“Making Health Everyone’s Business”. Investing the... · • Estates Strategy • Workforce...

Confident Place, Confident People.

“Making Health Everyone’s Business” Professor Kate Ardern Director of Public Health Wigan Council


Wigan Borough Population of Wigan about 320 000 Nearly 98% of Wigan's population are White British: • 54.6% of adults are physically active, Significantly

worse than England average • Higher than average rates of obesity • 65% of the borough population are of working age. • 23% of residents have long term illness. • There are nearly 34,000 carers of which 3,000 are

likely to be children. • Nearly 100,000 people in the borough are living in the

most deprived quintile. • Rates of homelessness are high 3.63 per 1,000

households compared to 2.48 per 1,000 for England. • 16 excess cancer deaths each for women and men

under 75yrs against the England rates 2012-14 (majority are lung cancer deaths)

Our population aged 65+ will increase by 30,000 over the 20 years. “Wigan is developing a culture of giving good people the time and space to do great things. Evidence-based working is important, but evidence can only be achieved in the first place by trying something new.”


Value Trend* Gap Change** Value Trend* Gap Change**

Wigan 62.5 37 months 41 months

61.1 18 months 17 months

Barnsley 56.2 11 months 7 months


Rotherham 59.0

11 months 7 months 57.1

13 months 14 months

Wakefield 62.0 12 months 16 months


Tameside 58.6 22 months 25 months


England 63.9 63.3

Healthy Life Expectancy

*From 2009-11 to 2011-13 **Reduction in gap compared to England

4 months 1 month

Statistical Neighbours


Public Service Reform Principles

• A new relationship between public services and citizens, communities and businesses = Do with, not to.

• An asset based approach that recognises and builds on the strengths of individuals, families and our communities rather than focusing on the deficits.

• Behaviour change in our communities that builds independence and supports residents to be in control

• A place-based approach that redefines services and places individuals, families, communities at the heart

• A stronger prioritisation of well being, prevention and early intervention.

• An evidence led understanding of risk and impact to ensure the right intervention at the right time


Making Health Everyone’s Business: The Approach

Asset-Based Community Development

For Health

Developing Leadership/

Culture change

Commissioning levers

Investment in health & wellbeing services

Developing staff skills

& confidence

Staff Health & Wellbeing

Maximising Health Gain

Confident Place, Confident People. Enabling Better Care • Estates Strategy • Workforce Reform

• Aligned Commissioning • Share to Care

Reducing Non Elective Admissions Reducing Health Inequality New model of social Care Award winning Integrated Neighbourhood Teams Prime Ministers Challenge on primary care access success Best performing GM system in 2015/16 winter Benchmark for place based public service reform in GM

Wigan Locality Plan for Health & Care Reform

7

Population Health Gain Heart of Wigan

Transformational Programmes

Standardisation of Acute Services WWL standards based horizontal alignment

A number of place based MCPs built from Primary Care Clustering and used as the default place based setting for the implementation of existing reform programmes/business cases: • Community

Nursing and Therapies

• Outpatients • Reformed Adult

Social Care • New integrated

children's model • Place based PSR

addressing wider determinants

Transformed Community Based Care The Wigan Integrated Care Organisation

authorising

Track Record of Delivery

Place based integrated working

Outcomes

Financial Sustainability Reduced Acute Activity Reduced Institutionalised Care Improved Care Outcomes Residents well and independent Public Services Orientated towards prevention not crisis


Heart of Wigan

1 • North Karelia Whole System CVD Prevention

2 • Heart Start from Seattle

3 • Lessons from Heart of Mersey

4 • RSPH Health Improvement Level 2 (Heart Champions)

5 • Community Defibrillator roll-out

6 • NHS Health Checks ..plus Vascular Dementia risk


Success in Attracting Greater Manchester Transformation Fund Investment Phase 3 transformation will focus on work streams that afford the greatest opportunity to achieve cumulative outcomes and accelerated impact across a number of clinical and non-clinical areas including: • Planning & Transport, • Green Space • Utilisation, early identification of conditions such as diabetes and chronic

kidney disease (‘Finding the Missing Thousands’) - increased development & use of digital solutions, awareness raising and capacity building with communities

• Inclusion of primary and secondary prevention interventions into clinical and social care pathways; to reduce duplication, and reduce or delay reliance on costly treatment and support services.

• Total investment required for delivery - £558,577 • Overall financial return on investment (ROI) – 2.74 (Commission for the

New Economy CBA) • Payback period – 3 years


Heart of Wigan Phase 3

HWBS Priority 1. Increase Physical Activity • Review targeted early intervention and

prevention, and universal physical activity offer. • Develop programmes targeting key cohorts

(Learning & physical disabilities, mental health etc).

• Review the weight management offer across clinical and community programmes – across start live and age well

• Launch “Wigan on the Move” as part of Wigan WellFest (3rd-11th Sept 2016)

• Borough-wide roll-out of Daily Mile in all primary schools

HWBS Priority 2 Finding the Missing Thousands • Expand Health Check screen to include

depression and anxiety • Expand Health Improvement Service offer to

develop and include effective level 1 alcohol reduction and wellbeing offer.

• Develop and implement appropriate and adaptable wellbeing programme to be delivered by and for WWL staff groups

• Embed routine NRT provision within pre-operative process for elective surgery

• Vascular dementia risk awareness programme and support developments of Dementia united and dementia friendly communities.

• Maximise the potential of new technology for Health Improvement eg. Wellness kiosks, Quit-it app, mobile support offer.

HWBS Priority 3. Increasing Independence & Resilience • Ensure Health Improvement outcomes are

incorporated into Deal For Communities (including ‘Get Wigan Moving’ allocation).

• Strategic placement and registering of defibrillators.

• Expansion of CPR training and Heart Champion programme.

HWBS Priority 4. Transport and Planning • Borough wide strategic cycle plan. • Develop & agree local criteria on Section

106/community levy investments. • Broaden the scope of the current ‘greenspace

offer’.


Smoking rates in Wigan

• Smoking Prevalence in adults has reduced from 22.8% in 2011/2012 to 18.7% in 2015 – a reduction of 4.1% over 4 years. Wigan is now ‘not significantly different’ when compared to the England average.

• Smoking Prevalence in routine & manual occupations has reduced from 31.4% in 2011/2012 to 24.4% in 2015 – a reduction of 7% over 4 years. Wigan is now below Eng Av of 26.5% (PHE 2015)

• Smoking Prevalence at age 15 (current smoker – WAY survey, 2014/2015) is 7.1% and ‘not significantly different’ when compared to the England average

Smoking in Pregnancy (Smoking at time of delivery SATOD) • Locally Smoking at Time of Delivery (SATOD) has reduced from 20% in

2010/2011 to 14.8% in 2015/2016 – a reduction of 5.2%. • Wigan remains ‘significantly worse’ when compared to the England

average (10.6%).


Heart of Wigan

Reducing early deaths and increasing healthy life expectancy in Wigan


Health Improvement Services • Remodelled – integrated

health improvement service with one front door • Online booking

solutions, text and Apps

• Professional referral forms & Opt-out solutions

• Front line staff having remote access to technology

• High St access


“Councillor Saves Life” & Senior Management Get Cardiac Smart


Creating a Culture of Health Our “Health Movement for Change” currently includes: 1350 Health Champions 495 Heart champions 856 Cancer Champions 8,400 Dementia Friends The Community Health champions are: 1. Embedded within existing programmes, 2. Made up of members of the community, front line staff

and volunteers from across the public voluntary and private sectors.

3. Recruited through specific targeting of staff groups who share either Public Health outcomes or priority groups or have complimentary objectives within their work programmes.

Wigan is the Alzheimer Society Dementia Friendly Town of the Year 2016 Eg: GMFRS, WALH tenancy support, pharmacy assistants, home care workers


Physical Activity is the Most Effective Drug

• Overall economic & social cost of inactivity in Wigan Borough is estimated at £21,779,819 per 100,000 population, per year.

• On average, an inactive person spends 38% more days in hospital than an active person, and has 5.5% more family physician visits, 13% more specialist services and 12% more nurse visits than an active individual.

• Referral into physical activity is embedded within the NHS health check • Diabetes pathway redesign - more emphasis placed on early intervention

and self-care, aiming to increase referrals to lifestyle services • Integrated Community Nursing and Therapies Services and the Older

People’s Pathway developments - Early intervention an prevention and self-care are at the heart of these new approaches

• CQUIN for 2016-17: referrals from treatment room staff into Early intervention and lifestyle services


Inspiring Healthy Lifestyles • Range of physical activity services commissioned by Public

Health (PCT) provided by the former Wigan Leisure & Culture Trust - Included developments in infrastructure, promotion of population participation and targeted services Eg GP referral scheme

• 2015-16 - Realignment of wider leisure services commissioning (leisure centres, destination parks etc) with Public health – maximise wellbeing offer

• Broader approach to engaging people in physical activity – ‘The Deal’, Heart of Wigan, Specfit, SHAPE, professional and amateur sports clubs, dementia friendly communities, Deal for communities investment fund – Wigan on the Move.

• Wigan Health Walks: Wide range of walks from 40 minute taster walks for beginners to longer 2 hour walks for regular walkers.

• Power walks, Nordic walking, hill walks and Park Workout walks for something more challenging or a variation to their exercise programme.

• Over 95% of walks are volunteer led meaning we have created a long term sustainable walking programme which isn’t reliant upon paid members of staff.

• Annual cost per head as little as £34 & benchmarked as the most successful walks programme nationally.


Start Well: Let’s get movin’ …

National Exemplar for Tackling Childhood Obesity • Integrated working • Targeted schools programme • Specialist service • Integral to Wigan’s Deal for Children and Young

People. • Impact on oral health • Our service solutions reaching over 7,000

children and families every year – alongside measuring children we provide a preventative intervention for all children and families.

• NCMP Reception participation increased from 91% to 96% & Obesity reduced from 13% to 10%

• NMCP Yr6 participation increased from 77% to 93%


Lose Weight Feel Great: Kieran and Shirley Lloyd & Gary Harris


In Conclusion:

• Public health is fundamental to system-wide transformation

• Improvements to outcomes have accelerated since the transfer

• Health, care and wellbeing are tackled on an integrated basis across the council, the NHS and other partners

• Staff are given time, space and training to identify flexible solutions.

“Wigan is developing a culture of giving good people the time and space to do great things. Evidence-based working is important, but evidence can only be achieved in the first place by trying something new.”

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