Keynote Address

Keynote Address

Mary HindsDirector of Nursing, Public Health Agency

Today • Why Reform?• What the Public Health Agency aims to do?• What does that mean for you?

Improving Your Health and Wellbeing

Why Reform?

• Hospital Focused Service • A sickness service not a health service • Quality concerns • Duplication of effort • Financial Constraints

Improving Your Health and Wellbeing

What happened?

• 18 Trusts to 5 • Patient Client Council • Health and Social Care Board • Public Health Agency • Smaller more strategic DHSSPS• Health and Social Care Reform Bill

Improving Your Health and Wellbeing

The Road Ahead • Demographics

– Working age population to grow by 9% (2019)– Over 65 years population by 35% (2019)

• Trends in diseases – Chronic diseases on the increase– Increases in lifestyle diseases - alcohol - obesity – respiratory

conditions • Scientific advance and new knowledge

– Possible / probable • Increasing public expectations• Increasing pressures on the health and social care

system – Person payment/ state cost

Improving Your Health and Wellbeing

Financial context

• £3.8 billion spent – Eastern 1,069 million– Northern 600 million – Southern 449 million – Western 427 million – Family Practitioner

Services 695 million

• Acute Hospitals– 1035m, 55% expenditure

• Mental health – 191m

• Health Promotion & disease prevention – 12.7m

• Staff costs– 31% relates to nursing

How healthy and equal are we?• People who are poor and those socially excluded are more likely

to die at a younger age and experience a higher rate of ill health.

• The poorest are twice as likely to die from heart disease, cancer and stroke

• Unemployed twice as likely to have mental health problems – the suicide rate in economically deprived areas is twice that in better off areas.

• In NI people over 75 are most likely to live in a house built before 1919 without central heating or deemed unfit and are also at higher risk than others to have an accident in the home.

Improving Your Health and Wellbeing

How healthy and equal are we?• The average NI man and women consumes more fat and more

calories than their peers in England, Scotland and Wales.

• Over 3000 people a year would survive if we met the European average mortality rate.

• Travellers live on average 10 years less than settled people

• Belfast has the 6th highest homeless rate and the rate is rising

Improving Your Health and Wellbeing

Poverty• 29.6% of NI’s population was living in poverty (2002/3)

• The poor die on average 7 years earlier that those better off in NI.

• Children of the poorest families: – 4 times more likely to die before 20years – 15 Times more likely to die in house fires– 5 times more likely to die in accidents

Improving Your Health and Wellbeing

Food Poverty

• Low income families• Eat less well • Pay more • Get worse access • Suffer more ill health

• What does this mean?• People go hungry • Borrow money to buy

food • Eat nutritionally poor diets

Eating your 5 a day could reduce deaths

from chronic diseases by up to 20%

Improving Your Health and Wellbeing

• Northern Ireland is one of the most unequal

societies in the developed world, with evidence that inequality is increasing.

(Bare necessities – Poverty and exclusion in NI 2003)

Improving Your Health and Wellbeing

We have made progress

• Cancer services• Access targets

– Waiting lists – Theatre usage – Delayed discharges – Delays in A&E

Improving Your Health and Wellbeing

The inequalities challenge remains

Creggan Cultra

Multiple Deprivation Rank 11 563

Free school meals (2006) 68.9% 1.5%

Aged 3-5 registered with dentist (2005) 38.2% 74.0%

Births to unmarried mothers (2004) 51.7% 5.2%

Improving Your Health and Wellbeing

The top ten 1. The social gradient

– What you do– How much you earn– Who you are – Where you live

2. Stress3. Early Life 4. Social exclusion 5. Working Conditions 6. Unemployment 7. Social Support 8. Addiction 9. Health Food 10. Transport policy

Physical disease Mental health Mortality

Improving Your Health and Wellbeing

What I am going to try to do?

• Describe how the system will work, what each part does and where the Public Health Agency will contribute to making a difference.

Improving Your Health and Wellbeing

Public Health Agency

• Health and wellbeing Improvement • Health and wellbeing Protection • Reduce inequalities

Improving Your Health and Wellbeing

What are we trying to do?

Improving Your Health and Wellbeing

Health and Wellbeing Improvement

• Make sure what we have works well – Commissioning services HSC Board and LCG’s

• Pilots with local Councils • Invest in community led health and wellbeing

improvement plans– Physical Activity Programmes, Community integration

programmes, awareness programmes alcohol, childhood safety

Improving Your Health and Wellbeing

Health and Wellbeing Protection

• H1N1 Pandemic preparation• Children and vulnerable adults• Management of infectious diseases outbreaks• Suicide prevention

Improving Your Health and Wellbeing

Addressing inequalities

• Targeting specific actions in vulnerable groups:– Elderly – Travellers– Poor – Gay and Lesbian community – Prisoners

Improving Your Health and Wellbeing

Health and Social Care Board

• Establish and maintain effective systems to enable it to:– Commissioning for health and social care

• Assessing need, meeting need, outcome measures not outputs

– Ensuring resources are used effectively– Manage the performance of Trusts

Improving Your Health and Wellbeing

Local Commissioning Groups • Commissioning of Health & Social Care at a local level • Aim to:

– Improve health and social care wellbeing – Plan and commission to meet needs – Secure delivery that is efficient, coordinated and cost

effective– Improve availability and quality of health & social care – Get local voices involved

Improving Your Health and Wellbeing

DHSSPS

LCG

Local Government

Local Providers

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Improving Your Health and Wellbeing

DHSSPS

LCG

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Local Providers

LCG

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Improving Your Health and Wellbeing

Nursing & Allied Health Professions in the Agency

Health & Wellbeing Improvement

Commissioning Service innovation

Quality Patient experience

Patient, Public Involvement Performance management

Policy implementation

Health & Wellbeing Protection

Midwifery supervision Commissioning

Standards Patient Safety

Quality Infection/Outbreak control Support to Primary Care

Health & Wellbeing Protection

Community Development Commissioning

Implementation of policy Targeting minority/ marginalised groups

The challenge for Nursing

• Work in both Agency, Board and LCG• Ability to influence rather than control• Need to address historical perception and practice • Need to develop capacity to lead, support and facilitate• Bring the balance

Improving Your Health and Wellbeing

Why is it important to Nursing?

• Sets the direction, standard and the delivery• Who and how many• Where• Why • When

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Can it work?

• Improve daily Living Conditions • Tackle the inequitable

distribution of power, money and resources

• Measure and understand the problem and assess the impact of action.

Improving Your Health and Wellbeing

Improving Daily Living Conditions

• Equity from the start – Early child development • Health Places, healthy people • Fair employment and decent work.• Social protection across the lifecourse• Universal health care

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Tackle the inequitable distribution of power, money and resources

• Health equity in all policies, systems and programmes• Fair financing • Market responsibility • Gender equity • Political empowerment - inclusion and voice • Global good governance

Improving Your Health and Wellbeing

Measure and understand the problem and assess the impact of action

• Monitoring• Research • Training

Improving Your Health and Wellbeing

Is closing the health gap in a generation feasible?

• If we continue as we are we have no chance at all

Is closing the health gap in a generation feasible?

• If there is a genuine desire to change, if there is a vision to create a better and fairer world where peoples life chances and their health will no longer be blighted by the accident of where they happened to be born, the colour of their skin, or the lack of opportunities afforded to their parents, then the answer is we could go a long way towards it.

• If you ever need me:• [email protected] • Telephone – 028 9055 3739