Older people • Sustainable places

10. Champs public health collaborative service • Led by the 9 Cheshire and Merseyside local authority Directors of Public Health, facilitated by a support team. • Owned and delivered by our local public health teams. • Generates efficiencies and improves service quality and outcomes. • It does this across four key areas: • Improving commissioning • Advising the NHS • Protecting health • Leading public health

11. Key successes • Mental health • Asset based approaches • Mental health champions • Suicide prevention • Behaviour change • PHE mental wellbeing pilot • Breastmilk It’s Amazing campaign • Pharmacies campaigns • Sector led improvement • Health Checks review • National Child Measurement Programme review • Sexual Health review

12. Healthy places • An innovative large scale change programme. • A fresh approach to working with our commercial, public and 3rd sector partners. • Our aim is to support communities to create their own healthy places to live. • Ultimately, it’s about prevention and reducing reliance on services.

13. Shaping healthy places CW&C – the journey so far Caryn Cox – Director of Public Health Cheshire West and Chester Council

14. The background • Wholesale changes to healthy system • Public health moved into the local authority • Planners unsure of how to engage with ‘health’ • Raft of guidance and evidence already out there • Public health - no understanding of where health fitted into existing planning processes

15. Getting started and the baseline • Established links with planners – strategic/spatial and development control • Public health hosted and facilitated a meeting • CCGs x 2 • CSU – Cheshire and Merseyside • Local authority planners • NHS England • NHS PropCo • Public Health England • Commissioned health planners to audit existing processes and recent planning applications to understand baseline • “Better Health Outcomes Through Spatial Planning”

16. The journey continues • Local development framework consultation – significant PH submission and all key stakeholders also submitted • Agreement to develop a Supplementary Planning Document (SPD) as part of the Local Plan on Health and Wellbeing • Preparing evidence for the Community Infrastructure Levy (CIL) • All significant planning applications pass through Public Health • Active member of SPAHG (Spatial Planning and Health Group) and strong links with WHO at UWE • Housing links – local authority and RSLs • Healthy Places – new key area for ChaMPS

18. Cheshire & Merseyside PHE(North West KIT) Key Assets for Recovery Tom Hennell Friday 4th April 2014

21. Observations on long-standing illnesses from population surveys • Long-standing conditions characteristically progress from being ‘limiting’ to being ‘non-limiting’. • The proportion of persons reporting a long-standing condition, and experiencing it as non-limiting/limiting, is an indicator or recovery/non-recovery. • Higher levels of positive wellbeing are associated with lower levels of limiting long-standing illness; through increased capability at ‘getting ill better’.

24. Two agendas for Public Health • ‘Getting ill less’: • interventions aimed at reducing incidence of illness, through reducing exposure to avoidable health risks. • ‘Getting ill better’: • Interventions aimed at earlier recognition of illness, and reducing inhibitions against becoming ill. • Interventions aimed at reducing duration and recurrence of illness, through improving access to recovery assets; and reducing inhibitions against recovery.

26. Proposed ‘characteristics of recovery’ • derived from reported experience of recovering persons; together with analyses of self-reported limiting long-term illness in Health Survey for England and British Household Panel Survey.(see Bartley et al. JECH 2004; 58, 501-506) • Recovery is: • Universal; everyone is potentially able to recover, given access to recovery assets, and non-exposure to inhibitions, • Non-clinical; recovery is to be distinguished from discharge from clinical treatment or long-term condition management, • Transformational; recovery is conditional on acquiring the capability to change social context, such that the condition does not recur, • Communicable; recovery is best achieved when co-produced within a community of recovering persons, supporting practitioners and reciprocal social partners. Presentation title - edit in Header and Footer

27. Jobs, Homes, Friends • Employment and Job Security • Being able to retain employed status while recovering; together with flexibility and capability for adjusting employment conditions to support recovery and reduce risk of recurrence. • Housing and Financial Security • Having access to secure and sufficient housing to support recovery; allied to assurance of sufficient financial resource (especially including access to benefit income) for housing to be sustainable without creating or exacerbating problems of debt. • Wider Social Engagement and Shared Recreation • Specifically, having access to mutual support from other recovering persons – as in ‘recovery communities’; but more widely in regular, non-work, engagement with friends and local neighbours outside of the immediate household, offering trust and being trusted.

28. Supporting local decision-making - the i-hit tool -Clare Perkins and Matt HennesseyKnowledge and Intelligence Team (North West)

29. i-hit • Originally developed by the former North West Public Health Observatory, with Liverpool John Moores University, to support Salford PCT/LA and their partners in understanding where to invest to achieve maximum gain in life expectancy • Salford wanted to develop a model that would predict the effect on life expectancy of improving key determinants of health, through investment in effective public health interventions. To better understand the ‘causes of causes’ and to identify priorities for multi-agency investment • i-hit models statistical associations between indicators in the health profiles, using Bayesian mathematical methods and conditional independence algorithms, and quantifies the scale of change needed across all the health indicators to achieve ambitions for life expectancy • The tool demonstrates that to achieve sustained health improvement, effort is needed across the spectrum of determinants of health Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

30. Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

32. Scenario: What is the scale of change needed to improve life expectancy for men by 2 years? Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

33. Scenario: What is the scale of change observed if we reduced adult smoking in Salford to the national average?Note the effect on child poverty and wider social determinants Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

34. Scenario: What is the scale of change observed if GCSE attainment equalled the current national average?Note that life expectancy (males) would increase by over 4% and unemployment would be down by nearly 60% Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

35. Next steps for i-hit • Stage 1 (in progress) • Refresh with recent data from Public Health Outcomes Framework and produce new map • Increase map interactivity • Scale up the tool for piloting across North West Local Authorities and Health and Wellbeing Boards • Stage 2 • Model impact for different geographies • Develop functionality to be able to: • ‘fix’ indicators in the tool • model changes in multiple indicators ‘on the fly’ Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

36. Impact of i-hit in Salford • The tool was used in Salford to develop a long list of priorities and to consider the scale of the challenge • It increased the Board’s focus on social determinants of health which became one of the key priorities • It strengthened wider stakeholder engagement in considering inter-relationships of factors e.g. smoking and child poverty, violent crime and life expectancy • Shaped the scale of challenge – creating more realistic scaled challenges for the first three years of the strategy alongside aspiration for long term goals Engaging with Health and Wellbeing Boards and Wider Partners; the i-hit tool

37. Local first • Forthcoming National tools to support the local systems: • National conversation on Health inequalities • Health and Wellbeing Framework for England and menu of interventions • Alcohol licencing support pack • Forthcoming NoE/Centre tools to support the local system: • PHOF summary tool • Health Equity North • Horizon scanning for emerging issues • Child health resource pack • Working with NHS England to identify local data requirements

38. Wellbeing Sefton Dr Janet Atherton Director of Public Health

39. Sefton’s Award WinningArts on Prescription Programme for adults with mild to moderate depression, stress or anxiety

40. Creativity flourishes in Sefton • Seed- ‘Arts & Health pilot’ in 2005 • Roots- ‘Invest to Save’ three year funding • Shoots- Weekly workshops in four locations NHS Sefton/Council joint funding • Fruits- Creative Alternatives as a jewel of The Atkinson Centre- ‘Sefton’s Centre for Wellbeing through Culture &Creativity’

41. Rooted & growing in Sefton • Labyrinths • Mazes • Heritage walks • Exhibitions • Creativity with vulnerable groups • Go with the Flow • Volunteering

42. The Impact? The Data I have struggled with anxiety since I was fourteen but never found effective help. For me Creative Alternatives was a final attempt. At Creative Alternatives no one judged me, problems were shared and I have formed some special friendships. I have done many things through the programme which I never would have thought possible – they have encouraged me out of my comfort zone. Creative Alternatives has really increased my confidence in travelling to different places. Since leaving the programme I have been doing voluntary work. This was a big achievement for me as I had not worked for nine years as a result of anxiety. I loved seeing what a difference I could make to other people. I have halved my medication and now feel more in control of my anxiety, it doesn’t stop me from doing things as much as it used to, now I am living my life instead of just existing. Case Study: Joanne’s Story Wellbeing • 78% improvement in mental wellbeing SWEMWEBS measure 3.5 point shift from low to medium wellbeing Lifestyle improvements • Physical activity 66% • Diet 36% • Increased social activity 68% • Smoking cessation 29% • Alcohol reduction 32% • Reduced medication 32% • GP visits reduced 34% Social Return on Investment • £6.95 for every £1 invested £6.95 for every £1 of expenditure

43. Sefton results: 5 point improvement on a 35 point scale from 20 to 25 Moving from low wellbeing to moderate wellbeing 43

44. Promote Prevent Recover • SEAS- Sefton Emotional Achievement Service delivered in Sefton schools • Wellbeing Sefton- a collaborative of social prescribing providers targeting adults with low wellbeing • Recovery College- an approach by Mersey Care enhancing the talents, skills and resources of service users to support their own recovery

45. Community Wellbeing • Building community resilienceCommunity asset development in 3 localities: ‘Fair Deal’ five ways to wellbeing kit utilised for community engagement • Integrated Wellness Service- a holistic approach to individual and community wellbeing • Green infrastructure for wellbeing • Healthy Streets

46. Champs Mental Wellbeing Programme • Commissioning for mental wellbeing outcomes • Brief Intervention • Integrated Wellness Services • Social Prescribing • Leadership & Workforce Development • Public awareness- PHE marketing Five Ways • PH role in reducing burden of mental illness • Mitigating the impact of welfare reform

47. Steps to flourishing • Vision & drive • Opportunities seized • Creativity • Partnerships • Evidence • Influence • ££ ?

48. Public Health Approach to addressing Domestic Abuse in Knowsley Matthew Ashton Director of Public Health Knowsley MBC

49. Overview • Background • Process • Key findings • Political scrutiny • Scrutiny Recommendations • Key messages

50. Background • Domestic abuse is a significant public health issue, having a major impact upon those directly affected and their families. • Locally, it had been raised as a issue at the Safeguarding Children’s Board and through the wider Knowsley Partnership. • Previous needs assessments (and consequently services) developed from a Community Safety perspective. • Need for new needs assessment from health perspective