Enterprising venture: the organised efforts of society and the third sector Mr Abdul Razzaq Joint Director of Public Health, Trafford.

Enterprising venture: the organised efforts of society

and the third sector

Mr Abdul RazzaqJoint Director of Public Health, Trafford

Maturity Model: Public Health Timeline

INTRODUCTION GROWTH MATURITY DECLINE

1

2

3

4

19th CenturyTowns were characterised by overcrowding, poor housing,

bad water and disease

19th Century1848 Public Health ActSmallpox vaccination

Slum clearance, clean air and water

20th CenturyFree School Milk Act

Beveridge – Welfare State5th July 1948 - NHS

21st CenturyAgeing populationChronic diseases

Rising costs

Our Health and Wellbeing Today• We are living longer than ever before with dramatic changes in the nature of

health over the last 150 years– infectious diseases now account for only 2% of deaths– 4 in every 5 deaths occur after the age of 65– clean air, water, and environmental protection

• BUT: success brings new challenges– circulatory diseases account for 34% of deaths– cancers 27% and respiratory diseases 14%– rising prevalence of mental ill-health – persistence of long-term conditions

• Lifestyles and behaviours influence our outcomes and inequalities– 21% of the adult population still smoke– 61% of adults are overweight or obese– Fewer than 40% of adults meet physical activity guidelines– 2.4 million adults regularly drink more than recommended

A. Give every child the best start in lifeB. Enable all children, young people and adults to maximise their

capabilities and have control over their livesC. Create fair employment and good work for allD. Ensure healthy standard of living for allE. Create and develop healthy and sustainable places and

communitiesF. Strengthen the role and impact of ill health prevention

Fair Society: Healthy Lives: 6 Policy Objectives

Mobilising the Assets of the Third Sector

• There are 900,000 voluntary sector organisations (by which we mean charities, social enterprises, housing associations, mutuals, research organisations, co-operatives and other non-profit organisations) in the UK, with a combined annual turnover of £157 billion, a workforce of 1,600,000, combined assets of £244 billion, and the capacity to mobilise over a quarter of the population to volunteer formally at least once a month.

• It has immense associative power: the ability to bring together coalitions for change, people from one profession or many, agencies across different silos within a locality, communities and the state.

• The voluntary sector is, in effect, ‘organised civil society’, or organised community action. It is therefore a heterogeneous but hugely significant economic and social force, one which is at the heart of the current Government’s overarching ‘Big Society’ vision for Britain

Innovation & person centred

The voluntary sector brings unique expertise to population health policy-making, oftenhaving a depth of understanding of particular issues or areas

Expertise

Harnessing the Potential

Lead

ersh

ip a

nd C

olla

bora

tion The third sector plays a

particularly important role in giving voice to less well-served groups, and therebyreducing health inequalities.Chapter

Social attitues & public opinion

Improved population

health

Fairness and social value

Asset Models: Key Roles for the Third Sector

Leadership, voice and advocacy

Informing and shaping policy and stratgey

Designing and delivering and

supporting services

Third sector plays an important role in designing and delivering frontline services, but also in delivering second-tier services (such as training)

Third sector acts as a social force for improved health

Stepping up to the mark

A new social market for population

health

Cross government, cross sectoral policy making

Collaborative approach to

evidence

A fully functioning market in which effective commissionerspurchase the best services available from a variety of providers, but also agenuinely social market in which both commissioners and providers collaborate as well as competing

Improving population health needs to be based on “the organised efforts of society”, and on genuine partnership between the state and the voluntary sector. It is recognised that it is not just Governmentthat needs to change – the voluntary sector will need to step up to the mark aswell.

Four Steps to Releasing the Potential

INTRODUCTION GROWTH MATURITY REINVENTION

The need to have an approach to evidence-gathering that is more collaborative, more cross sector and more person- and community-centred.

Government formulates population health policy in a way that is:•more cross-governmental•more open and cross-sectoral, and less of a closed, bureaucratic process

SOCIAL MARKET FOR POPULATION HEALTH

• commissioning of population health-related activity should be joined-up across Government

JOINING UP

• commissioning should be based on a long-term strategy of shifting resources from acute care to prevention and population health and longer term contracts

LONG TERMISM

• stimulate the growth of new providers in the market, and

• ensure that the market is backed up by a new social finance architecture

STIMULATE DEMAND & SUPPLY SIDE

Join

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Your own footer Your Logo

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Engg

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Selli

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STEPPING UP TO THE MARK & LEVELLING THE PLAYING FIELD

• Many are highly adept at gathering information together for policy-making design of public services.

• Some are less good at seeing information as an asset, less good at gathering data or convincing others.

GATHERING AND SHARING EVIDENCE

• Many voluntary sector organisations are highly adept at engaging with policymakers in order to bring about positive change for their beneficiaries – others not

ENGAGING WITH POLICY MAKERS

• Many voluntary organisations have become highly adept at selling their services to commissioners, demonstrating the business case for why a commissioner should invest in what they do.

SELLING SERVICES TO COMMISSIONERS

Case Study: Green Gym

• The BTCV Green Gym® is a scheme which inspires to improve both health and the environment at the same time. Experienced leaders guide you through a range of practical projects, giving you the opportunity to tackle physical jobs in the outdoors – improving your strength and stamina, boosting your practical skills and confidence and benefitting your local green spaces.

• An independent evaluation by Oxford Brookes University has proven the mental and physical health benefits of Green Gym, and a separate evaluation based on NICE costing models has shown the service’s cost-effectiveness: over a four year period the Green Gym delivered 132 Quality Adjusted Life Years (QALY) at a cost of £4,031 per QALY. This is substantially less than the £30,000 ceiling usually applied by NICE in deciding cost-effectiveness. Over four years the Green Gym delivered savings to the health service of £1,359,453 (based on life cost averted savings).

Public Health funding and commissioning

Key

Route for funding

Route for

accountability

Local communities

Department of Health including Public Health

England

NHS Commissioning Board

Local Authorities GP Consortia

Providers

Public Health Outcomes Framework: alignment with the NHS AND Adult Social Care – Missing Link to the Third Sector?

Adult Social Care

Public Health

NHS

Adult Social Care and Public Health:

Maintaining good healthand wellbeing.

Preventing avoidable ill health or injury, including

through reablement orintermediate care services

and early intervention.

Adult Social Care and NHS:Supported discharge fromNHS to social care.Impact of reablement orintermediate care serviceson reducing repeat emergency admissions.Supporting carers and involving in care planning.

ASC, NHS and Public Health:The focus of Joint Strategic Needs Assessment: shared local

health and wellbeing issues for joint approaches.

NHS and Public Health:Preventing ill healthand lifestyle diseasesand tackling theirdeterminants.Awareness and early detection of major conditions

But:Marmot on Public Health Challenges in Current Climate• Giving local communities control is challenging when they face

budget cuts of 20-25%;• “responsibility deals”

– Evidence from history suggests that public health advances – clean water, reduction of air pollution, healthier working conditions, reduction in drink-driving – have come to greater degree from action by local and central government than by voluntary agreements with industry.

• While the Public Health White Paper picked up five of the six domains of recommendations from the Marmot Review it was silent on ensuring a healthy standard of living for all.

• It is still possible to make progress and measure using indicators.

Public Sector Reinvention: Role of the Third Sector

INTRODUCTION GROWTH MATURITY DECLINE

1

2

3

5

19th CenturyPoor health and living conditions

20th CenturyIntroduction of the Welfare

State and the NHS

20th CenturyScientific and technological

advancemnets

21st CenturyReinvention as an alternative

scenario to decline

4

REINVENTION