NHS Five Year Plan: Responding to the Prevention Challenge

1. Confident Place, Confident People.
Making Health Everyone’s
Business
Professor Kate Ardern MBChB
MSc FFPH
Director of Public Health for
Wigan Council

2. Confident Place, Confident People.

3. Confident Place, Confident People.

4. Confident Place, Confident People.

5. Confident Place, Confident People.

6. Confident Place, Confident People.

7. Confident Place, Confident People.
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

8. 50/500
Families identified
Work Programme
Leavers
317,800
Total Wigan
Population
4,035
Risk Stratification Residents in top
30% at risk of non-elective
admissions
0-18 = 162
19-64= 1,494
64+ = 2,379
621
Confident
Families
28,710
Claiming out of work benefit
JSA = 8,860 ESA = 16,440 LP = 2,530 Other = 880
(6,310 claimants aged 25-54 have 1 child dependent or more)
15/116
Spotlight Clients
in CF cohort
1,471
Receiving
Community Based
care
47/644 Looked After
Children in CF cohort
(8% of all
Confident Families)
Population Headlines
Aged 65+ = 54,500
Aged 65+ Living Alone = 15,927 (29%)
Aged 25-49 = 109,900
Aged 25-49 Living alone = 13,260 (12%)
Working Age Singles
Working Age Parents with children
Aged 65+
• New Delivery Model for Work
Programme Leavers
• New Delivery Model for Work
Programme Leavers
• Confident Families
• Early Years New Delivery Model
• Life
connecting datasets
• Extended Integrated Neighbourhood
Teams
Denotes NHS number
available as a primary
identifier
1Work around legislative
barriers required
14/25
Life Families
316/1,948
Assisted
Bin Collection
Working on
68
Affected by
Benefit Cap
1

9. • Freeze Council Tax
• Help communities to support each other
• Cut red tape and provide value for money
• Build services around you and your family
• Create opportunities for young people
• Support the local economy to grow
• Listen, be open, honest and friendly
• Believe in our borough
• Recycle more, recycle right
• Get involved in your community
• Get online
• Be healthy and be active
• Help protect children and the vulnerable
• Support your local businesses
• Have your say and tell us if we get it wrong
• Believe in our borough
Signed Signed
Lord Peter Smith of Leigh, Leader of Wigan Council

10. Investing in the Community

11. The Deal for Adult Social Care &
Wellbeing
Overarching shift from dependence on formal health and
social care services to independence and self reliance
‘Different conversations’ with residents to better understand individual
assets, revealing insights about how to enrich their lives and recognising
strengths, gifts and talents.
Building community capacity to respond and meet this need:
- Mapping and utilisation of community assets
- Community hubs and micro enterprises
- Use of new technology and value exchange
- Step change in volunteering

12. Sunshine House Community Hub – Good
Practice
•Vibrant community hub - strong local knowledge &
flexible provision
•Capacity to grow and take ownership
•Secured Community Investment Funding
•Expanded the community use and widened offer to
people with health & social care need - dementia
reading group, mental health friendship group.

13. Quote from LGA’s Public Health
Transformation 20 Months On Report
2015
“The transfer of public health was a once in a generation opportunity to
transform the health and wellbeing of the people of Wigan. The Marmot
vision is very clear about what needs to be done; employment, planning,
transport, housing, education, leisure, social care – all are interlinked
and have an impact on physical and mental health.
Wigan has taken every opportunity to appoint the right staff to support
transformation, and two of the most important attributes are energy and
motivation for change. Innovation is key to future progress, and staff
must be given the time and space to try new things, and to make
mistakes at times and learn from them.”
Cllr Keith Cunliffe – Portfolio Holder Adult Social Care &
Health

14. Confident Place, Confident People.
Making Health Everyone’s Business: The
Approach
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

15. Confident Place, Confident People.
Public Health Transformation
 The Public Health functions transferred from the NHS into the
local authorities across England and Wales in April 2013.
 Public Health programmes, the wider council and the clinical
Commissioning Group in Wigan have separated programmes
and services into ‘Start Well’, ‘Live Well’ and ‘Age Well’.
 Some programmes of work do not fit neatly into the Start, Live
and Age Well model so areas including physical activity and
screening programmes take a ‘Life Course’ approach with one
of the three service managers taking the lead role.
 Director of Public Health is also the Council’s chief officer for
civil contingencies (AGMA lead DPH for health protection &
emergency planning) and for commissioning leisure services.

16. Confident Place, Confident People.
Wigan’s Integrated Well-being, Health and
Social Programme Approach
Programme Key Features
Children’s Integrated Care – Start Well Focus on targeted implementation of
universal interventions and then primary
and community based interventions
Vision to establish an integrated, locality
based hub for children’s services with
primary care
Integrated Care for Adults of Working
Age – Live Well
Alignment of a range of planned and
preventative interventions around a risk
stratified cohort of adults of working age
Transformation of Lifestyle services into
an Integrated Health Improvement Model
Integrated Care for Older People – Age
Well
Extended INT for over 65s built around
primary care
Care Home programme - developing

17. Confident Place, Confident People.
Start Well, Live Well, Age Well
Commissioning for 2015/16
• The NHS Health Check will
target geographic & higher risk
communities esp 40-50s
• Review of physical activity
services -integrated lifestyle
approach and piloting integrated
programmes with Adult Social
Care £200k JCB investment in
radical upscale of “Exercise on
Prescription”
• Review Sport, leisure, health &
wellbeing infrastructure –
SHAPE, sports council, local
sporting clubs as community
hubs + £500K Wigan on the
Move programme
• Heart of Wigan: prevent
cardiovascular disease for
people living in the 20% most
deprived areas -includes Heart
Champions, Heartstart &
Accessible defibrillators.
• Falls Prevention: New referral
pathway from GMFRS, Pilot
programme with Inspiring
Healthy Lifestyles later life
strength & balance
programme, one of 24
national pioneer cohorts for the
PHE Falls and Fragility
Fracture programme.

18. Confident Place, Confident People.
Fuel Poverty & Dementia Examples
• £200k from JCB (2 years) to bring
1000 local residents out of fuel
poverty each year
• Strategic housing & health data
overlaid to identify most at risk &
target GP practices
• Data sharing agreements access
to GP data - commenced March
2015 – piloting RCGP One Click
Referral
• Remodelling of contract provision
with Manchester Care & Repair
• Sheffield Hallam conducting
evaluation
• Support from PHE & DECC -
Wigan Case study used as e.g. of
good practice in new National
Strategy
• £130K from JCB to roll out
community led ‘Dementia Friendly
Communities’ model across 10
communities over the next 18
months
• Over 30 innovative & sustainable
activities/ programmes already
established e.g. Dementia cafes;
classic cinema club, library
reminiscence
• All sign up to Local Dementia
Action Alliance and develop
Dementia action plans
• ‘Dementia Friends’ awareness
sessions delivered to tackle
stigma and promote
understanding across the borough

19. Confident Place, Confident People.
Lose Weight Feel Great: Kieran and
Shirley Lloyd & Gary Harris

20. Confident Place, Confident People.

21. Confident Place, Confident People.
“Councillor Saves Life” &
Senior Management Get Cardiac Smart

22. Confident Place, Confident People.
Making Health Everyone’s Business

23. Confident Place, Confident People.
• RSPH Level 2 Award in Understanding Health Improvement
This accredited course is aimed at organisations with an interest in the health and wellbeing of
their workforce and customer/client groups.
• RSPH Train the Trainers course
Allows the team to ensure quality whilst implementing a cascade model
• Essential Public Health
Essential Public Health is a training programme developed by NHS Stockport, which is being
used to develop confidence in addressing lifestyle issues through conversations with patients/
clients; and increase referrals into lifestyle support services.
• Contacting Communities to Health
Connecting Communities to Health -an InnovateNow programme, developed by the Team to
target a range of communities with the aim of empowering, engaging and informing individuals to
take responsibility for their own health and wellbeing through an informal model of conversation
and facilitation. The six themes running throughout the course are smoking, alcohol, healthy
eating, sexual Health, mental wellbeing and physical activity.

24. Confident Place, Confident People.
“I try and act as a role
model. I go for a walk
each lunch time. I’ve
also talked with family
and friends and even
placed bowel cancer
awareness leaflets in the
toilets at church.”
“The
qualification is
the first one she
has got. That’s
a real
achievement.
She left the
course much
more confident
and with a
qualification
she can put on
her CV.”
“Most of the
group of young
Mums had
disengaged
from school.
They had poor
literacy, no
qualifications
and an
absence of
praise.
The whole point
of community
empowerment
is a stronger
voice, feeling
better, making
Wigan a better
place to be,.
“You can’t tell someone to give up but you can
talk about the benefits of stopping smoking
and suggest things that might help.”
We’ve really embraced it at
Electrium. It’s amazing how
many people are interested
in a healthier lifestyle.”

25. Confident Place, Confident People.
Health Improvement Outcomes:
Accelerated Progress
• Progress on a number of major indicators has accelerated since the
transfer to the local authority.
• 2008/9 Wigan was ranked 34th out of 39 North West local
authorities for obesity; in 2013-14 it had had improved to 11th.
• The gap in smoking prevalence in adults between Wigan and the
England average has reduced from 4.7 % in 2010 to 1.8 % in 2014,
and at 20.2% Wigan is now 0.1% above the North West average.
• Smoking in manual classes now 27% August 2015 (below both the
NW – 30.1% & Eng – 28.6% averages)

26. Confident Place, Confident People.
*Compared to England
Healthy Life
Expectancy
Up 18 months
in last 2
years.Gap* down
17 months in
last 2 years.
62.5
Up 3 years in
last 2 years.
Gap* down
over 3 years
in last 2
years.
61.1
*Compared to England
Cardiovascular
Mortality (under 75)
Down 25% in
last 5 years.
Gap* down
40% in last 5
years.
58.1/100,000
Down 27% in
last 5 years.
Gap* down
50% in last 5
years.
133.7/100,000
*Compared to England
Cancer Mortality
(under 75)
Down 12% in
last 5 years.
Gap* down
42% in last 5
years.
137.8/100,000
Down 6% in
last 5 years.
Gap* up 12%
in last 5
years.
169.1/100,000
*Compared to England
Suicide
(All ages)
Down 20% in
last 5 years.
Gap* down
73% in last 5
years.
Each suicide is a
tragedy. However
as the number is
small for women (6
deaths a year),
Public Health
England has not
calculated a rate.
15.9/100,000
Public Health Outcomes Framework
The Public Health Outcomes Framework provides indicators that relate to the absolute health within Wigan Borough
The key indicators below show that health in Wigan Borough is improving and the gap with England is reducing
Challenges
1. To reduce the gap in health experience between areas across the Borough
2. To help people make lifestyle choices that improve their health
3. To focus on what individuals and communities can do to improve health
Deal for the
Future

27. Confident Place, Confident People.
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
56.3
12 months 13 months
Rotherha
m 59.0
11 months 7 months
57.1
13 months 14 months
Wakefield 62.0
12 months 16 months
58.1
2 months 4 months
Tameside 58.6
22 months 25 months
57.9
5 months 4 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

28. Confident Place, Confident People.
Lessons Learnt
• Identifying and linking with change agents, people who
have an enthusiasm for promoting health and wellbeing,
is a good way of building system-wide commitment
• Training customised to the needs of individuals and
groups helps to make public health messages real to
both individuals and organisations
• Highlighting & sharing examples of what works builds an
understanding of the benefits of change
• Involvement of councillors leading task and finish
groups, e.g. under-18s alcohol reduction and Heart of
Wigan, means that there is senior leader engagement in
promoting health and wellbeing.

29. Confident Place, Confident People.
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.”