HC 1048-III Health CommitteeWritten evidence from Staffordshire County Council (PH 29)

1. Introduction

We strongly welcome the drive to embed public health into the work of the wider public sector. Local government, with the diverse and everyday nature of public services has an important contribution to make, particularly in terms of prevention and early intervention.

Staffordshire is taking a whole system approach, across local government tiers as well as the voluntary, community and business sectors. We believe our holistic approach utilises more opportunities for long term general health improvement and a very local needs led approach rather than working as individual bodies in a segmented or dislocated way.

We believe this approach is forward-thinking and already seeing improvements to outcomes. This is evidenced in the information provided below, which we have aligned with the Committee’s key lines of Inquiry.

2. Evidence

2.1 The creation of Public Health England within the Department of Health

As our response will demonstrate, we believe that local authorities, in partnership with other public sector, community, voluntary and private organisations have a pivotal role to play in achieving positive public health outcomes. The diverse nature of local government services means that local needs can be met with local solutions.

The move from a centralised and prescriptive approach brings a tremendous opportunity for clear accountability and will enable a locally tailored approach to the identified needs of local communities which accounts for the diversity of a county this size.

In light of this, it is essential that Public Health England (PHE) has a complimentary and effective relationship with all key local bodies—and not just traditionally “health focussed” organisations eg the NHS. We would be concerned if PHE exercised an over-zealous central control which limited the ability to determine appropriate local actions and innovative local solutions.

2.2 The future role of local government in public health

The greater role of local government in public health provides a strategic platform to raise the profile and aspirations of improving public health within the local authority and with the wider, non health, public sector. This will enable a more integrated and holistic approach across social care, health and other organisations that traditionally may not have seen public health to be part of their core remit, but who can have a positive impact on the wider determinants of health.

Responsibility for public health improvement sitting with local authorities will allow it to be embedded within our local leadership and place-shaping role and aligned with our duty to promote community wellbeing. This is the right strategic leadership context to see improved public health and provides greater local accountability within the political and democratic framework to local people.

The substantive work of local government impacts directly on the wider determinants of public health. For example, our work around education, employment, economic prosperity, culture, leisure and transport can all influence positive public health outcomes. The shift in perception away from public health being only within the NHS domain encourages more focus on the public health implications of wider public sector activity. The following examples evidence how we are moving the shared public health agenda forward locally within the public sector, how we are taking valuable steps to ensuring effective prevention and early interventions and how we are using the good partnership frameworks we already have in place to genuinely embed public health into our work as a local authority.

2.2.1 Prevention and Early Intervention

We believe that local government and the wider public sector has an important role to play in public health, particularly in terms of prevention and early intervention. Part of the role as a local authority is in preventing people from needing to access costly acute and long-term health care by ensuring that the appropriate effective preventions and early interventions are in place. Three key examples of our work regarding prevention and early intervention are:

Staffordshire Cares

   Our “Staffordshire Cares” programme demonstrates commitment to developing a fuller, wider and more accessible range of community and preventative services to meet the needs of vulnerable adults and older people. We know that our residents want to live independently for longer and have more choice and control over the information, advice and help they receive. Staffordshire Cares is our radical initiative to help people live as normal a life as possible, whether coping with disability, other health challenges or simply getting that bit older. It provides a set of tools to help people take personal responsibility to design a life and achieve their aspirations. Through groundbreaking web-based interactive information, advice and signposting system and trained advisors available by telephone and face-to-face, Staffordshire Cares will give people control to maintain their independence and to live more fulfilling lives.

A people approach

   In Staffordshire we are moving significantly towards a whole of life approach. The County Council structure has been radically changed in order to see individuals and families in the round rather than “pigeon holing” into segments through age or other identifiers. This holistic approach results in a more joined up strategy.

Families First

   “Families First” is a Staffordshire County Council project which will transform our services for children, young people and families. The focus is on early intervention and is about delivering the right help at the right time to ensure children, young people and families the best possible outcomes in life. Through Local Support Teams, Staffordshire will move towards a consistent focus on family involvement, family services and family outcomes. For example, Local Support Teams will be closely aligned with school nurses and health visitors. As a result of effective early intervention, many children will not require higher level specialist services as agencies will intervene at an earlier stage to prevent problems from escalating.

2.2.2 Joint Director of Public Health

We have already taken significant steps towards an integrated model of working. For example, the appointment of a Joint Director of PH is part of our collaborative approach between the local authority and Staffordshire’s health organisations.

2.2.3 Embedding Public Health Outcomes into Strategic Planning

Our Strategic Plan (2011–16) sets out our vision and plans for the next five years and contains the nine key priority outcomes which give more detail to our vision. We have a specific outcome which helps to define our ambition for public health in Staffordshire:

“Staffordshire is a place where people live longer, healthier and fulfilling lives.”

This outcome is underpinned by several strategic priorities, which demonstrate the cross-cutting nature of public health and how it is intrinsic to much of our work as a local authority. Strategic priorities linked to this outcome are:

Improve the health of children and young people.

Improve mental health and wellbeing.

Improve the health and wellbeing of older people.

Reduce the harm caused by alcohol misuse.

Reduce the harm caused by smoking.

Improve housing, local areas and communities.

Assess the impact of policy and planning decisions on health.

Listen to our local communities’ needs and how to meet these needs.

We are already undertaking work to support this outcome, and with our enhanced role and new powers we will use our resources to address local problems with local solutions.

2.2.4 Health and Wellbeing Board (H&WB).

The county council are leading on the development of the proposed H&WB, which will give greater local control over services to local communities. We have been successful in securing a £40,000 place-based leadership bid for 2011, for the development of the Board.

In line with our current thinking on effective partnership working, we are keen that the Board does not have unnecessary layers of bureaucracy, does not duplicate existing activity and is focussed on delivering outcomes.

Rather than setting up an entirely new “stand-alone” Board, we have recognised that the NHS Commissioning Board and GP Consortia will have remits which cross-over with County Council remits. It is at this “cross-over” point that the H&WB will be created, to ensure the delivery of shared priorities, to manage our formal relationship with Health partners and to govern public health activities in Staffordshire (see Figure 1).

Figure 1

The work of the H&WB will be based on a strong, broad outcomes focussed Joint Strategic Needs Assessment, which will encompass a wide spectrum of information including health, safer communities and children’s services information.

2.2.5 Health & Wellbeing Strategy

A three year Joint Health & Wellbeing Strategy for Staffordshire has been produced, adopting a collaborative approach with the County Council, the PCT’s and District Councils and other stakeholders. The Strategy was agreed by Cabinet and PCT Boards in September 2010.

The Strategy is intended to add value to existing local initiatives, particularly with regard to those issues where it is important to have a single Staffordshire approach.

2.2.6 Local Initiatives to Promote Public Health

We are well placed as a local authority to use our influence to promote public health. The following examples describe schemes which are designed to promote public health and to foster shared responsibility and accountability for achieving positive public health outcomes:

Staffordshire Caring for Health Award Programme

   Caring for Health is a unique, multi-disciplinary award scheme designed to improve standards of care and the lives of people in residential care homes. The scheme focuses on improving four areas of care:

(1)Food, Nutrition and Hydration.

(2)Oral Health.

(3)Falls awareness and prevention.

(4)Physical and social activity.

   Through these four areas the award places strong emphasis on the importance and support of personalisation and social inclusion in care.

   The award was conceived by the Health Development Team and the initial development was carried out with support from The “Live Well Be Well in Staffordshire” partnership. The partnership included NHS, local authority, private sector and voluntary sector representatives.

Nurturing Health Early Years Award Scheme

   The “Nurturing Health” early years award scheme is a novel pan-county, multi-agency partnership award, which sets high quality standards for food and drink provision, the mealtime environment, physical activity and oral health for 0–5 year olds in private, voluntary and children’s centre nurseries.

Workplace Health Award

   This work illustrates the locally led link across communities and government, seeing health and wellbeing as integral to civic and social responsibility. It will also further develop the link between local government and the private sector across Staffordshire.

   At a local level we will be supporting the private sector to engage in corporate social responsibility and positively impact on the health and wellbeing of the local community.

   This is a key strand of our workplace health award programme; one which contributes to building the “Big Society” and will provide Staffordshire’s working age population with links to programmes such as Staffordshire Volunteering.

   It has produced some early successes and engagement and involvement has been secured with private sector businesses in Staffordshire. The Chamber of Commerce has agreed to fully endorse the health and wellbeing agenda and work with us to further engage with Staffordshire businesses and support this priority as it develops.

   Through this programme we will continue to support Staffordshire businesses/employers to provide opportunities for employee health and wellbeing and to enable our business communities to positively impact on the health of Staffordshire residents within their local communities.

Community Wellbeing Fund

   Our £1 million Community Wellbeing Fund is intended to enable small, local, grass roots community groups to provide local services to improve the health, independence and wellbeing of vulnerable adults and older people in their community. To date 120 community organisations have been supported to develop preventative health, wellbeing and independence services for older people and at least 1792 older people have been direct beneficiaries of the scheme.

2.2.7 Involving Community and Voluntary Sector in Public Health

We are aware that responsibility for public health does not rest with the public sector alone. We believe that public health is a shared responsibility and we are embedding this approach within our wider partnership arrangements. Public Health needs to be embraced by all organisations working with and for our communities, many of whom have a key role to play in addressing the wider determinants of health.

Three examples of recent work demonstrates how we are taking an innovative approach in Staffordshire to involve organisations who typically may not have considered themselves to have significant roles to play in achieving positive public health outcomes.

Benefits Advice

   In the north of the county, outreach services have been commissioned from Citizens Advice Bureau providers, to address the practical, financial and legal issues which can adversely impact on an individual’s health, through the provision of a holistic client-centred advice service. In particular, it allows clients to access financial, debt and benefits advice through their GP surgeries or via a dedicated telephone line and caseworker.

   The approach is based on evidence that the targeted communities are more likely to have mental health problems which can be exacerbated by financial issues. The schemes have shown significant benefits for the clients in terms of financial status and concomitant mental and social health benefits. This has been evidenced by case studies of clients and from feedback from GP’s and other referring healthcare professionals.

Healthy Walks

   It is recognised that walking has many health benefits, including disease prevention, weight management, the prevention of illnesses related to being inactive and mental wellbeing.

   As part of a partnership approach, NHS North Staffordshire have provided funding to enable a local CVS to facilitate healthy walks with trained volunteer walk leaders. The aim is to increase the local community’s awareness of the health benefits of physical activity, to motivate and encourage sedentary people to be active and to provide local communities with opportunities for activity.

   The take-up rate by local people within the target ward areas has been high with stretch outcome targets for recruitment and participation in the walks achieved.

Wild Steps Programme

   Staffordshire Wildlife Trust have developed a “Wild Steps Programme” to provide opportunities for activity which combine physical exercise and access to the natural environment. The initiative is based on research that highlights the health benefits of engaging in outdoor activities on local green spaces.

   Sessions are provided across priority wards to promote health and fitness and offer opportunities for a range of activities from walking through to involvement in practical conservation work. In addition to learning new skills, participants have been able to achieve the recommended 30 minutes of moderate activity.

2.2.8 Engaging Communities in Public Health

Engaging Communities Staffordshire is an innovative project that is making good progress to ensure we are working better together on how we engage and involve people across the County in health and social care matters.

The vision is to establish a social enterprise for the benefit of the people of Staffordshire that will ultimately bring public engagement, consultation, complaints and consumer advice services together in a central organisation and provide local Healthwatch too. It will be community led, utilizing agencies that already do things well. By coordinating things centrally it will become a hub of information, an intelligent organisation, to enable us to see the “bigger picture” in a way that has not been possible before.

The transcripts from the public inquiry into Mid Staffordshire NHS FT are beginning to provide evidence that there are areas of overlap and disconnection and that the idea for this new organisation was well founded. Work has been on-going on this project since May 2010 and following a development and testing of concept phase sponsored by Staffordshire County Council in partnership with South Staffs PCT, Mid Staffs and DH, the Council has been funding the next phase of its development from September 2010.

It is intended that Engaging Communities Staffordshire will add value to what is currently in place such as Community Groups, Support Groups, GP practice groups etc and to ensure trends and themes can be spotted across organisations so that prompt responses can be put in place as soon as they become apparent.

3. Arrangements for commissioning public health services

As GPs will have an increasingly important role in terms of local commissioning arrangements, we have made significant progress in forging strong effective relationships with them.

We have held an initial GP Project Steering Group event in January 2011, which was followed by a successful GP engagement event, “Collaborating to benefit patients across Staffordshire”. Speakers at this event included Elizabeth Buggins, Chair of the Strategic Health Authority, Graham Urwin, Chief Executive of the PCT Cluster and Dr. David Hughes, Executive Chair of the shadow GP Commissioning Consortia (GPCC) Board in North Staffordshire.

Seventy five people were in attendance at the event, including 40 GP’s, contributing to a positive atmosphere of engagement and collaboration. There has been a request from the North Staffordshire GPCC for a repeat of this event in their area.

Our Joint Commissioning Unit (JCU), which was set up in a partnership arrangement between the county council and the local PCT’s, is leading the way in forging close working relationships with local GP Commissioning Consortia. Professor David Colin-Thomé, previously Government Advisor on Primary Care, is working with our JCU and has visited all six GPCC in the Staffordshire area. This work is paying off and the JCU have been invited back to visit the GPCC to present aspects of social care to increase collaboration and they are now working with GP representatives to convene several “Task & Finish” Groups to further develop key aspects of integrated commissioning.

4. The future of Public Health Observatories

Regional Public Health Observatories provide a useful service for local authorities in the provision of regional intelligence to understand health inequalities. Staffordshire regularly uses a number of products/data made available by the Regional Public Health Observatories including local health profiles and alcohol profiles. Staffordshire is currently working to develop its customer insight to better target resources and services. We would welcome any national support that would aid opening up access to local, low-level data on health inequalities to public services. This will truly allow public services to understand the underlying health needs of its residents and put in place suitable services and support to tackle inequalities and change behaviours.

June 2011

Prepared 28th November 2011