Slides to support Birmingham's first Public Health Workshop.

1. Public Health Transformation
Workshop 1
21st March 2012

2. Introduction
Jason Lowther
Director of Strategy, BCC

3. Agenda
• Introduction
• Session 1: Vision
• Lunch
• Session 2: Strategic outcomes and
intended benefits
• Session 3: Stakeholders
• Conclusion and next steps

4. Introduction
• Health & Social Care Bill
• Welcome back to local government!
• Transition Plan (SHA)
• Transition Board
• Transformation Approach (CHAMPS2)

5. The New Public Health System
The new delivery structure: an integrated whole system approach
Government Local authorities
• DH responsible to parliament, with • New public health functions
clear line of sight through system integrated into their wider role, helping to
tackle the wider social and economic
• Cabinet sub-committee and determinants of health.
significant contribution from across • Leading for improving health and
departments to improve health
outcomes coordinating locally for protecting
health
• CMO to continue to provide
independent advice to Government • Promoting population health and
wellbeing
Public Health England NHS
• New, integrated national body • Delivering health care and tackling
inequalities
• Strengthened health protection
systems • Making every contact count
• Supporting the whole system • Specific public health interventions,
through expertise, evidence and such as cancer screening
intelligence

6. Introduction – CHAMPS 2
• Established methodology
• Familiarisation course
• Web materials
• Paper manual
• Expert support

7. Introduction – timeline
Phase Timing
Transformation Initiation to April 2012
Vision
Planning
Design May – Jul 2012
Service Creation Aug – Dec 2012
Proving and Transition Sept 2012 – Apr 2013
Stabilisation Apr – Dec 2013
Benefits Realisation Dec 2013 onwards

8. Introduction – progress to date
• Leadership commitment
• Transition team identified
• Lots of work in various areas

9. Introduction – work needed to
complete phases 0-2
• Defining the desired strategic outcomes
• Understanding customer needs and preferences
• Current business capabilities
• Development of the future operating model (FOM)
• Process design
• Organisational design
• High level technological design
• Assessment of change impact and benefits

10. Session 1: Vision
Principles
• BCC values and welcomes the skills and expertise
coming through transfer of public health.
• The transfer should form part of how the City Council
and its health partners achieve the best health and
wellbeing outcomes for citizens
• Particularly given the current health status of many of
our citizens, the future approach to public health needs
to be transformational.
• Adopting Marmot “life stages” framework.

11. Session 1: Vision (2)
“Birmingham 2026” community strategy
• Be healthy’ is about ensuring that people enjoy long, healthy and fulfilling lives.
We want to ensure that Birmingham people live longer and live well, enjoying
rich cultural experiences.
By 2026 we want:
• Reduced health inequalities and mortality across Birmingham, resulting in people
living longer
• More people enabled to choose healthy lifestyles, enjoying rich cultural
experiences and improve their wellbeing, resulting in people living well
A healthy Birmingham will mean that we will:
• improve health for all, in particular for people who belong to the least healthy
groups, narrowing the gap in life expectancy between the least healthy areas
and the city average
• have more people choosing healthy and active lifestyles, lowering levels of
obesity, increasing levels of physical activity, stopping smoking and encouraging
healthier eating
• enable more people to live independently for longer

12. Session 1: Vision (3)
Priority One: That in Birmingham every child makes the best start in
life.
• Rationale: given that the city is the youngest in Western Europe, if it
fails to achieve the best outcomes for children and young people it will
be failing to make use of the asses they represent. Young people will
need to be highly skilled, well educated and emotionally connected
people to compete in the economy.
Priority Two: That Birmingham is a healthy and sustainable city for
adults
• Rationale: the city faces a low growth in numbers of older people but
costs growing above the national average due to poverty and poor
health. The number of years lived with disability and long term
conditions is reducing working age and adding to poverty as well as
placing considerable strain upon the care and health systems.
Reversing this to achieve better use of resources will also unlock the
contribution that older adults bring to the life and economy of the city

13. Session 1: Vision (4)
Redesign principles
• It is for the new health and wellbeing board to adapt new priorities and set out a
public health vision. However we should set this within the context of supporting its
need to be clear about its shared sense of purpose before moving through strategic and
business process issues
• The health strategy should be built as an iterative and incremental process that:
– Establishes a deep understanding of local people, their views and aspirations, their health and
needs and how these are best met
– Where common agreement exists, the strategy should be developed through to actions
– Where further time is needed to establish common perspectives, this should be explicitly taken
– Rather than work to deadlines of time the strategy and action plans should move forward set by
common agreement
– Long term plans must also be accompanied by clear markers of success and progress.
• Its vital that this opportunity is taken to think anew and to establish public health
approaches that work across the five outcomes of the community strategy
(succeed economically, stay safe, etc) and at a range of levels:
– Around the individual – altering behaviours, preferences etc
– In specific localities or interest groups
– At a city wide level
– With partners on a sub regional level
– At a national level – including influencing key relationships such as the one with the National
Commissioning Board.

14. Session 1: Vision (5)
• Its vital that this opportunity is taken to think anew and to
establish public health approaches that work across the five
outcomes of the community strategy (succeed economically, stay
safe, etc) and at a range of levels:
– Around the individual – altering behaviours, preferences etc
– In specific localities or interest groups
– At a city wide level
– With partners on a sub regional level
– At a national level – including influencing key relationships such as
the one with the National Commissioning Board.

15. Session 1: Vision (6)
Exercise 1 [30 minutes then 2 mins verbal feedback]
3. Introduce yourselves to each other
4. What is your gut reaction to the vision outlined?
5. Do the “principles” cover the key areas for the
transition?
6. Do the two “priorities” cover the more important
and urgent issues?
7. Are the “redesign principles” appropriate?
8. What is your most optimistic view of how this
might turn out?

16. Working Lunch Break
Please bring your meal back
to the seminar table

17. Strategic Outcomes and
Intended Benefits
Denise McLellan
Chief Executive, NHS Cluster

18. NHS System Architecture
Key: Parliament
Accountability
Funding
Department of
Health
NHS Commissioning Monitor CQC
Board
Local Office Licensing
Local Authorities
Partnership Clinical Commissioning
Groups (CCGs) Contracts
2° and 3°
Local HealthWatch Providers
Commissioning Support
Service (CSS)
Birmingham HealthWatch
Patients & Public
Solihull HealthWatch 18

19. The LA, the CCG/NHS CB and PHE will all play a crucial role in
ensuring an effective local delivery system and in improving and
protecting health and wellbeing
LOCAL ROLE RATIONALE
Local Authorities will: LAs will take the lead role in
• Have a duty to improve health
PH, commissioning majority of
• Bring together holistic approach to
services and assuring and
health and wellbeing across full range
coordinating through DPH and
of their responsibilities Local Authorities HWBB
• Receive ring-fenced PH budget
• Lead commissioning of public health
services (health improvement, drugs, NHS will continue to commission PH
sexual health) services where:
DPH has specific functions to bring • within PC contract
together the local PH system: • integral part of pathway
• Deliver LA functions CCGs/NHS CB • 0-5 services and Health Visitors
• Assure health protection plans
• Assure vac and imms and screening
• Provide “core offer” to NHS PHE will provide the local health
• Produce DPH report protection service, linking to
• Advise HWBB resilient national service that links
to scarce expertise, nationwide
PHE (Local) intelligence and national
leadership for serious incidents
CCGs and NHS CB will
• Commission healthcare
• Commission specific PH services • Coordinates local strategy
(eg QoF, Immunisations, Military through:
• JSNAs
and Prison health)
• Joint health and wellbeing
strategy
PHE local units will be part of Health & • Review of commissioning
local delivery system: Wellbeing plans
• Providing health protection service • Receives and reviews PHE’s
and expert advice Board programme for its locality
• Specialist EPRR function

20. Session 2: Strategic outcomes and
intended benefits
Scope of change
– All public health functions including those which will become the
responsibility of the local authority.
– Council functions which could significantly impact on public health
and well being
• Key drivers
– Economic context
– JSNA/ Marmot- wider determinants of health and wellbeing
– Opportunities for joined up working - delivery, comms,
commissioning
– Localisation
– Public accountability
– The Compact - Uniting for a Healthier Birmingham and Solihull-
binding the NHS system once PCTs abolished

21. Session 2: Strategic outcomes
• A highly effective public health system in Birmingham which addresses
health inequalities and can demonstrate a coordinated approach to
impacting on the wider influences on health.
• Key stakeholders (including the Health & Well Being Board and CCGs)
are very satisfied with the services provided.
• Public health is perceived by GP commissioning groups to provide
timely, reliable and highly usable advice around population health and
well being needs, and on healthcare issues.
• Highly efficient operation: removing duplication of effort, streamlining
processes, ensuring accurate information is available, reducing costs.
• Evidence-based practice: rigorous analysis of the evidence and
costs/benefits of all programmes to ensure the most cost-effective
approaches are used in delivering priority outcomes.
• More effective engagement with local areas in terms of front line
practitioners, elected members and communities.

22. Session 2: Intended benefits
• Benefits to customers / stakeholders: better targeted information and advice,
improved customer satisfaction, higher quality and more cost-effective interventions
• Benefits to employees: better information and networks to deliver their objectives,
improved working environment with co-location with key partners in delivering public
health outcomes
• Efficiency savings: reducing costs to free up resource to deliver greater public health
benefits
• A more citizen centric view of health - less top down and target driven
• Focus on physical and mental wellbeing as well as quality of life
• Opportunity to redesign current investment in nhs providers, integrate with “place”
and regulatory role of city council and increase range of wellbeing services provided
by third sector
• New community leadership role by local politicians
• Engagement with and stronger accountability to local communities
• Evidence based approach to policy development, investment and disinvestment
• Experienced public health team with specialist expertise, clinical networks and
established relationships with nhs commissioners
• Greater clarity about who is responsible for what, especially in relation to
commissioning services for vulnerable people

23. Session 2: Strategic outcomes and
intended benefits
Exercise 2 [30 minutes with written feedback]
• Do these capture the most important strategic outcomes?
• What are the two most important outcomes?
• Are the most important benefits identified?
• What are the two most important benefits?

24. Stakeholders
Rachel Farthing
Chief Executive’s Project Team

25. Session 3: Stakeholders
Thanks for completing the survey (n=14)
Increasing our understanding of stakeholders
Today’s work will feed into the stakeholder
engagement plan and communications
plan

26. Session 3: Stakeholders
High Medium Low
Key
players –
High need
strong
buy-in
Active
Potential impact of programme on
consultation
Medium
Maintain
interest
stakeholders
Keep informed
Low
Importance of stakeholders to the programme
Influence / Impact Matrix

28. Session 3: Stakeholders – key for matrix

29. Session 3: Stakeholders - High influence and
impact
• Secretary of State for Health
• Clinical Commissioning Groups
• Health and Wellbeing Board
• Department of Health
• Birmingham Drug and Alcohol Action Team
• PCT Clusters
• NHS Commissioning Board
• Public Health England (Development)
• Local Authority Elected Members
• BCC Adult’s and Children’s Services

30. Session 3: Stakeholders - No consensus on
matrix position
The below may warrant further discussion
• GP Practices
• Health Protection Agency
• PCTs
• Mental Health NHS trusts
• West Midlands Public Health
• Community pharmacists
• SHA Clusters
• Acute NHS trusts
• West Midlands Police
• Criminal Justice, Youth offending, Probation
• Sports and leisure groups
• Unions
• Local Media
• MPs

31. Session 3: Stakeholders
Stakeholder needs and experiences will need to
be more precisely analysed including:
– What are the customers’ real expectations,
requirements and judgement criteria?
– What do they say they want and what do they really
need?
– What problems do they have?
– How do they use the services and products?
– How do these differ between different customers (eg
CCGs, PHE, general public)?

32. Session 3: Stakeholders
Exercise 3 [30 minutes with written feedback]
• Is the mapping of stakeholders roughly right?
• Are there any major amendments needed?
• What do we already know about the needs and views
of each group?
• How can we improve our understanding especially of
the groups with the highest impact and influence?

33. Conclusions and next steps
1. Write up of today’s discussions:
– Vision
– Strategic outcomes
– Intended benefits
– Stakeholders

34. Conclusions and next steps
• Next workshop (4th April)
– Review of today’s discussions
– Overview of current business capabilities
– Refine design principles
– Identify key components of the future
business
– Identify the key differences against the
current operation
– Start to outline key changes required

35. Public Health Transformation
Workshop 2
4th April 2012