A presentation to a multi agency strategy group of council and system leaders on what each agency could achieve on prevention

1. www.hertsdirect.org
Prevention:
What could we achieve?
Jim McManus, Director of Public Health, Hertfordshire County Council
Jim.mcmanus@hertfordshire.gov.uk
Hertfordshire Forward Strategy Group
January 2017

2. www.hertfordshire.gov.uk
Context
• We can no longer afford to treat after adverse
events
• System never designed for this level of
need/demand
• We need to prevent, reverse or mitigate need
for services
• Significant avoidable and preventable burden of
ill health and inequality
• The background to STPs

3. www.hertfordshire.gov.uk
A Prediction from 2000
• Derek Wanless
– Too much rising demand for us to cope,
from avoidable need for service (preventable
disability, long term ill health)
– Public services financially unsustainable
– Could be reversed with a strategic shift to
preventing people need service
– Needs determined strategy

4. www.hertfordshire.gov.uk
What is Prevention?
• The avoidance, whether permanent or
temporary, of need for public service or an
adverse event/hazard or exposure leading to
need for public service
– SHORT TERM (eg up to 24 months)
– MEDIUM TERM (eg 2-5years)
– LONGER TERM (eg 5 years plus)
• Prevention is NOT rationing or restricting
eligibility

5. www.hertfordshire.gov.uk
Levels of Prevention
• three levels. Preventative activities may be delivered by any
agency.
• Primary Prevention – ‘prevent’ or stop harm or need for
service arising in first place – physical activity, recycling
• Secondary Prevention – ‘reverse’ harm or need for
service – rehabilitation
• Tertiary Prevention – ‘reduce’ or mitigate harm/need for
service – an Anti Social Behaviour Order? A wheelchair
for a diabetic foot amputation

6. www.hertfordshire.gov.uk
Immobility or lack of
fitness?
• Much immobility due to
ageing is preventable.
Maintaining or losing
strength to walk is an
important predictor of
other need for public
service

7. www.hertfordshire.gov.uk
Reducing the need and spend curve:
Preventing avoidable spend,
Volume of
spend
Severity of need
Existing curve
The Achievable
curve?
Reduce or delay need here
Highest cost.
Reduce and delay
Need here
Intervene here before need
escalates

8. www.hertfordshire.gov.uk
The Questions
• Where could we reduce need or demand for
public service?
• What skills and strengths do we have that we
could apply to this?

9. www.hertfordshire.gov.uk
So what could be done?
• A culture of self-reliance
• A culture of nudging people to do right thing
• Diversion
– Can we create a culture where people deal
with minor issues themselves

10. www.hertfordshire.gov.uk
So what could be done? Examples
Levels of
Prevention
Crime and
Disorder
Mental Health Cancer
Prevent/Stop
harm or need
Reduce alcohol
related injuries
and violence
Reduce drug
related crime
Prevent lost
productivity by
workplace ill-
health
Routine physical
activity for
everyone to retain
balance and
mobility
Reverse harm or
need
Physical activity
for rehabilitation
Reduce/Mitigate
harm of need
Cheaper
alternatives?
(social groups for
lonelines)

11. www.hertfordshire.gov.uk
Quick wins in the system
• Drug testing on arrest and early referral in
• Using “behavioural insights” on council tax notices and
letters and on recycling
• Leisure centres and services
• Early intervention to prevent slips, trips and falls
• Using “behavioural insights” in recycling

12. www.hertfordshire.gov.uk
Quick wins in the system
• Night time economy work on alcohol with retailers
• Routine, universal, physical activity
• Physical activity and social contact for people isolated
• Behavioural contracts with offenders
• Mental Health First Aid
• Getting people temporarily sick back into work

13. www.hertfordshire.gov.uk
Just suppose
• An army of signposters who as part of their day
job signposted you to the lowest level of place
which could meet your need
• We already have 1,300 mental health first
aiders in employers – the UK’s largest number.
What more can we do

14. www.hertfordshire.gov.uk
A good employer
• Positive psychosocial workplace – the seven
tips for employers helps keep people at work
• Healthy workplace – simple things to keep
people healthier longer
• Enable carers – help keep carers able to care
• Make it easier to get back to work

15. www.hertfordshire.gov.uk
5. Prioritising Prevention – the Decision Cycle
What population?
What issue/need?
What outcomes do
we want?
Which
interventions fit
best?
How do we know
it’s working?
(Evaluation)
1. Service cost and
demand
2. Needs (JSNA)
Define the outcomes clearly
so you can really assess
feasibility
1. Financial Assessment
2. Evidence Assessment
3. Logic mode where
evidence silent
1. Financial Assessment
2. Outcome Assessment
Questions to ask Tools for HCC

16. www.hertfordshire.gov.uk
What can the science do
• Science of behaviour change
– Behaviour insights “nudge” on council tax
payment and recycling behaviour
– Behaviour change backed

17. www.hertfordshire.gov.uk
Desired Outcome
• An appropriate prevention plan which models
savings achievable from prevention
• A plan underpinned by evidence and a logic
model
• Clear articulation of who needs to deliver what
to achieve it
• System wide expectations