This presentation on making Hertfordshire County Council a public health organization is designed for our corporate policy and performance workshops (8th October 2013) and looks at how we build on our success, to mainstream public health mindsets and approaches across the Council

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The 6 Steps
Making Herts County Council a Public
Health Organization
Corporate Policy and Performance Workshop on
Public Health October 8th 2013
Jim McManus
Director of Public Health

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Our success so far
• Our healthy workplace work shows we can
a)improve health, b) reduce sickness absence
in our workforce and c) save the taxpayer
money. ..see end of this slideshow for more
• So we have the ability to be a strong public
health organization
• Here’s how...

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The Six Steps to being a Public Health
Organization
1. Leadership commited to Public Health
2. Understand our Public Health Challenges
3. Identify what each area can do
4. Identify what Public Health Tools and Skills we can use
5. Consider every area of the business systematically
6. Make us an example of healthy employer and service
provider

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1.Leadership
• Exec Member
• Cabinet Panel
• HWBB
• Partnerships
• But what about officers across County?

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1. Leadership Our Public Health Strategy
OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5:
We
understand
what’s
needed and
we do what
works
Priority 6: We
make public
health
everybody’s
business and
work together
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT
POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer, H
ealthier
Lives
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Building
Blocks
For the
Public Health Family
Strong
Leadership
Capable,
Skilled People
Co-production
with citizens
Effective
Partnerships
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels

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2. UNDERSTAND OUR PUBLIC
HEALTH CHALLENGES

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Hertfordshire
• 1.1m People in 37 Settlements
• 10 Districts
• 1 County Council
• 2 NHS CCGs
• 8 NHS Trusts
• 1400+ vol orgs
• Urban/Rural mix

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Our Burden of Disease
• – Non-Communicable Diseases
– Over 60% of deaths due to lifestyle and behaviour
– Smoking
– Lack of effective primary and secondary prevention across
system
– Knowing what works
– Poorest fare worst (smoking, diabetes, heart disease)

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Learning the lessons from the
National Audit Office 2010
not on course!

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Interface of PH, health inequalities & social care
• NHS gone from infectious disease focus in 1948 to LTCs, cancer and
mental health in 21st century
• 1 in every 7 GP appointments for LTCs*
• 50% of adults with a mental health problem had a MH, behavioural or
emotional problem before the age of 14 yrs
• MH biggest spend of NHS than any other health condition
• Social determinants AND quality and accessibility of health & social care
• Old model of health and social care – deliver to, not with…co-production,
co-creating health, shared decision-making …
• Personal budgets… for social care (and health ??)
• Shift from one size fits all

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The Big Strategic Challenges for Hertfordshire
Health
Improvement
Health
Protection
Service Quality
Imms
Vaccs
TB
HCAI
Environment
•Non
Communicable
Disease
•Public Mental
Health
•Development
•Ageing
Health Care Quality
Public Service Outcomes

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3. IDENTIFY WHAT WE EACH
CAN DO

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Conceptualising wider determinants
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health
5%
Health
Behaviours 30%
Education 10%
Employment
10%
Income 10%
Family/Social
Support 5%
Community
Safety 5%
Socioeconomic
Factors 40%
Access to care
10%
Quality of care
10%
Clinical Care
20%
Environmental
Quality 5%
Built
Environment 5%
Built Environment
10%
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.
Contributors to overall health outcomes

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Questions for you to answer
1. Where do we touch people where we can build
resilience, motivation and opportunity to be
healthy?
2. Where do we touch people in a way which
mitigates against better health?
3. What do I want to know about evidence-based
practice tools which will help me do my core
role better?

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Systems thinking on wider determinants
A framework for you to use
The wider determinants of Health and Local Government functions
(Must adopt a Lifecourse approach!)
The Lives people lead and whether LA functions help or
hinder healthy lifestyles (policy, service
quality, access, behavioural economics, behavioural
sciences)
The services people access such as primary care
(high quality, easy access, good follow up,
behavioural and lifestyle pathways wrap around)

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An example from housing
• Warm, decent homes is a public health strategy

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4. IDENTIFY WHAT TOOLS
AND SKILLS WE CAN USE

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Some Tools
• Needs Assessment
• Evidence Based Practice
• Evaluation
• Whole Systems Thinking on Public Health
• The 3 Domains Model

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5. CONSIDER EVERY AREA OF
THE BUSINESS
SYSTEMATICALLY

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Making Herts County Council a Public Health
Organisation
• Every service understands and owns a public
health role
• We skill and motivate people to self-manage
their health and wellbeing
• We focus on the person and co-ordinate around
them
• Physical, Social, Psychological and Spiritual are
all part of the dynamics of health
• Mindset of staff,volunteers, carers and users

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Healthier Herts: A Public Health Strategy for Hertfordshire
OUR PURPOSE
to work together to improve the health and wellbeing of the people of
Hertfordshire, based on best practice and best evidence
OUR VISION:
A Healthy, Happy Hertfordshire: everyone in Hertfordshire is born healthy, and lives full, healthy
and happy lives. We compare well with England and every area in Hertfordshire compares well
against Hertfordshire
Priority 5:
We
understand
what’s
needed and
we do what
works
Priority 6: We
make public
health
everybody’s
business and
work together
HOW WE WILL WORK TOGETHER
(our strategic priorities: how we do it for
our County)
The
Public
Health
Outcomes
Framework
(the national
PHOF will
Help us measure
Our success)
WHAT WE WILL ACHIEVE WORKING FOR AND WITH OUT
POPULATION
(our strategic priorities: what we achieve for our County)
Priority 1:
Our
Populatio
n lives
Longer, H
ealthier
Lives
Priority 2:
Our
Population
Starts Life
Healthy
and Stays
Healthy
Priority 3: We
narrow the
gap in life
expectancy
and health
between
most and
least healthy
Priority 4: We
protect our
communities
from harm
(chemical,
biological,
radiological and
environmental)
Building
Blocks
For the
Public Health Family
Strong
Leadership
Capable,
Skilled People
Co-production
with citizens
Effective
Partnerships
Evidence and
Knowledge
Driven
Plan and
Deliver for
Localism
Whole
System
Approaches
Making better use of behavioural sciences at individual, interpersonal, community and service levels

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The Strategy Pyramid
2
Missio
nVision: Where we want
to get to
Strategy: How we want to get to the
vision
Implementation Plans : What we need to do in each area
of the business and for each topic
Individual Plans: My personal objectives and must dos
Mission:
Why ?
Where/What do
we want to be?
Why do we
Exist ?
How we want to
get there?
What we
need to do!
What I
need to
do!
Values, what’s
important to us ?
{

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County of Opportunity- Questions to ask
• The conditions for everyone to be healthy, from
conception to end of life
• The conditions for the poorest and worst off to
be healthier
• Intervene early
• Public services which put this at the core of their
business
• People thriving and prosperous
• Healthy workforce, prosperous County

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Health
Improvement
Health
Protection
Commissioning
priorities, Evidence,
acting when evidence is
silent, making it work,
supporting
implementation
Ensuring we have the right
frameworks in place
Long term, medium term,
short term impacts
Let’s assume you run a day centre.....
FALLS PREVENTION?
Service
Quality and
Improvement

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What Outcomes can I contribute to?

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The public health mindset means working
across different dimensions of time and
responsibility
•Think through what we can do short term
•Start work on the medium term
•Set the policy framework for the long term
•Build this understanding among partners
•Get started and realise
•County, District, Parish, NHS, Business and
Community Sector working together

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HERTFORDSHIRE LOCAL PUBLIC HEALTH MODEL (For Place or for People Settings)
Development of a local plan for each area and agency between partners with use of existing
community networks
2. WORK ON THE COMMON RISK
FACTORS FOR BIG KILLERS
Neighbourhood interventions for
Diet, Physical
Activity, Smoking, Alcohol,
3a. IMPROVE LOCAL
NEIGHBOURHOOD QUALITY
Physical Environment, Green
Space, Crime/ASB. INCREASE
SOCIAL CONTACT BETWEEN
NEIGHBOURS
4. INCREASE UPTAKE OF PREVENTIVE HEALTH PROGRAMMES
Immunisation, Screening, This may differ from area to area depending on issues
1. Complete a Basic health profile – identification of health issues salient for the
neighbourhood or service user group by checking the basic basic profile from
JSNA or other source
5. Skilling people for their own health– develop and deliver basic personal health
skills training. (Physical and mental health)
So…towards a model
explicitly designed to be as easy as possible for non-health specialists
can implement it
3b. IMPROVE SALIENT HEALTH OUTCOMES
Address issues specific to your population e.g. Coping and resilience for carers

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6. Make us an example of a healthy employer
• Smokefree policy
• Healthy Herts – employee wellbeing programe
• Show Leadership across County
• StepJockey
• CREATE A
MOVEMENT

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Healthy Employer - what we’re doing
1. Smokefree policy – already in place for employees,
moving to next stage
2. Healthy Herts –nominated for two awards, saved
money, reduced sickness absence
1. Next stage is sorting the food culture!
3. Counselling and wellbeing offer
4. Leadership – setting up workplace health offer and
seminars with employers
5. Stepjockey – took part in the trial, now rolling it out
across candidate buildings. Increased stair use by 29%
from baseline

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The Six Steps...what are you going to do?
1. Leadership commited to Public Health
2. Understand our Public Health Challenges
3. Identify what each area can do
4. Identify what Public Health Tools and Skills we can use
5. Consider every area of the business systematically
6. Make us an example of healthy employer and service
provider