Public Health: Embedding health in London boroughs

Delivering Public Health

Embedding health in London boroughs 26 March 2014

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Delivering Public Health

Welcome & Chair’s Introduction Lisa Taylor

Director, Future of London

Agenda 8.30

Arrivals and refreshments

9.00

Chair’s welcome – Lisa Taylor

9.10

Borough perspective – Dr Ruth Wallis

9.25

City health check – Anna Scott-Marshall

9.40

A pan-London action plan – Lucy Saunders

9.55

Working with LBs – Helen Macfarlane

10.10

Q&A and discussion

10.30

Coffee and networking

11.00

Close

Delivering Public Health

Embedding health in LBs Dr Ruth Wallis

Director of Public Health for Lambeth and Southwark

Embedding health in local authorities Policy into practice in Lambeth and Southwark

Dr Ruth Wallis Director of Public Health, Lambeth & Southwark March 2014

• • • •

History and new responsibilities Health issues in Lambeth and Southwark Protecting and improving health Progress and challenges

Public health in local authorities 1. Dominant local influences, housing,education, ‘vulnerable’ direct provision, employed staff 2. Pre-NHS provided health care and health education 3. Continued provision until 1974 + LA and NHS provision of Public Health until 1984 (common training, common structure all health care provision (child health, TB control nurses, family planning -> NHS) 4. Single NHS/teams, joint DPH posts

New responsibilities for public health in local authorities • •

Lead organisation for health improvement, and public health/DPH + Responsible for commissioning specific ‘public health’ services, – – –

Sexual health, including prevention and GUM services Drugs and alcohol Health improvement: smoking cessation, vascular risk, injury prevention, etc

Total public health budget Southwark 5% 1%

Lambeth & Southwark Public Health Team

9%

Sexual health Health improvement

33% 36%

Substance misuse Community sports Contingency fund

16%

Teenage pregnancy in Lambeth and Southwark

•Clarity about outcomes, needs assessment •Effective partnership •Implementation of evidenced based practice and development •Sustained focus, investment and mainstreaming

All age all cause mortality Preventable premature mortality from cancer; CVD; respiratory disease; liver disease Mortality causes amenable to health care* Smoking prevalence Adult obesity prevalence* Teenage conceptions Emergency hospital readmissions* Unplanned hospital admissions (ACS)* Hip fractures in elderly Infant mortality Low birth weight Injuries in young people Physical activity adults* TB incidence Childhood vaccination related diseases Childhood tooth decay* Suicide Preventable sight loss Excess winter deaths*

Hypertension prevalence Alcohol related burden Drugs related burden* Childhood obesity Sexual Health burden (HIV, STIs) Lower prevalence of LTC (lower detection)* Falls injury (older people) Wider determinants of health burden Violence related health burden* Low wellbeing levels * Mental ill-health* Social isolation in adult social care users*

Vit D deficiency rickets Mortality from communicable diseases* Injuries in Children Road traffic injuries / mortality*

All age all cause mortality Preventable premature mortality from cancer; CVD; respiratory disease; liver disease Mortality causes amenable to health care* Smoking prevalence Adult obesity prevalence* Teenage conceptions Emergency hospital readmissions* Unplanned hospital admissions (ACS)*

Infant mortality Physical activity adults* Childhood vaccination related diseases Childhood tooth decay* Suicide* Preventable sight loss Excess winter deaths*

Hypertension prevalence Alcohol related burden Drugs related burden* Childhood obesity Sexual Health burden (HIV, STIs) Lower prevalence of LTC (lower detection)* Falls injury (older people) Wider determinants of health burden Violence related health burden* Low wellbeing levels* Mental ill-health Social isolation in adult social care users Hip fractures in elderly Vit D deficiency rickets Road traffic injuries / mortality Mortality from communicable diseases Low birth weight Injuries in Children Injuries in young people TB incidence

The Marmot Framework

Marmot

• Give every child best start in life • Enable all to maximise capabilities and have control over life • Create fair & good employment • Ensure a Healthy standard of Living • Healthy & Sustainable communities • Strengthen Ill Health prevention

Wider determinants • Benefits advice in primary care, health indicators of ‘recession’ • Built environment:– Planning: fast food, alcohol, road speed(s), knee high – Primary care and localities: what’s where? And how much – Health impact assessment – Housing strategy: housing redesign, rented accommodation (quality and overcrowding) – Homelessness strategy

Mental health and wellbeing The Five Ways to Wellbeing are a set of evidence-based actions individuals can do in their everyday lives which promote wellbeing

• • • • •

Connect Be active Take notice Keep learning Give

Challenges and lessons • • • •

The importance of effective partnership(s) Cultures and evidence, including intelligence Complexity and common outcomes London issues: – – – –

Population, mobility, diversity and vulnerability Housing affordability and quality Employment and income, hidden economies Health and wellbeing for young people, risks and opportunities – Development +++ – The public health profession, workforce, leadership and status

Delivering Public Health

Embedding health in LBs Anna Scott-Marshall

Head of External Affairs, RIBA

RIBA City Health Check

Why? • Walking trips have fallen by 27% over the last 15 years • Local Authorities have responsibility to join up health policy with other strategies around housing, planning and transport infrastructure • Adults should undertake 150 minutes of exercise per week • Study showed that people with access to large attractive public spaces were 50% more likely to walk

London • London in comparison to the eight core cities in England is the second least deprived city of those we compared but its health performance varied. • Life expectancy in London is similar to the national average, and London performed well compared to other cities (top for men and second for women).

Physical activity

London is in joint eighth place with Newcastle with only 9.9% of adults meeting recommended exercise levels according to Public Health Observatory (PHO) data.

Diabetes London’s proportion of adults with diabetes is similar to the national average, putting London in fourth place.

Obesity in children London has a higher rate of childhood obesity than England and was ranked fifth out of the nine cities analysed.

Land Use Land use in the best performing and worst performing local authorities found a clear correlation between land use and health outcomes with the authorities with the poorest health outcomes had a greater housing density (larger area taken up by housing) and lower level of green space.

Public Survey • RIBA YouGov survey of 150 people in London suggests that a larger figure, 45% of London adults, self-report meeting minimum levels of activity.

• To improve physical activity London boroughs should include a focus on more attractive designs for public parks.

• Safe, attractive and playable parks could help to combat high childhood obesity, as well as safe and attractive routes to school.

Recommendations • London Boroughs should develop Healthy Infrastructure Action Plans to sit alongside and as part of the Local Plan.

• A proportion of the Community Infrastructure Levy obtained from new developments should be redirected to fund the areas identified as necessary in the Healthy Infrastructure Action Plan.

• Developers and Architects when submitting plans should outline within their Design and Access Statement how they fulfil the priorities set out in the Healthy Infrastructure Action Plan.

Delivering Public Health

Embedding health in LBs Lucy Saunders

Public Health Specialist – Transport and Public Realm, GLA and TfL

Improving the health of Londoners: transport action plan Lucy Saunders, FFPH Public Health Specialist – transport & public realm Transport for London & Greater London Authority 26th March 2014

Public health responsibilities shift to local authorities: A new opportunity?

Proportion of adults meeting physical activity recommendations

57% Londoners Active

“A mass shift in current activity levels is needed.

For most people, the easiest and most acceptable forms of physical activity are those that can be incorporated into everyday life.�

Chief Medical Officer

Proportion of adults in London currently meeting their physical activity needs through walking and cycling

TfL’s new Health Improvement Action Plan         

Policy Context Physical Activity Air Quality Road Traffic Collisions Noise Access & Severance Healthy Streets Our action plan Tools & resources

Chapter Structure • • • • • •

Overview Key health impacts Key groups of people affected Spotlights on good practice Highlight on key issues Action TfL is taking

Our 10 actions for new ways of working 2014-2017

Thank you lucy.saunders@london.gov.uk

Percentage of time spent by each type of transport

Demonstrating the relative size of health impacts: population level

Demonstrating the relative size of health impacts: individual level

Delivering Public Health

Embedding health in LBs Helen Macfarlane

Acting Head of Research, Community Engagement and Co-production, Turning Point

Embedding health in London boroughs (and beyond) !

Who or what is Turning Point?

• 50 years old this year • Social Enterprise, RSL and a charity • £95m turnover • National – 250 services • Employs c. 2,700 staff • Roots in LD, mental health and substance misuse • Also employment support • Primary care • And Connected Care (me)!

What is Connected Care?

Essentially a model of community-led commissioning A person-centred, asset based approach Recruiting and training local people as community researchers across 19 areas we have demonstrated: • improved health outcomes through service redesign • greater focus on early intervention/prevention • reduced costs by tackling duplication • developed low cost community-led service models and • achieved stronger accountability and trust between commissioners and communities.

Watch the video of our work in Worcester NHS England produced a film showcasing our work in Worcester and the benefits it brought to the community and the commissioners. Watch the video here http://www.youtube.com/watch?v=4fK6TY5 1M4g&feature=youtu.be

“The project has made a big difference in my life now. Healthy eating, anxiety, everything helped. I feel I have got better control over my health than before.” (Community member with multiple long term conditions) “I really felt the commissioners were listening to us and making decisions based on what we are saying. They are taking notice of us and investing in our opinions.” (Community champion)

Worcester Project Outcomes: • Demonstrable gains in wellbeing for previously socially isolated people • Changes in health management towards healthier eating, moderate exercise and reduction in smoking • Increased uptake of local services including health trainers and health checks • Patients enabled to feedback to commissioners and health professionals on ways to engage with seldom-heard patients • Growth in confidence of patients with previously unmanaged long term conditions to provide peer support to each other.

• Sustainable legacy for individuals and the community

Turning Point – the vision for improving health and well being : • • • • • • • • • • •

Giving a voice to those at greatest risk of health inequalities and poor health Seeking out the ‘seldom heard’ Co-producing the evidence base and supporting community led solutions, service improvements and redesign options Working across organisational boundaries to be ‘person centred’ Looking at the health, social care, welfare needs (e.g. impact of low level mh issues, loneliness) – ‘wrap around’ primary care Increasing use of existing services through guided signposting etc.

Supporting community health messaging (well-being ++) Potential for IBA e.g. for alcohol Developing behaviour change packages (f2f, telephone) Developing new forms of social action (CLE, timebanks, peer mentoring, befriending), social value, cohesion, community resilience Working preventatively to achieve savings to the public purse

Other examples of our Connected Care work ‘Embedding’ – creating a sustainable legacy in (for example): • Earl’s Court Health and Well Being Centre • Birmingham Navigator Pilot • Barnsley: The Dearne Approach Helen Macfarlane Helen.macfarlane@turning-point.co.uk

Thank you!

Future of London www.futureoflondon.org.uk @futureofldn

Future of London