Public Health
Are We Nearly
There Yet?
Pete Hill &
Sarah James

Public Health Are We Nearly There Yet?
• A Quick Recap
•Draft Health & Wellbeing Strategy
•DPH and the Life Course
•JSNA Update
•Lies Damned Lies and Statistics!
•Something To Think About.

Health and its determinants
“Health is a state of complete
physical mental & social wellbeing
and not merely the absence of
disease or infirmity.” World Health
Organisation (1948)
Health is the science & art of
promoting & protecting health &
wellbeing, preventing ill health &
prolonging life through the
organised efforts of society.” UK
Faculty of Public Health 2010
Health Improvement Health Protection Health Services

The health and well-being of individuals and populations across
all age groups is influenced by a range of factors both within
and outside the individual's control.

Draft Health & Wellbeing Strategy
Children and Working Age Older People
Young People Adults
Healthy Weight
Reducing smoking
Managing long term conditions
Supporting family carers
Promoting good mental health
Helping families to Thrive
Reduce the harm caused by drugs and alcohol
Fulfilling lives for people with learning difficulties
Physical Activity

Health & Wellbeing Boards
JSNA
Health Health & Public
Watch Wellbeing Board Health
Outcomes
Framework
Joint Health &
Wellbeing
Strategy
LA NHS CCG
Commissioning Decisions

Director of Public Health
• Jim McManus
• Appointed July 2012
• Employed by Hertfordshire County Council
• Principal Advisor to Health & Wellbeing Board
Responsible for:
Health Improvement
Health Protection
Health Services

Health Influences Over the Life Course
Health Influences Over The Life Course
8
From Neal Halfon

“District Councils in particular have functions crucial to health in
health protection and environmental health, planning, housing and
leisure/culture to name but a few. I think this gives us an opportunity
to develop arrangements which work locally for us”.
“In particular, I think we will be able to re-emphasis that the
specialist public health family is larger than we think.”
Jim McManus
Director of Public Health Hertfordshire County Council

Its Public Health
Jim but not
as we know it!

The Future of Public Health
In April 2013, the Health and
Social Care Act 2012 will be
implemented, which means that
Hertfordshire County Council
will take on the duty to improve
the health of people in its area
and with it, acquire many of the
public health services currently
the responsibility of the NHS.
The landscape for both public
health and the NHS will be very
different.’’
Jim McManus DPH

Jim’s vision
…..this gives Hertfordshire a
significant opportunity to
develop a robust public
health function which works
across the various partners
in the County, and a
significant opportunity to
realise the shared ambitions
for a healthier population.

Six domains of specialist public health
activity are emerging
1. Commission and account for Mandated Services (e.g. smoking,
Chlamydia, health checks, sexual health etc)
2. Healthcare public health support to CCGs
3. Health Protection and resilience role (still being defined) DPH will co-
chair local Health Resilience Fora and have system duties for infectious
disease and other health protection issues
4. Applying public health skills to local authorities and the public sector
(Link consultant in public health to each Directorate of HCC,Links to
Districts)
5. Joining things up between and across agencies (e.g. Obesity)
6. Delivering health and wellbeing Board priorities

Specialist Public Health links to these through lead officers
and also by a modest amount of financial support.

Update

How JSNAs, JHWS’s and Commissioning plans fit together
So what have we achieved? – what difference have we made to
people’s lives? (outcomes)
What services do we need to commission, or de-commission / provide and shape
both separately and jointly? (our commissioning plans)
So what are our priorities for collective action, and how will we achieve them
together? (our JHWS)
What are we doing now, how well is it working and how efficient is it? (an
analysis on our progress)
So what does that mean they need, now and in the future and what assets do we
have? (a narrative on the evidence – our JSNAs)
What does our population & place look like? –evidence and
collective insight

The JSNA process will be easily used and understood by everyone including:
Health & Care
Commissioners
Representatives
General Public
& Healthwatch
Schools &
Providers
Education
JSNA
Criminal Economy &
Justice Employment
Housing
Environment Community
Transport Organisations
Leisure

JSNA Design and Structure

JSNA
3. OUR
1. WELCOME 2. OVERVIEWS 4. YOUR 6. RESEARCH
PRIORITIES 5. OUR HEALTH,
COMMUNITY AND 7. YOUR VIEWS
CARE AND RESOURCES
WELLBEING
2.1 Needs 3.1 Healthy
Summary Weight
1.1 What is JSNA
4.1 Community
Profiles
6.1 Funding /
2.2 Performance
3.2 Smoking Finances
Snapshots 7.1 Discussion
5.1 Health and Comment
1.2 How to use
JSNA 4.2 Clinical Conditions and
2.3 Priorities 3.3 Long Term Commissioning Disabilities
Progress Conditions Group Areas
6.3 Current Data
1.3 How we
commission and 3.4 Carers
4.3 District Areas
monitor 5.2 Health
Improvement and
3.5 Mental Health Healthy Living 6.2 Assets and
and Wellbeing Services
1.4 FAQ
3.6 Thriving
Families
5.3 Life Stages
and Social Groups
3.7 Alcohol
3.8 Learning
Disabilities
3.9 Dementia

5. OUR HEALTH, CARE
AND WELLBEING
5.2 Health
Improvement and
Healthy Living
5.2.4 Health 5.2.6 Sexual 5.2.8 Mental
5.2.2 Drug Misuse
Improvement Health Wellbeing
5.2.3 Healthy 5.2.5 Physical
5.2.1 Alcohol 5.2.7 Smoking
Eating Activity
5.3 Life Stages
and Social
Groups
5.1 Health
Conditions and 5.3.6 Particular
5.3.2 Carers 5.3.4 End of Life
Disabilities Groups
5.1.6 Mental
5.1.4 Learning 5.1.8 Physical
5.1.2 Cancer Health and 5.3.3 Children and 5.3.5 Mother and
Disabilities Disabilities 5.3.1 Ageing
Dementia Young People Baby
5.1.1 Acute Care 5.1.3 Infectious 5.1.5 Long Term 5.1.7 Other 5.1.9 Sensory
and Trauma Diseases Conditions Disorders Disabilities

4. YOUR COMMUNITY
4.2 Clinical
Commissioning
Group Areas
4.2.1 East and
4.2.2 Herts Valleys
North Herts
4.3 District Areas
4.3.10 Welwyn
4.3.2 Dacorum 4.3.4 Hertsmere 4.3.6 Three Rivers 4.3.8 Stevenage
Hatfield
4.3.1 Broxbourne 4.3.3 East Herts 4.3.5 North Herts 4.3.7 St Albans 4.3.9 Watford
4.1 Community
Profiles
4.1.2 Community
4.1.3 Community 4.1.5 Employment 4.1.7 Equality and
Resources and 4.1.9 Other
Safety and the Economy Deprivation
Leisure
4.1.1
4.1.4 Education 4.1.8 Health and
Accomodation and 4.1.10 Population 4.1.6 Environment
and Learning Wellbeing
Housing

Community Profiles
• http://www.hertslis.org/keyresources/profiles/

Lies Damned Lies & Statistics!
• Food Poisoning
• Foodborne Illness
• Healthy Eating
• Obesity
• Costs To NHS

Health & Safety Data A B C D E F G H I J Total
Number of LA Enforced Premises 1545 2592 2005 1474 2163 2092 1027 1700 2029 1388 18015
Number of Interventions 2011 386 273 71 340 48 104 315 68 99 243 1947
Number of Complaints requests 2011 36 7 50 82 74 132 41 422
RIDDOR Incidents Notified 98 7 106 138 32 164 115 51 161 243 1115
RIDDOR Incidents Investigated 61 7 28 36 32 15 4 27 14 224
Formal Action Notices 6 3 8 15 1 1 2 2 3 6 47
Intervention % 24.98 10.53 3.54 23.07 2.22 4.97 30.67 4.00 4.88 17.51 10.81
RIDDOR % 6.34 0.27 5.29 9.36 1.48 7.84 11.20 3.00 7.93 17.51 6.19
Investigation % 62.24 100.00 26.42 26.09 0.00 19.51 13.04 7.84 16.77 5.76 20.09
Complaint % 2.33 0.27 2.49 5.56 0.00 0.00 0.00 4.35 6.51 2.95 2.34
Accident Rate 0.10470 0.00483 0.07698 0.13800 0.02518 0.11664 0.13690 0.05842 0.17829 0.21991 0.09992
Population 93,600 144,800 137,700 100,000 127,100 140,600 84,000 87,300 90,300 110,500 1,115,900

Health &
Safety
Mastermind
Health &
Safety
Special

Workers' rights on health
and safety to be scaled
down

New health and safety
laws will push workplaces
back to 'Victorian era’

Cuts ‘put public at risk’

Local Authority
Spending on
Environmental Health
and Trading Standards
has been Cut by 32%
since 2009!

Health and safe-E.T. gone mad

UK Newspaper Circulation Figures Jan –Jun 2012
1. The Sun 2,622,123
2. Daily Mirror 1,091,094
3. Daily Star 612,568
11. The Independent 100,139

So
• How Do We Prove We Make a
Difference?
• Are We Concentrating on the
Right Things?
Are We……….

Cost Analysis
Cost of poor health in the UK working age population in 2007 was between £103-129 billion^
The Total Cost of Workplace Injuries in 2009/10 was £5.4 billion*
Cost to the NHS of Workplace Accidents & Ill Health in 2009/10 was £608 million*
In 2009/10 700,000 people suffered a Workplace Injury*
The HSE Cost Model Predicts each Workplace Fatality Costs £1.5 million*
Annually 16,000 People Leave the Labour Market as a Result of a Workplace Injury or Illness*
more than three-quarters of the population do not have disability-free life expectancy as far as the age of
8. If society wishes to have a healthy population, working until 68 years, it is essential to take action to both
aise the general level of health and flatten the social gradient” – Sir Michael Marmot
*Costs to Britain of Workplace Injuries & Work Related Ill Health 2009/10 – HSE Publications
^ Working for a Healthier Tomorrow – Dame Carol Black Review 2008

Where Do You Fit In
The Health Jigsaw?
“I’m not like everybody else” – Ray Davies 1966

Public Health
Are We Nearly There yet?
Pete Hill Sarah James
Environmental Health Projects Officer Chartered Environmental Health Practitioner
Welwyn Hatfield Borough Council Watford Borough Council
01707-357404 01923 278582
P.Hill@Welhat.gov.uk Sarah.James@Watford.gov.uk
© PH/SJ2012