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Public health transformation six years on Partnerships and prevention Case studies Cover: Liverpool Fit for Me Community Health Ambassador, Liverpool City Council
Foreword
It is six years since public health transferred A theme identified in this annual report is that
to local government and with each successive having built a sound foundation of services
Local Government Association (LGA) annual that have been effectively reshaped and
report we see how public health is becoming recommissioned, public health is able to
an increasingly effective and vital part of local give more time to developing partnerships.
government, both leading and supporting Key partnerships for upper-tier councils are
our aims to develop healthy, prosperous and with districts and boroughs, many of which
inclusive communities and environments. are now extremely proactive in shaping their
work to promote health. In 2019, the LGA will
Councillors with responsibility for health and
publish a report on good practice in districts
wellbeing and directors of public health
to help all reach the level of the best.
(DsPH) from over 50 local authorities have
contributed to the series of annual reports Partnerships with the NHS are also a
and all have identified the many opportunities high priority, with many DsPH leading
to improve health and wellbeing that working the prevention strand of sustainability
in local government has brought. This year’s and transformation partnerships (STPs).
contributors continue to give this message, Unfortunately, while relationships are good
and their commitment remains impressively and there are examples of excellent joint
high. Despite the challenges they face, DsPH work, there is also disappointment that
and their teams love their work because the main focus has been on tackling NHS
they see results and there are always new priorities, such as reducing A&E attendance
opportunities to make a difference. Lead and organisational deficits. This is a missed
councillors are equally enthusiastic and point opportunity to collaborate to improve health
out how, over the years, their colleagues are and wellbeing and reduce future demand on
increasingly engaged in improving health health and care services.
and wellbeing.
In the first annual reports we emphasised
In 2019, despite the huge financial constraints the fact that public health was new to local
facing public health and councils overall, government and that relationships and
public health teams have continued to do working patterns needed to be established.
an excellent job across the whole spectrum In the later reports public health had become
of activity: mental health and wellbeing for so embedded, while also maintaining its
children and adults, the best start for children important reach out into the NHS, that it
and young people, supporting healthy scarcely seemed necessary to mention
behaviours, better data and intelligence, that it was a local government function.
healthy places – both rural and urban, However, this year it is important to reinforce
addressing the wider determinants of health the reasons why responsibility for key
including economic growth, tackling health public health functions was transferred to
inequalities by working with neighbourhoods. local government. The case studies in this
publication were written before the publication
of the NHS Long Term Plan.
2 Public health transformation six years on
They show the excellent work that public
health in local government is doing to
commission for quality and best value across
all areas. They show how councils are
developing integrated services for children
aged 0-19 – improving access and support
through use of technologies, reaching out
to community services and neighbourhoods
to focus on children and families facing
deprivation, working closely with schools
and the NHS to develop resilience to avoid
the need for specialist child and adolescent
mental health services. Case studies also
show how sexual health services can provide
better value for money while also expanding
their reach through being more effectively
placed in accessible community settings, and
through using technology that attracts the
populations most at risk.
All of this excellent work is in the context of
a reduction to public health grant funding
of over £700 million in real terms between
2015/16 and 2019/20 at a time when the
NHS is to receive additional funding of £20.5
billion over five years, and prevention was
high on the national agenda. The forthcoming
government Green Paper on Prevention
should allow us to consider the opportunities
for prevention from a system-wide perspective
which includes all the social determinants
of health. However, it must be based on
engagement with councils and with the public
health community, and for any progress to
be made it must be accompanied by proper
funding for local government public health.
Councillor Ian Hudspeth
Chairman, LGA Community Wellbeing Board
Partnerships and prevention 3
Contents
Introduction 6
National developments 7
Key themes identified from the case studies 8
Health in all policies continues to advance 8
Delivering local priorities 8
Fairness, wider determinants and communities 9
NHS reforms – developments in health and wellbeing boards, joint health
and wellbeing strategies and joint strategic needs assessments 9
Communicating with the public 10
Use of technology 11
Districts proactive in health and wellbeing 11
Challenges 12
What areas would do if they were adequately funded 12
Suggestions for legislation and regulatory change 13
Key messages 13
References 14
4 Public health transformation six years on
Case studies 15
Derbyshire County Council 16
Hampshire County Council 23
Hull City Council 29
Liverpool City Council 36
London boroughs of Camden and Islington 43
Norfolk County Council 51
Stevenage Borough Council 58
Warwickshire County Council 64
Partnerships and prevention 5
Introduction
The LGA’s Public Health Annual Report for The case study areas are:
2019 provides a snapshot of public health
based on information from eight case studies. • Derbyshire County Council
It also considers information from other recent • Hampshire County Council
case studies and reports produced by the
• Hull City Council
LGA on the topics of health, integrated care,
and wellbeing. • Liverpool City Council
The report shows that progress in public • London boroughs of Camden and Islington
health continues to gather pace. Public health • Norfolk County Council
became established in local government very
• Stevenage Borough Council
quickly; case studies suggest that this was
partly because of shared values – the focus • Warwickshire County Council.
on tackling inequality, promoting inclusion,
A number of themes and messages have
and working with communities and their
been identified from the case studies and
assets to bring about change.
related LGA publications. Because this is
The title for this year’s report is ‘partnerships a small sample, themes are indicative of
and prevention’, reflecting the fact that the direction of travel and cannot be seen
many areas feel they have established good as representing the state of public health
foundations for health and wellbeing which throughout England. However, as in previous
has allowed them to reach out more widely to years, there has been significant consistency
partners. Prevention is included because of in information, which suggests that it presents
its increasingly high profile. As one director of a reasonable reflection of effective public
public health stated – prevention was rarely health in local authorities.
mentioned five years ago, now it is high on
everyone’s agenda.
The eight case studies were chosen because
they show the wide range of ways in which
public health is working to improve health and
wellbeing and tackle health inequalities in
response to local priorities. The case studies
are of councils across England, covering
both rural and urban environments and with
varying degrees of deprivation and affluence.
6 Public health transformation six years on
National developments
The Association of Directors of Public Health The NHS Long Term Plan4 sets out the actions
(ADPH) became one of the signatories to the NHS will take in relation to the top five risk
the health and care national membership factors for premature death in the renewed
organisation document, ‘Shifting the Centre of NHS prevention programme: smoking,
Gravity: making place-based, person-centred poor diet, high blood pressure, obesity and
health and care a reality’1 which refreshed alcohol and drug misuse. It will also take a
the original partnership vision in ‘Stepping ‘more concerted and systematic’ approach
up to the Place’ (2016)2. There was a greater to reducing health inequalities, including
emphasis on prevention in the refreshed vision, targeting a greater share of funding to areas
which shows the growing importance of public with high levels. The NHS will also focus on
health’s role in integrated health and care. the best start in life, ageing well and mental
health. Emerging integrated care systems are
Prior to the publication of the NHS Long Term
described as providing stronger foundations
Plan, in December 2018 the Department of
for the NHS working with local government
Health and Social Care (DHSC) published
and the voluntary, community and social
‘Prevention is better than cure: our vision to
enterprise sector (VCSE) on the broader
help you live well for longer’3 which explains
agenda of prevention and health.
why prevention matters, advises the NHS
and local authorities to put prevention at the Despite the welcome focus on prevention,
heart of everything they do, and describes health inequalities and population health, the
prevention for people with a health and success of the next few years will depend
social care need and how they can live on proper funding for local government
well for longer. The document signalled the public health, and on local partners working
Government’s intention to produce a green effectively together to build on place-based
paper on prevention in 2019. plans to improve health and wellbeing.
Despite this focus on prevention, proposed
reductions to public health grant allocations
for 2019/20 were made in December,
meaning real terms cuts to the grant of over
£700 million between 2015/16 and 2019/20.
1 LGA et al, 2018, Shifting the centre of gravity.
www.local.gov.uk/shifting-centre-gravity-making-place-
based-person-centred-health-and-care-reality
2 LGA et al, 2016, Stepping up to the place.
www.local.gov.uk/stepping-place-key-successful-health-
and-care-integration
3 DHSC, 2018, Prevention is better than cure. 4 NHS England, 2019, The NHS long term plan
www.gov.uk/government/publications/prevention-is-better- www.england.nhs.uk/long-term-plan
than-cure-our-vision-to-help-you-live-well-for-longer
Partnerships and prevention 7
Key themes identified from the
case studies
Health in all policies (HIAP) applies a special cumulative impact policy
to five areas of the city with large clusters of
continues to progress alcohol premises and risk from alcohol harm,
including one residential area.
As in previous years, progress continues
to be made on a wide range of health in all Public health is also involved in responding
policies (HIAP) approaches. Developments to health issues in major new developments,
like making every contact count (MECC) including healthy new towns, and advising on
are being rolled out to a wider range of issues such as improving active travel. Air
participants from different organisations – for quality was a growing issue and is likely to
example, moving beyond the council into see more focus in the coming years.
health services like general practice or into
the voluntary and community sector. There Despite this progress, there was a general
was a strong sense that partners within and feeling that having formal powers in relation
outside the council who didn’t ‘get’ the public to health aspects of planning would ensure
health agenda were now in the minority, and greater consistency, and when areas were
many partners now see health and wellbeing asked what legislation would help their work,
as an integral part of their work. this was the most popular response. Counties
with many districts face greater challenges
As in previous years, a few areas did not use in developing HIAP initiatives – public
the language of HIAP or MECC – generally health in unitary authorities require only one
because the names were not seen as helpful relationship with partners, such as planning,
for engaging with people. However, Liverpool whereas county public health teams have
City Council has gone further than HIAP and links with multiple partners which generally
uses the concept of Health in all Policies and requires more time and resources.
Places (HIAPP) which provides a focus on
locality as well as policy. The next steps in HIAP are for areas to keep
their foot on the pedal of a comprehensive
Public health involvement in planning and strategy to make sure that effective initiatives
licensing is becoming the norm. Methods are applied consistently and are rolled out to
for this include health as a consideration in all other partners wherever these would have
supplementary planning documents and in a health impact.
the local plan, setting up cumulative impact
zones, and health impact assessments on
large-scale projects. Areas pointed to limits Delivering local priorities
on the sale of fast food near schools, and
to limits on gambling premises and alcohol Some areas had local priorities because of
licenses in sensitive areas. In Islington a geographical conditions, the profile of the areas
‘concentration of uses’ supplementary or being outliers in terms of national outcomes.
planning document, intended to resist For example, Norfolk public health is the lead
clustering of unhealthy premises, led to a council department for resilience partnerships
new betting shop being refused. Liverpool and won a Sustainable Health and Care Award
for the best resilience strategy. Norfolk also
8 Public health transformation six years on
focuses on improving road safety to reduce Derbyshire aims to go further and established
deaths and serious injuries. Live Life Better Derbyshire community-based
teams in wellness hubs in boroughs and
A key priority for public health in Hampshire
districts and aligned with integrated health
is reducing the impact of violence and,
and care.
as part of this, is transforming domestic
abuse services, including tendering for a In many areas, public health is seeking to
new service aimed at preventing the cycle shift how it operates to enable people to
of abuse by peer mentoring through an take charge of their own health, establish
integrated, single point of contact and a peer support and self-sustaining groups,
whole family approach for those wishing to and to have conversations with communities
remain in their relationships. about what matters to them. Many of the
case studies had done insight work with
Some areas, particularly the cities of Hull and
communities facing health inequalities.
Liverpool, had interwoven public health with
Development work with a local neighbourhood
large-scale, big-impact initiatives involving
in Camden identified lack of access to
regeneration and creating prosperity and
healthy food as a barrier to healthy eating,
inclusion.
and part of the response was to support a
local organisation to set up ‘the people’s fruit
and veg stall’ on Camden Market. In Hull, an
Fairness, wider asset-based stop smoking project involved
determinants and community partnerships working together to
develop innovative stop smoking opportunities.
communities One development is smokefree sidelines – a
Many councils were developing their role as voluntary code to stop spectators smoking at
place leader and shaper and were refreshing youth football matches.
their visions to establish a new relationship
However, case study areas were aware that
with citizens based on coproducing solutions.
capacity was required to start-up community
A common theme, particularly in councils
initiatives, and although this would reduce
with significant poverty and deprivation, was
significantly once things were up and running,
that councils were seeking to emphasise
there were challenges identifying resources
fairness and inclusivity, reduce inequalities
to cover all areas. When case study areas
and encourage opportunities for all. Some
were asked what they would prioritise if they
health and wellbeing boards (HWBs) were also
received adequate funding, many identified
refreshing their work in light of this approach,
working with communities.
as well as health reforms which are discussed
below. This meant that public health was putting
increased focus on tackling wider determinants
of health with a wide range of partners.
NHS reforms –
developments in
In Hull, public health supported the
development of Hull Money, a scheme run by health and wellbeing
a charity credit broker to support people with boards, joint health and
little or no financial resilience by providing
access to cheaper, safer borrowing and wellbeing strategies and
to savings and current accounts through joint strategic needs
a credit union, as well as budgeting and
savings advice. Derbyshire is developing
assessments
an ambitious model to interconnect lifestyle Several of the case studies mentioned
services with support for social determinants that their HWBs, joint health and wellbeing
of health, such as debt advice and housing. strategies and joint strategic needs
These services already have good links, but assessments (JSNAs) were being refreshed
Partnerships and prevention 9
and reshaped. There was a trend for HWBs Public health was also highly involved in social
to update their priorities, moving from a focus prescribing initiatives that were often linked to
on specific health conditions to the wider neighbourhood integration. Connect Well Hull
determinants of health, health inequalities social prescribing model offers advice and
and supporting the development of healthy support to people to make positive changes
neighbourhoods and environments. Rather to health and wellbeing across a range of
than the HWB overseeing the details of locations. The service collates, analyses and
public health grant or the Better Care Fund, reports to commissioners on trends and gaps
they were putting more emphasis on taking in services and is supported by a £1.8 million
a system-wide approach to health and social prescribing community fund to respond
wellbeing and to integrated care. This trend to gaps.
was also seen in the LGA’s longitudinal
Another theme was the development of joint
study of HWBs, ‘The power of place’, which
work across more than one HWB in an STP
identified it as a marker of an effective HWB5.
footprint. Warwickshire Council has set up
This approach dovetailed with how HWBs a Place Forum with its neighbour Coventry
were updating their work to respond more City Council made up of the HWB from each
effectively to sustainability and transformation area and corresponding to the Coventry and
partnerships (STPs) and the development of Warwickshire STP footprint.
integrated care systems. Directors of public
health (DsPH) were often involved as leaders
of STP prevention workstreams, but there was Communicating with
disappointment that prevention tended to be
stuck on short-term measures to address NHS
the public
pressures on A&E, delayed transfers of care, Public health needs to provide information for
and NHS deficits. DsPH were hoping to widen local citizens to enable them to make good
the approach to prevention to cover the social decisions about improving their health, and
determinants of health, and to encourage so they know where to go to for support. Most
other STP workstreams to include prevention. areas ran campaigns on key local health
issues to raise awareness and set out how to
Many areas were refreshing JSNAs to better
access help. Liverpool has a comprehensive
understand the needs of neighbourhoods
approach to creating health campaigns based
within primary care networks (30,000 –
on insight work, co-development with local
50,000 people). A growing area of interface
people and measuring impact. Campaigns
with the NHS was the role of public
include Save Kids from Sugar, Drink Less,
health in contributing to population health
Enjoy More, and Let’s Clear the Air Liverpool.
management. Some areas were just starting
on this, but others, such as Camden and Some areas had developed website portal
Islington, as part of north central London, approaches linked to service directories
have developed a population management which allowed local people to easily find
system with real time data. The system will information about health and wellbeing. Some
be tested in neighbourhood health and care websites were mainly focused on healthy
integrated teams. Camden and Islington are lifestyle support, others also covered areas
also working with academic partners on a such as debt advice, housing, falls, mental
predictive model for people at risk of needing health and other health and wellbeing topics.
adult social care services to better target Warwickshire operates a comprehensive,
prevention and early intervention. regularly updated portal/directory with
information and referral pathways for health
and care practitioners, including those
5 LGA/Shared Intelligence, 2017, the Power of Place involved in social prescribing and making
www.local.gov.uk/sites/default/files/documents/The%20 every contact count.
power%20of%20place%20health%20and%20wellbeing%20
boards%20in%202017.pdf
10 Public health transformation six years onThere is also a public-facing portal which Live Life Better Derbyshire’s website for
provides detailed information about the integrated health and wellbeing services
main ways of improving health, including provides advice and information and access
campaigns, and how to access support. to individual or group support through an
online self-assessment using a wellbeing,
Stevenage’s Healthy Hub provides a
assessment and care management tool.
one-stop-shop for health and wellbeing
Individuals can self-refer to the service or be
information and support located near the
referred by a professional. A personalised
town centre in a previously unused space
priorities plan is developed for everyone who
within Stevenage Arts and Leisure Centre.
completes an assessment.
A range of local partners from the NHS,
public health and voluntary and community Hampshire has set up a ChatHealth texting
sector organisations deliver services in service for parents of children 0-5 launched
the centre, which also provides specialist by the health visiting service in October
exercise equipment for the rehabilitation and 2018. This allows parents to get advice
management of chronic medical conditions. and support on a wide range of health and
wellbeing issues such as crying babies,
sleep disruption and behaviour problems. The
Use of online and service has already proved very popular with
interactive support parents, who are still able to speak directly
with a health visitor or meet face-to-face in a
Public health is increasingly using online baby clinic or at home if needed.
offers to improve services and to allow people
Hampshire also runs the ‘Be size-wise’
to access information and support more
campaign, part of which is the POWeR
easily. Online services generally focus on
(positive online weight reduction) programme,
people with lower level needs who can be
developed by Southampton University, which
helped by support through an app or online,
Hampshire Public Health helped to make
meaning that face-to-face time can be freed
available to the public.
up for people with complex needs. In rural
areas, making best use of online options is Warwickshire’s Big White Wall is a safe online
seen as fundamental because of travelling community of people 16 and over who are
distances. The main topics from the case anxious, feeling down or not coping who
study where this is being used are: support and help each other by sharing
what is troubling them, guided by trained
• sexual health – online access for postal
professionals and a range of information.
testing seems to be reaching more people
and to be cost effective
• mental health Districts proactive
• children and young people in health and wellbeing
• healthy living support. The role of second-tier councils – districts,
Norfolk’s integrated sexual health service boroughs and cities – in delivering health and
includes prevention, community-based clinics, wellbeing has increased in each LGA public
outreach support, and an online testing offer health annual report. For the first time the
for people who are asymptomatic. This has annual report includes a case study from a
proved both popular and cost effective, with borough council – Stevenage – which shows
around 2,000 more people tested a year and the achievements that can be made when
high return rates. councillors and officers are passionate about
improving health in their areas.
Partnerships and prevention 11Directors of public health (DsPH) in the case change and the complexities of working with
studies pointed to the importance of district multiple partners, especially in sustainability
partnerships and described themselves as and transformation partnerships (STPs).
the Director of Public Health (DPH) of each
district as well as county as a whole. Strategic Unsurprisingly the biggest challenge for all
partnerships with districts included the areas was reductions to the public health
following measures: budget within the overall context of huge
reductions to council funding. To mitigate
• Devolved budgets – these were of different budget cuts, public health teams had
sizes and had different levels of autonomy; undertaken a range of activity:
a common theme was that as the overall
public health budget reduced, districts • Streamlining and recommissioning services
were having to focus on doing more for – successive annual reports have shown
less but remained committed to promoting that recommissioning can result in savings
health and wellbeing. and quality improvements, but generally
this sort of saving is a one-off opportunity.
• District-level Joint Strategic Needs
Assessments (JSNAs), Joint Health and • Seeking opportunities for outside funding
Wellbeing Strategies (JHWSs), annual reports – there were some successes, for instance
and health and wellbeing partnerships linking through Sport England funding, but this
in to county health and wellbeing priorities. was seen as a highly competitive field.
• Regular contact between county and • Identifying opportunities to raise income –
district councillors on health and wellbeing. some departments were considering areas
where they had particular expertise, such
• Public health link officers supporting as workforce health; data and intelligence;
districts, with the DPH or a consultant and public health campaigns.
providing overall coordination.
• Partnerships with others, such as joint
Partners in Stevenage developed a Healthy posts with the NHS.
Stevenage Strategy which sets out a vision
• Using technology that resulted in savings
and priorities for how the borough council
while improving access.
and its partners will tackle health inequalities
up to 2022. The strategy has been endorsed Public health was doing its best to manage
by Hertfordshire Public Health and by its resources as well as it could. However,
Hertfordshire and West Essex sustainability ongoing cuts to funding meant that several
and transformation partnership (STP). areas were concerned that they would
have to start focusing more on mandatory
Derbyshire County Council has worked
responsibilities.
with districts and boroughs to set up local
partnerships, each supported by a locality
lead from public health. The partnerships
have specific needs assessments, priorities
What areas would do if
and plans and manage a devolved public they were adequately
health budget to commission local activity. funded
There is an annual director of public health
report for each partnership area and for the Case study areas were asked what they
county as a whole. would prioritise if more funding were made
available. The overall response was that they
would be able to invest in more capacity so
Challenges that successful programmes that were being
implemented slowly or in limited areas could
Case study areas mentioned several general be scaled-up and rolled-out more quickly
challenges – recruitment of skilled staff, the and extensively.
time and resources it takes to bring about
12 Public health transformation six years onThe areas most mentioned were asset-based
approaches to working with communities
Key messages
and the social determinants of health, and Case study areas identified the following key
preventative measures for mental health messages for the best ways to continue to
problems for children and young people and improve health and wellbeing.
adults. Workplace health, drugs and alcohol
and sexual health were also mentioned. • Provide clear evidence and short, clear
messages about the case for prevention
to all partners and keep repeating and
Suggestions for legislation reinforcing these.
and regulatory change • Make the case for ‘big hit’ programmes
that will make a significant impact across
Case study areas were asked to identify what all partners.
legislative or regulatory changes would best • Scan the horizon for opportunities; prepare
help to improve people’s health and make interventions that can be rolled out quickly
their job more effective. The most popular if a funding opportunity arises.
suggestions were:
• Highlight that health and wellbeing are not
• the NHS should have a statutory just a public health issue, a council issue or
responsibility to deliver on prevention an NHS issue; health problems and health
and to fund this inequalities are a societal challenge and
• health, including mental health, should need a system-wide approach nationally
be a statutory consideration in planning and locally.
applications and licensing applications • The public health workforce will need
• a national minimum unit price for alcohol to change over time, becoming multi-
skilled and able to work in a range of
• addressing changes to the benefits system areas, including community development,
that have led to greater poverty behaviour change, and helping people
• limit national advertising for gambling, tackle the wider determinants of health.
and further work to develop strategies • When setting up initiatives, build-in evaluation
to address gambling addiction and an exit strategy from the start, rather than
• further reduce sugar and limit advertising trying to assess impact retrospectively.
of sugary items to children. • Consider all council investment as
Other suggestions included: potentially having an impact on health.
• A business-like approach to public health
• hold private landlords accountable for
spending, based on value for money and
providing decent homes
quality, is the foundation for partnership
• a statutory duty on schools to cooperate working and innovation.
with councils, including districts, on health
• Public health needs to identify and influence
and wellbeing
key individuals and partners and support
• clarity on responsibilities, including funding, partners to develop shared solutions.
for domestic abuse
• For a borough council to have a voice in
• tighter regulation to prosecute illegal sales major health and care developments such
of cigarettes and alcohol to children as the sustainability and transformation
• regulate for the expectations on public plan (STP), it is helpful to have a clear
health services and embed this in peer vision, priorities and plans which
reviews demonstrate the borough’s contribution to
health and wellbeing and how it will work
in partnership.
Partnerships and prevention 13• Highlight success stories, so that councillors, other decision makers, and the public know what is being achieved. References ADASS, ADPH, LGA, NHS Clinical Commissioners, NHS Confederation, NHS Providers, 2018, Shifting the centre of gravity: making place-based, person- centred health and care a reality. www.local.gov.uk/shifting-centre-gravity- making-place-based-person-centred-health- and-care-reality ADASS, LGA, NHS Clinical Commissioners, NHS Confederation, NHS Providers, 2016, Stepping up to the place. www.local.gov.uk/stepping-place-key- successful-health-and-care-integration DHSC, 2018, Prevention is better than cure www.gov.uk/government/publications/ prevention-is-better-than-cure-our-vision-to- help-you-live-well-for-longer LGA/Shared Intelligence, 2017, The Power of Place www.local.gov.uk/sites/default/files/ documents/The%20power%20of%20 place%20health%20and%20wellbeing%20 boards%20in%202017.pdf NHS England, 2019, The NHS long term plan www.england.nhs.uk/2019/01/long-term-plan 14 Public health transformation six years on
Case studies
Partnerships and prevention 15Derbyshire County Council
Summary Organisation
• An ambitious model to join up behaviour- Derbyshire Public Health is a department
change services with support for the wider within the directorate of adult care and has
determinants of health in community hubs taken on the knowledge and intelligence
across the county. function for adult social care. The department
has brought the contract for lifestyle services
• Public Health works closely with the eight
in house, from an NHS provider, to develop
district and borough councils on health
these so they are more integrated and
and wellbeing strategic planning and
accessible, and focused on engaging with
health in all policies.
the health needs of communities, particularly
• A focus on developing data and those at risk of health inequalities.
intelligence to make the case for
investment in prevention. Derbyshire Health and Wellbeing Board
(HWB) has recently updated its health and
wellbeing priorities, moving from a focus
Overview on tackling specific health conditions to
addressing the wider determinants of health
Derbyshire County Council has a population and supporting the development of healthy
of around 771,000 and covers an area of neighbourhoods and environments. This is
around 1,000 square miles. It is made up of in line with plans by the county council to
large rural areas with some urban centres, develop its role as place leader, working in
mainly in the form of market towns including partnership with other organisations and
Buxton, Matlock and Chesterfield. The health with communities.
of people in Derbyshire is varied compared
with the England average. Life expectancy is
lower than the England average and around
15 per cent of children live in low-income
families. Population health needs are diverse,
and levels of health and wellbeing vary
significantly across the county, with some
areas of deprivation and health inequalities,
particularly in the ex-mining towns of the
North East.
16 Public health transformation six years onLocal partnerships
Erewash district public health annual report
Working with district and borough councils There is an annual DPH report, presented
to develop their potential for promoting in infographic style, for each partnership
health and wellbeing is a priority, and area and for the county – See example for
local partnerships, each supported by a Erewash district.
locality lead from public health, have been
established. The partnerships have specific Public Health also intends to establish
needs-assessments, priorities, outcomes relationships with town and parish councils
and plans which reflect their local areas. to support the development of health and
For example, some are more focused on wellbeing initiatives within neighbourhoods.
the mental health needs of younger people,
others on the needs of carers and older
people. The partnerships manage a devolved Health partnerships
public health budget to fund and commission Derbyshire works closely with the four Clinical
activity to meet local and county-wide Commissioning Groups (CCGs) and local
priorities. Over time, and with a reducing NHS providers, which are involved in many of
overall budget, the local partnerships have the initiatives described below. Derbyshire’s
focused more on harnessing assets to work CCGs have a £95 million deficit and have
more effectively together. The Director of proposals for cuts, including preventative
Public Health (DPH) views himself as DPH of services in the voluntary, community and
each borough and district as well as for the Social Enterprise (VCSE) sector, which would
county as a whole. have a major impact on health and wellbeing
support across Derbyshire.
Partnerships and prevention 17The DPH for Derbyshire chairs the prevention
board which oversees the prevention
Health and wellbeing
workstream of Derbyshire sustainability and initiatives – highlights
transformation partnership (STP) – Joined up
Care Derbyshire. The STP is working with the Health in all policies –
council to develop a place-based approach
to integrated health and care, and public examples
health is keen to accelerate this agenda to put All eight districts have signed up to a strategic
more focus on prevention, as well as tackling statement in their Local Plans to bring
NHS pressures. principles of ‘active by design’ into planning
developments. For example, comments
Councillor perspective from public health on a development of
I have been involved in promoting health 300 dwellings resulted in additional cycling
and wellbeing for many years, as Leader infrastructure and vehicle charging points.
of Erewash Borough Council, as Chair of Public health has also completed a health
Derbyshire Local Strategic Partnership impact assessment on a major development
and now as Derbyshire Cabinet Member of former industrial site which identified
for Health and Communities. Through opportunities for connecting open space,
this time, I have seen how understanding linking new children’s play spaces with green
of public health and the importance of infrastructure, good design for community
prevention has increased greatly. Some safety and links to healthier food.
wonderful programmes are taking place
Where tackling fast food near schools is a
across the county, often involving third sector
local priority, districts have set limits on the
organisations delivering in local communities
number of takeaways within 400 metres.
– sports for young people, keeping active for
For example, the borough of Chesterfield
older people and many more.
has recently refused two applications for
Partnership working is fundamental to takeaways. Public health intends to extend
improving health and tackling health the fast food approach to tackling gambling,
inequalities. It is even more essential when which is proving a growing problem in some
money is scarce to ensure that there is urban centres.
no overlap or duplication and to identify
Derbyshire has designed a local approach
creative, cost effective ways of working. For
to brief health interventions, working with a
example, Derbyshire County Council and
psychologist and community health provider
Derby City Council HWBs have started to
to develop ‘quality conversations’ – local
do some work together to look at shared
stakeholders did not think the brand of making
priorities across the Derbyshire STP footprint.
every contact count (MECC) was the best way
A challenge currently facing Derbyshire of encouraging people to get involved. Training
is the large budget deficit in the county’s in brief interventions has taken place with staff
CCGs, leading to proposals from them to in sexual health services, health visitors and
reduce funding to the third sector. We will general practice and is now moving into social
continue to work in partnership to resolve care and other council services.
these issues together.
Community wellness approach
Councillor Carol Hart Derbyshire is developing an ambitious
Cabinet Member for Health and approach to interconnecting lifestyle services
Communities, Derbyshire County Council with support for social determinants of health,
such as debt advice, and housing. Many of
the building blocks of this approach, such
as Live Life Better Derbyshire (LLBD) are
described below.
18 Public health transformation six years onThese services already have good links – for Live life better Derbyshire (LLBD)
instance LLBD teams have a strong relationship LLBD is a county-wide advisory service
with the Citizens Advice Bureau, but the new which provides integrated access to a range
model intends to go further and deeper. As a of health improvement services that are
first stage, LLBD community-based teams are either directly provided by the county council
being established on a borough/district footprint or networked from other providers. Topics
which align with Joined Up Care Derbyshire include stop-smoking, losing weight, getting
‘places’. The teams will work from ‘wellness active, mental wellbeing, alcohol awareness,
hubs’ providing face-to-face, as well as a digital falls prevention, healthy housing, healthy
support. This is an evolving model which will workplaces, and debt and money advice.
develop alongside health and care community
integration over the next two years. The LLBD website provides advice and
information, and access to individual or group
An important part of the model is shifting the support through an online self-assessment
way that public health works, from a deliverer using a wellbeing, assessment and care
of health services to an enabler of people management tool called OCTIGO. Individuals
taking charge of their own health. This will can self-refer to the service or be referred by
involve better conversations with communities a professional. A personalised priorities plan
about what is important to them, and a is developed for everyone who completes
focus on volunteers, peer support and self- OCTIGO, based on the topics listed above.
sustaining groups. Derbyshire also operates
to the principle of proportionate universalism Over time, the vision is for front-line staff and
– all areas receive some health and wellbeing volunteers to be able to signpost people
support, but more focus and resources are they are in contact with to complete an
given to those with greater deprivation and OCTIGO assessment. Since OCTIGO went
health inequalities. live in January 2018, over 2,100 people have
Partnerships and prevention 19completed an assessment and consented Healthy workplaces Derbyshire
to onward referral. The Healthy Workplaces Derbyshire team
provides tailored support for organisations
Derbyshire Citizens Advice GP programme
seeking to reduce worker absence and
This well-established programme continues
turnover and create happier and more
to be a national leader in providing citizens
productive organisations. The type of support
advice sessions in GP surgeries and, more
provided includes:
recently, children’s centres. It helps reduce
health inequalities in rural and deprived areas • engagement with senior management
by helping people with complex financial and and employee groups to identify shared
social pressures such as redundancy, debt, priorities for improving health and wellbeing
homelessness, child poverty and domestic
• reviewing policies and procedures
abuse. Key outcomes from the public health
funded advisory services during 2017-18 • onsite health MOTs and LLBD support
include: • mental wellbeing events and training
• help and advice given to 12,232 • training health champions.
individuals or families
Derbyshire Suicide Prevention
• additional income of £16,297,728 Partnership Forum
secured for individuals and families Derbyshire Public Health leads the multi-
• debts of £6,913,434 rescheduled agency Suicide Prevention Partnership which
or written-off. includes Derby City Council. A key priority is
skilling professionals and volunteers in suicide
Active Derbyshire prevention, and the training programme for
Active Derbyshire is one of the 44 county primary care staff was shortlisted for the 2018
sports partnerships in England. It receives Health Service Journal awards. There has
investment from the county council, including also been national recognition for the forum’s
a contribution from public health, and also work with Network Rail to reduce the number
attracts funding from Sports England and of suicides on Derbyshire’s railways, and for
other external funders, bringing additional its collaboration with league and non-league
resources to the area. The county council football clubs on World Suicide Prevention
and the eight districts are Active Derbyshire Day. In September 2018, suicide prevention
partners and help shape its strategic information was given to an estimated 30,000
approach. fans attending five matches.
In recent years, as part of the LLBD Falls prevention and pathway development
approach, there has been a shift from a Public health is involved in several initiatives to
focus on sport to providing a range of support the implementation of a new system-
offers for people of all ages and abilities to wide falls pathway. These include:
get moving. This includes the mile-a-day in
schools, inclusive activity aimed at people • a place-based pilot on identifying older
with disabilities, physical activity for women people at risk of falls
and girls, walking for health and a workplace • a social marketing project to develop
challenge. Active Derbyshire has been very consistent and effective messages about
successful at getting people moving. For falls across system partners
example, Jog Derbyshire has a network of
6,500 joggers and is further developing its • the development of resource guides
work to attract people with health conditions and training.
such as diabetes.
20 Public health transformation six years onKnowledge and • Greater use of digital technology and
online STI testing and information, for
intelligence function example, using YouTube. A pilot for online
screening has been extremely successful
Public health has been working to improve
in terms of uptake and returns rate.
data collection, analysis, intelligence
and evaluation to support health and
care integration and the work of the local
partnerships.
Services for children
Examples include:
and young people
Services for children and young people
• A collaborative project using a market
0-19 are commissioned from Derbyshire
segmentation tool within a health equity
Community Health Services NHS Foundation
audit to identify communities with low take-
Trust which provides a programme of
up of bowel cancer screening and develop
prevention and early intervention services
targeted interventions within communities
covering breastfeeding, 0-5s health visiting
delivered by a range of partners.
and 5-19 school nursing. Performance on
• Providing analysis capacity to the STP to achieving children’s reviews is significantly
focus on the drivers of poor health and to better than the England and East Midlands
move towards measuring outcomes rather average. The Trust works very closely with
than attendance and activity. public health and co-hosts a children’s health
psychologist based with the team. The Trust
• Identifying financial and social return
is seeking to embed a public health approach
on investment – public health uses this
across its organisation. The 0-19 service
information to provide clarity about what
is increasingly being aligned with council
needs to be done to improve health, and to
children’s services including children’s
raise awareness of its potential for reducing
centres. Developments include intensive
demand on health and care services.
home visiting for vulnerable families and
For example, the return on investment in
breastfeeding peer support.
citizens advice services is £15.23 to clients
for every £1 invested, and every £1 spent
on drug and alcohol treatment saves £4.
Challenges and impact
of budget reductions
Sexual health programme Making major developments in public health
The council and partners in the NHS and VCSE services can bring challenges because
sector are part-way through a programme to people and organisations start from different
make sexual health support more effective stages and need time to get on board with
and accessible in a large, predominantly rural, change. However, once reforms embed, new
county. Measures include: approaches have proved very successful.
• Social marketing project – talking with The biggest challenge facing public health is
local communities and at-risk groups, co- lack of funding, which is limiting the speed
creating the Your Sexual Health Matters at which it can establish new initiatives.
campaign, and analysing the results. Cuts to the public health budget have been
• Working across the STP to improve access compounded by overall council cuts and the
to long-acting reversible contraceptives for poor financial position of partners in the NHS.
women in high-risk groups.
Partnerships and prevention 21Public health puts considerable attention • In planning pilots and new services, it is
on how to attract new funding and make the important to build-in evaluation from the
best use of current resources. For instance, start, rather than trying to assess impact
it worked with Sports Direct, which is based retrospectively. Some interventions will
in Derbyshire, on workforce development, need exit plans, such as developing peer
and received funding to develop health and support and involving volunteers.
wellbeing support for its workforce.
• The public health workforce will need
Much has been achieved with limited funding. to change over time, becoming multi-
Many initiatives require funding to kick-start skilled and able to work in a range of
a process, then, once embedded, require areas, including community development,
coordination and updating which involve behaviour change, and helping people
lower levels of resources. An example of this tackle wider determinants of health.
is working with districts and boroughs to limit
takeaways around schools; the main work
was in setting up the system. Contact
Such initiatives are good investments, Dean Wallace
however initial funding and staff resources Director of Public Health
to keep things on track is essential and with Derbyshire County Council
the reduction in the public health budget new dean.wallace@derbyshire.gov.uk
developments cannot be tested or scaled up
as quickly as public health would like. If the
budget had not been reduced, Derbyshire Documents and links
would move more quickly to:
About public health in Derbyshire
• align and embed lifestyle services across www.derbyshire.gov.uk/social-health/health-
the borough and district footprint and-wellbeing/about-public-health/about-
• invest in children’s mental health and public-health.aspx
resilience with low level interventions Active Derbyshire
that could reduce demand on Child and www.activederbyshire.org.uk/about-active-
Adolescent Mental Health Services derbyshire
• scale-up work on obesity, active places and
Derbyshire STP
mental health.
https://joinedupcarederbyshire.co.uk
Health and wellbeing offers
Key messages www.derbyshire.gov.uk/social-health/health-
and-wellbeing/your-health/your-health.aspx
• It is important for public health to make
a short, clear, repeated case for the Heart of Derbyshire
benefits prevention brings to outcomes www.derbyshire.gov.uk/community/heart-of-
for all partners, and to keep reinforcing derbyshire/heart-of-derbyshire.aspx
the message that health and wellbeing is
everyone’s business. Live Life Better Derbyshire
www.livelifebetterderbyshire.org.uk
• Public health involves identifying and going
with ‘the energy’ – taking opportunities Sexual health on YouTube
where others are working on issues with www.youtube.com/channel/
a health and wellbeing element and UCnkUSvH1qVy1dArB-yObuVQ
capitalising on this. Public health also
needs to generate energy and enthusiasm
in others.
22 Public health transformation six years onHampshire County Council
Summary Organisation, partnerships
• New models for commissioned integrated and priorities
substance misuse and domestic abuse
Public health moved to Hampshire County
services based on improving access,
Council as a team in Corporate Services.
whole-family support, peer support and
Since then it has joined with Adult Services
identifying people at risk.
to form the directorate of adults’ health and
• Innovative schemes to prevent suicide, care. Public health has built on a history of
improve men’s fitness and options for working with district and borough councils
stop smoking. on health and wellbeing, with a link officer
• Engaged with boroughs and districts on to support the work of each council and
licensing and planning. a public health consultant responsible for
overall coordination and relationship building.
The DPH leads the prevention workstream of
Overview Hampshire and Isle of Wight sustainability
Hampshire is a large county on the southern and transformation partnership (STP).
coast of England with a population of The workstream is making progress with
around 1,365,000. It has a mix of rural supporting smoke-free hospitals, tackling
areas, including the New Forest National smoking in pregnancy, rolling out Make
Park, large conurbations, such as Andover, Every Contact Count (MECC) training and
Winchester and Basingstoke, and many other plans to embed prevention. It is set
market towns and villages. The health of to review its work to take a broader, more
people in Hampshire is generally better than social determinant approach to prevention.
the England average. Hampshire is one of the Public health also inputs to the other
20 per cent least deprived counties/unitary STP workstreams and will be leading on
authorities in England. However, there are developing better systems of population data
areas of deprivation and around 10 per cent management and intelligence.
of children live in low-income families. Hampshire is refreshing its Health and
Hampshire County Council contains 11 Wellbeing Strategy to put greater emphasis
borough or district councils. The largest on tackling the social determinants of health.
settlements in the area, Southampton and Priority workstreams include: improving
Portsmouth, are administered separately as mental and physical health in children;
unitary authorities. The Isle of Wight unitary tackling the risk factors for long-term
council lies off the coast of Hampshire. conditions and enabling people who have
long-term conditions to live healthier lives;
developing connected communities; creating
healthy home environments; and ensuring that
for people of all ages the last phase of life is
as good as it can be.
Partnerships and prevention 23Councillor perspective Health and wellbeing
When public health came to the council it initiatives – highlights
had a low profile and we had to push on
doors to engage with colleagues from other
departments. But over the years, there has
Health in all policies
been a huge step-change, and now there Alcohol licensing
is a great understanding of the importance Most boroughs and districts have a statement
of health and wellbeing. All departments in their licensing policies so that the health
across the council are interested in being and wellbeing of communities is considered
involved, as can be seen in the examples in relation to alcohol-related harm. Public
in the case study, and the public health health has also developed a screening tool
team is working flat-out to support all the so that its representations can be submitted
opportunities that have arisen. This also to councils if there is concern. For example,
applies to districts and boroughs which are after discussions with partners, including
supported by link workers in public health the police and a district licensing team, the
to improve health and wellbeing and tackle Director of Public Health (DPH) made a
local health inequalities such as healthy town representation to reduce alcohol harm in a
initiatives and the health implications of major music festival for 60,000 people which was
planning developments. planning to increase capacity by a third.
Owing to the number of concerns, including
Financially, it has been tough. Public health
by the public, festival organisers withdrew
has been very resilient, finding ways to
plans to increase in size.
provide the same level service for less, such
as through digital media. Also, developing Planning
innovative solutions has often resulted in Public health and district planning
better services, such as improved access. departments have agreed a Hampshire
However, we are approaching a deadline Planning and Public Health Position Statement
and without further funding we are likely which facilitates public health responses to
to have to start focussing services more major planning applications. For example,
exclusively on what we are mandated to do. public health recently responded to a
planning application for two drive-thrus on
It would be helpful if more areas of public
a leisure site in Hampshire. The response
health were given a mandatory responsibility
provided evidence on air quality, obesity,
to give more ‘bargaining power’ in
nutrition, deprivation and inequalities, and
discussions about funding across councils
recommended planning permission should
and with health partners. If we were funded
not be granted.
more effectively we would be able to extend
our influence across the system and be Public health has supported a local district
able to commission more evidence-based council to produce a Healthy Borough
prevention and early intervention initiatives, Assessment which provides the basis for draft
particularly for children and parents and to local plan policies to create healthy homes,
promote good mental health. Aligned with healthy neighbourhoods and sustainable
this would be the continuation and extension travel. This includes recommendations for
of close work with planners of proposed policies that restrict fast-food outlets and
new developments, the promotion of a better gambling premises and encourage high
food environment and better access to local quality green space and the adoption of
green space – all of which would reduce minimum space standards for new homes.
pressures on health and social care. Public health hopes to use the learning from
this to support other districts to introduce
Councillor Patricia Stallard
similar policies, either as part of local plans
Executive Member for Public Health,
or within supplementary planning documents.
Hampshire County Council
24 Public health transformation six years onYou can also read
