Leading better together – working with local government Martin Seymour Principal Consultant, Healthy Communities Programme.

Leading better together – working with local government

Martin Seymour

Principal Consultant, Healthy Communities Programme

About the Healthy Communities Programme

Helping local government to tackle health inequalities and improve the health of

their communities

Healthy Communities Programme• Peer support and peer reviews• Healthy Communities benchmark• The leadership academy• Knowledge website• Communities of Practice• Valuing Health – the business case• Community engagement and community asset mapping• JSNA• Partnerships• Total Place and health• Thematic and topical work, eg, coastal and rural health,

childhood obesity• The Communities for Health regional networks• Strategic planning

Social Determinants of Health

Developing a broader understanding of the impact that local authorities and their partners can have on heath inequalities

Strategic Review of Health Inequalities in England post 2010 – Key themes

•Reducing health inequalities is a matter of fairness and social justice – inequality is avoidable.

•Action is needed to tackle the social gradient in health – Proportionate universalism

•Action on health inequalities requires action across all the social determinants of health

•Reducing health inequalities is vital for the economy – cost of inaction

•A move beyond economic growth to well-being of society: sustainability and the fair distribution of health

Marmot review - delivery

• Taking a whole system approach – nationally, regionally and locally.

• Empowering people: securing local solutions.

• Creating the conditions in which people and communities take control

• Regional working - NW and London

"Public Health is delivered by a workforce most of whom do not have 'health' in their job title."

“Securing Good health for the Whole Population” Wanless Feb 2004

A history lesson: local councils and health

C19th – building the protective infrastructure and systems of regulation

C20th – provision of hospitals, health and social care services to meet need

C21st – helping people to change their behaviours and strengthening the social determinants for good health

The context for local governmentPolicy documents

Acheson reportTackling health inequalities: programme for actionChoosing HealthFair Society, Healthy Lives

Health service reviewsWanlessDarzi

Local government reviewsLG Act 2000 - Powers of well-beingLG and public involvement in health act 2007Lyons Report 2007 - Place shaping

Local performance framework

Local Strategic PartnershipsSustainable Community StrategiesLocal Area AgreementsComprehensive Area AssessmentsJoint Strategic Needs Assessments

Partnerships for health improvement

Evaluating partnerships

Process issuesEngagement of Senior managers in partnershipReorganisation impactLack of financial and human resourcesInformation sharing and best practiceCoterminosityNeed for quick wins

OutcomesHealth outcomesMonitoring and evaluation problems

Perkins et al (2009) What counts is what works? New Labour and partnership in public health. Policy Press

Defining health and health improvement

External Contextual Challenges

Stability

Political and policy changes

Power

Boundaries

Internal Process issues

Partnership working

Shared vision and place

Engagement

Resources

Data and knowledge

Organisational culture

The need for quick wins

Added value outcomes

Process outcomes

Health improvement outcomes

Maturing partnership

Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement

ImmaturePartnership

Little added value

MaturePartnership

Showing Added value

Gaining collaborative advantage for health improvement

Maturing partnership

Increasingly acting on social determinants of health

Process factors

External contextual factors

A Theory of Maturing Partnerships for Health Improvement

No shared vision

Dominant partner

Top down

Project focussed

Quick wins

Funding constraints

Grant giving

Internal focus

Individual ownership

Health an NHS issue

Medical Model

Confidence in partners

Shared identity

Shared vision

Joint ownership

Alignment

Joint posts

Citizen engagement

Accountability

Holistic

Health everyone's business.

Addressing SDH

Seymour M (2009) Do LSPs provide collaborative advantage for Health Improvement.

Significant challenges to deliveryTraditionally not seen as ‘core’ business – how can Fair Society,

Healthy Lives reinforce the view that this is the core business of local government?

How will Marmot be interpreted?

Reduced resources – impact on public health budgets

Accountability – who is responsible?

Partnerships dependent on personalities rather than embedded in culture

…and opportunities

• Financial constraint – never let a good crisis….

• Total Place - and parallel places

• Localism

• General power of competence for councils

• Big Society - “put more power and opportunity into people’s hands”.

Martin Seymour

Healthy Communities Programme

martin.seymour@idea.gov.uk

www.idea.gov.uk/health