Health Improvement Dr Jane Scarlett Consultant in Public

Health Improvement Dr Jane Scarlett Consultant in Public Health NSH Kingston

What is Public Health? • Small groups – 10 minutes discussion What does Public Health mean to you? What is Public Health? What does local Public Health do?

What is Public Health? • Populations • Three main strands – Health improvement – link to Local Authority – Health services quality – link to commissioning and to providers – Health protection – Health Protection Agency

Wanless Reports • April 2002 ‘Securing Our Future Health: Taking A Long-Term View’ – an independent review by Derek Wanless – the first ever evidence-based assessment of the long-term resource requirements for the NHS (to 2022). – Commissioned by Chancellor of the Exchequer

Fully engaged scenario • Best outcomes for population, and also least expensive. – “In absolute expenditure terms the gap between the best and worst scenarios was large – around £ 30 billion by 2022/23, or half of current NHS expenditure”

Report - Fair Society, Healthy Lives published in Feb. 2010 • Reviewed health inequalities in England • Clear social gradient in health • Universal action needed, proportionate to degree of disadvantage • ‘Proportionate universalism’ • Reducing health inequalities will require action on six policy objectives: — Give every child the best start in life — Enable all children, young people and adults to maximise their capabilities and have control over their lives — Create fair employment and good work for all — Ensure healthy standard of living for all — Create and develop healthy and sustainable places and communities — Strengthen the role and impact of ill health prevention

Health Improvement • Small groups of 4 -6 people • Develop a Health Improvement Strategy for Kingston to tackle your issue. This should include: – Why it is important – Your overall vision – where you would like to be in five years time – Your top three actions, and top action – Who should be involved – How you will balance between universal and targeted actions

What determines Health/being Healthy? The wider determinants of health Barton and Grant 2005 based on Whitehead and Dahlgren 1991

What does this translate to? Fixed Social and economic Environmental Lifestyle Life Chances - Access to services Genes Poverty Air quality Diet Education Sex Employment Housing Physical activity NHS Ageing Social exclusion Water quality Social services Smoking Environment access to green spaces Social Environment Transport Alcohol Leisure Sexual behaviour Drugs Our Healthier Nation (1998) 12

Nuffield Council on Bioethics Intervention Ladder

Relevance to Primary Care • • Identifying patients and families at risk Individualising risk to patients Respected trusted voice Effectiveness of brief interventions Linked into network of services Rewarding role And…

New Responsibilities** Local Authority Health Services Early Intervention Complex unstable conditions – living with disability Cradle… Protecting good health Local Authority Public Health Responsibilities: 1. Sexual Health Services 2. School Age Immunisations (HPV + school aged Booster) 3. Public Mental Health (Mental Health Promotion, Mental ill-health prevention, Suicide Prevention 4. Obesity/Nutrition (including Child Measurement programme, commissioning of weight management services, School nursing) 5. 6. 7. 8. 9. Drug and Alcohol misuse (treatment and prevention) Tobacco Control (including Stop Smoking) NHS Health Check Programmes (assessment and lifestyle interventions) Health at work Reducing and preventing birth defects Health and Social Care Services …Grave Stable Disease Easing the passing GP Linked Public Health Responsibilities (commissioning/provision) 1. Contraception Services* 2. All Childhood + Flu//Pneumococcal* 3. Mental Health Treatment 4. Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care, 5. Brief interventions and alcohol health workers in a healthcare setting 6. Brief interventions in primary, secondary, dental and maternity settings 7. NHS treatment and on-going risk management (following NHS Check assessment) 8. NHS Occupational Health 9. Interventions in primary care such as pre-pregnancy counselling, smoking cessation programmes and specialist services such as genetic services 10. Integral part of cancer services, outpatients, and primary care 10. Prevention and early presentation (including behaviour change 11. 12. 13. 14. services, services to prevent cancer, LTC - communication and awareness raising) Dental Public Health (fluoridation and oral health promotion) Health intelligence and information (with GP’s and PHE) Children’s Public Health services (initially not Health Visiting* but this is the longer term goal, including school nursing services, and the Health Child Programme for school-age children) Social Exclusion 15. Accidental Injury Prevention including falls 16. Community Safety, violence prevention 17. Seasonal Mortality (? Housing Fuel Poverty) 11. Dental Contracts* 12. Health intelligence and information (with LA and PHE) 13. All treatment services for Children 14. Responsibility for ensuring excluded groups have good access to services 15. Health services for the consequence of falls *NHS Commissioning Board Responsibility **Not exhaustive doesn't include Public Health England responsibilities

GP Linked Public Health Responsibilities (commissioning/provision) 1. Contraception Services* 2. All Childhood + Flu//Pneumococcal* 3. Mental Health Treatment 4. Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care, 5. Brief interventions and alcohol health workers in a healthcare setting 6. Brief interventions in primary, secondary, dental and maternity settings 7. NHS treatment and on-going risk management (following NHS Check assessment) 8. NHS Occupational Health 9. Interventions in primary care such as pre-

Others have been there before you…. When the winds of change blow, some people build walls and others build windmills (Chinese proverb)