Building Partnerships to Improve Health Parallel Session NWHPAF 1 st March 2012 Will Blandamer Director, GM Public Health Network

Transcription

1 Building Partnerships to Improve Health Parallel Session NWHPAF 1 st March 2012 Will Blandamer Director, GM Public Health Network

2 Population health in GM is on average poor relative to England

3 Male Life Expectancy Gaps in Greater Manchester Primary Care Trusts: to % 1% P ercentage difference from E ngland 0% -1% -2% -3% -4% -5% Salford PCT Stockport PCT Ashton, Leigh and Wigan PCT Bolton PCT Oldham PCT Bury PCT Tameside and Glossop PCT Heywood, Middleton and Rochdale PCT Trafford PCT Manchester PCT -6% -7% three years pooled

4 Female Life Expectancy Gaps in Greater Manchester Primary Care Trusts: to % 1% Percentage difference from England 0% -1% -2% -3% Salford PCT Stockport PCT Ashton, Leigh and Wigan PCT Bolton PCT Oldham PCT Bury PCT Tameside and Glossop PCT Heywood, Middleton and Rochdale PCT Trafford PCT Manchester PCT -4% -5% three years pooled

5 We have a coherence in GM that could support joint working on the problem

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7 CMMC Stockport T&G Bolton MCR MCR MH Christie Pennine Care Oldham Bury Pennine Acute Bolton Trafford Salford ALW Tameside Stockport Trafford Salford WWL UHSMFT BST MH 86% 66% 53% 75% 47% 16% 23% 4% 59% 52% 11% 47% 51% 2% 2% 13% 3% 3% 15% 27% 33% 0.01% 3% 8% 18% 2% 3% 4% 0.01% 6% 4% 4% 4% 19% 3% 11% HMR 4% 6% 14% 4% 3% 6% 7% 14% 5% 17% 9% 8% 7% 4% 3% 4% 0.2% 17% 4% 5% 13% 3% 5% 3% 5% 5% 3% 7% 7% 11% PCT Acute MH GM Acute Patient Flows (2007/08)

8 Transport: Commuting Flows in to Conurbation Core

9 we know that population health is determined by many factors, mostly outside of the nhs

10 Local Authority Delivery of the Determinants of Health/Wellbeing Employment & education Health Crime & fear of crime Economy & Income Life and working conditions Environment, Transport & Housing Work environment Unemployment Education Water & sanitation Agriculture and food production Age, sex and constitutional factors Health care services Housing Determinants model = Dahlgren and Whitehead, 1991

11 And yet leadership on health inequalities was variable and there was no sense of genuine partnership commitment at the city region level

12 GM Leadership An Audit Commission View Greater Manchester knows what the health inequalities issues are BUT There is no health vision for Greater Manchester and a lack of champions. Concerted, radical action is required to make a difference and reduce the health inequalities gap Audit Commission May 2006

13 around this time key strategic context was forming Manchester Independent Economic Review and GM Strategy

14 Manchester City Region Most significant economic agglomeration outside London million residents, 5 million within travel to work area - 54 billion GDP annually (5% of UK total) Highest worklessness outside of London - c.280,000 residents on out-of-work benefits - c.150,000 residents workless due to ill health Deeply entrenched deprivation - 19% of residents live in areas that are amongst the 5% most deprived nationally GM s GDP gap to national average is 4 billion - 25% of gap is due to worklessness, mostly health-related

15 MIER and the GMS Manchester Independent Economic Review (MIER) Detailed economic baseline and themed reports (innovation, skills etc) Outside London, GM is best placed to take advantage of the benefits of agglomeration and increase growth GM has the scale but punches below its weight: low productivity Need more spatial clustering of jobs, skills, influence, amenities Tighter policy focus on productivity required Greater Manchester Strategy: Prosperity for All Boost productivity and long term economic growth: ensure the benefits are shared across all communities 11 GMS Priorities, including: - Better life chances in the most deprived areas - Expand and diversify economic base - Increase the proportion of highly skilled people

16 New AGMA governance arrangements SCRUTINY POOL GREATER MANCHESTER EXECUTIVE BOARD BUSINESS LEADERSHIP COUNCIL STRATEGIC COMMISSIONS Commission for the New Economy Transport Planning & Housing Environment Health Public Protection Improvement & Efficiency

17 The responsibility was therefore to get the GM Directors of Public Health group organised in such a way as to exploit the opportunities to prioritise health in particular to recognise current health as a drag to economic growth and to be clear what interventions partners needed One of these opportunities was the GM Health Commission a fixed point of multiagency leadership

18 The GM Health Commission Set up in 2007 to improve the health of the two and a half million people living in Greater Manchester. Made up of leading representatives from Greater Manchester s Councils, NHS Primary Care Trusts, and the Higher Education Sector. Advised by the GM Directors of Public Health. Provided public health leadership on issues such as minimum unit price for alcohol, fuel poverty, and GMS issues such as work and wellbeing.

19 Role of the GM Health Commission To provide visible political leadership As a commission of influence to ensure all partners recognise the potential contribution To support and guide the other commissions for their contribution to addressing health inequalities

20 Health Commission achievements i) Ensured full appreciation of the role of health as a limiting factor to economic growth on the MIER Ensured consideration of health in the development of the GMS Engendered excellent joint working between health and Commission for the New Economy a. fit for work b. workplace health c. alignment of health offer in relation to work programme National advocacy a. minimum unit price b. tobacco legislation

21 Health Commission achievements ii) Local advocacy supporting the translation of public health priorities interventions into mainstream working at a local level e.g. prioritisation of fuel poverty opened doors locally Creating or supporting consistent interventions and at scale workplace health, AWARM Ensuring health in all policies in emergent GM wide arrangements Transport (Walking and Cycling in LTP3) Focal point for AGMA wide engagement with Key partners GM Sport strategy Changing Lives endorsed through Health Commission Focal point for AGMA consideration of the NHS White Paper

22 Health Commission priorities To respond to the major killers and key factors affecting life expectancy and health inequalities Cancer Heart disease Respiratory illnesses Smoking Alcohol Poor mental health Worklessness Air quality Fuel poverty

23 Once you have the credibility and authority associated with such a leadership forum prioritising health and well being, it makes engaging with the rest of the system easier

24 Look who we now talk to, and have programmes of work with about health NHS Greater Manchester GM Combined Authority Council of CCG Consortia AGMA on going voluntary collaboration NHS Acute Trusts Chief Execs group Academic Public Health UoM, MMU, Salford etc Combined Authority (inc Transport for Greater Manchester) GM Centre for Voluntary Organisations GM Sport GM Police GM Against Crime Strategic Partnership GM Fire and Rescue Service GM Business Leadership Council GM Local Enterprise Partnership GM Chambers of Commerce Etc etc

25 Look what we ve done E.g. Changed context of debate on alcohol, illicit tobacco, fuel poverty, cycling, 20mph, work etc Created GM wide products (Good Work Good Health) Delivered joint programmes e.g. fit for work Supporting shift in approach in some partners e.g. TfGM Delivered GM wide campaigns Seen partners unilaterally pick up health improvement activity

26 What I have learned about partnership building Be Clear on your priorities Present them regularly and forcefully Understand the priorities of partners and tailor accordingly Have arguments backed by intelligence/evidence Maximise leadership capacity Take a risk in partnership building Understand where power and influence is

27 Any evidence of progress?

28 GM Leadership An Audit Commission View Greater Manchester knows what the health inequalities issues are BUT There is no health vision for Greater Manchester and a lack of champions. Concerted, radical action is required to make a difference and reduce the health inequalities gap Audit Commission May 2006 There is much to be proud of. We outlined at that time what we hoped our report might look like in We can report with some confidence that this is now a good description of the position as it currently exists across Greater Manchester in This is a remarkable achievement in a short space of time. Audit Commission October 2008

29 oct Greater Manchester estimated progress in year apr09 jun09 aug09 oct' feb10 apr10 jun10 aug10 oct feb11 apr11 jun11 aug11 12 month rolling average: (actual deaths 2008, monthly deaths 2009, 2008-base monthly population denominators) male estimate male trajectory female estimate female trajectory feb All-age all-cause mortality estimate

30 But maybe good quality partnership working can only get you so far? What is it that gets in the way of genuine and binding partnership to deliver reform

31 Why Community Budgets? Public services are too often fragmented and uncoordinated, addressing symptoms not causes, particularly for the most challenging people and places Results in poor outcomes, high costs, and constraints on growth Public service reform initiatives have been supported by ad hoc funding, not been core to mainstream public services We need a transformational reduction in demand, away from unplanned, expensive, reactive spend, moving the most challenging people and places from dependency towards self-reliance This requires new delivery models, underpinned by workforce reform and effective use of information, building on Better Life Chances pilots And new investment models that enable us to work at scale, so money can flow freely across silos with incentives for partners to invest jointly to achieve returns for the whole public sector

32 Whole Place Community Budget GM concept of Community Budget Brings together joint investment from partners, to achieve shared priorities To overcome situation where one partner invests but many others benefit (e.g. reduced demand on criminal justice system will benefit health, LAs) And the time-lags that discourage investment in early intervention and prevention Involves investing in new delivery models that improve outcomes, reduce demand for services, and support growth Based on robust evidence of costs and benefits start with theoretical CBA models developed with 10 departments build on this through real achievements from interventions that reduce demand and take out costs In turn enabling cashable savings to be made (with flexible contracting and redeployment of staff across boundaries), creating a return on investment So partners can decommission and recommission services with confidence, across traditional boundaries, at scale Will reduce dependency and support growth, by improving productivity, worklessness and low skills alongside wider reforms to create conditions for growth Complex families are way in to wider reform, through complex, cross-cutting issue

33 Thanks