Working together for

Preventionmental health, physical health, money and

wellbeing

Stevenage CAB AGM

Jim McManus, Director of Public Health

October 2017

www.hertfordshire.gov.uk

What’s happening?

• Too many people getting complex preventable problems, not just illness and disability

• Too many variations in care quality and outcomes

• Not enough focus on preventing things happening or worsening

• Unsustainable, unaffordable, undeliverable

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Success is possible: Steve Atwell

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That’s the physical…imagine if we could capture every mental health, debt and stress success like that…

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• Over the next 20 years,

the shape of the

population will change

• By 2022, people aged 65+

(highlighted in orange) will

represent a greater

proportion of the overall

population…

1

How the STP

population will age

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• By 2027, this change will

be more noticeable (note

the widening of the lines at

the top)…

1

How the STP

population will age

© Copyright, 2017

Hertfordshire County

Council Public Health

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• By 2037, the change will

be much more dramatic

• There will be c.23,000

more residents aged 90+

across the STP footprint

by 2037 than in 2017

1

How the STP

population will age

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And we could tell the same story

• For children and young people

• For working age adults , especially those not coping with their financial or employment or debt or housing circumstances

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Money and Mental Health Policy Institutehttps://www.moneyandmentalhealth.org/

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Implied impact on ill-health recovery

• Source: Money and Mental Health Policy Institute

• Caveats around the data but indicates an issue of importance

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So what?

• The work done by projects like CAB, Money Advice Unit and local communities may not turn into money from the NHS in the short term

• But it puts down a significant marker that you are part of the health and wellbeing system and you and your funders make a strong, positive, tangible and measurable impact on health

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Avoidable mental ill-health

• Significant burden of ill-health

• 25% of adults at some stage

• 7-9% at any given time of population

• Significant amounts of it preventable

• Focus on suicide prevention is good, now what about the determinants?

– Debt, Poor workplaces, significant stress levels, inability to cope

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Money and Mental Health – 2ndary

Prevention

• “…… our health research demonstrated the ‘drag’ on recovery rates in mental health services presented by financial difficulty, and found that very few local areas are systematically tackling the issue, at the cost of both the patient and the NHS

• Money and Mental Health Project

• Annual Report

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Demand outpacing resource

• We can no longer afford to put all our energies into responding after adverse events

• System never designed for this level of need/demand

• We need to prevent, reverse or mitigate need for services

• Significant avoidable and preventable burden of ill health and inequality

BUT ALSO………

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But also….

• There is a strong and significant burden of avoidable mental ill-health which is in principle preventable through a range of actions

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What do we do?

• A population shift to prevention – mindset

• Primary

• Secondary

• Tertiary

• Everyone’s business

• Making it the day job

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What is Prevention?

• The avoidance, whether permanent or temporary, of demand or need for public service or an adverse event/hazard or exposure leading to need for public service

– SHORT TERM (eg up to 24 months)

– MEDIUM TERM (eg 2-5years)

– LONGER TERM (eg 5 years plus)

• Prevention is NOT rationing or restricting eligibility

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Levels of Prevention

• three levels. Preventative activities may be delivered by any agency.

• Primary Prevention – ‘prevent’ or stop harm or need for service arising in first place – physical activity, recycling

• Secondary Prevention – ‘reverse’ harm or need for service – rehabilitation

• Tertiary Prevention – ‘reduce’ or mitigate harm/need for service – an Anti Social Behaviour Order? A wheelchair for a diabetic foot amputation

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So what are our ambitions? The Three

building Blocks of Prevention

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

www.hertfordshire.gov.uk

So what are our ambitions? The Three

building Blocks of Prevention

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

www.hertfordshire.gov.uk

So what are our ambitions? The Three

building Blocks of Prevention

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

www.hertfordshire.gov.uk

So what are our ambitions? The Three

building Blocks of Prevention

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

www.hertfordshire.gov.uk

So what are our ambitions? The Three

building Blocks of Prevention

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

www.hertfordshire.gov.uk

The Enablers and Governance

People looking after themselves

• Cultural shift

• Most difficult to do

Making prevention the day job

• Mixture of

• Business Process

• Culture Shift

• Prevention Know How

The Big Return Programmes

• Bespoke projects we could use to transform demand and need

Enablers: Comminication (Internal, External), Programme Management,

Logic Tools, Directorate Worshops, Business Benefit Mapping

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Block 1: People looking after themselves

• Individual level motivation and challenge

• Societal Level – policies which reinforce this

• Lots of talk on this, little action

• We are working on a framework to help you address this

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Block 2: Making Prevention the day job

• What is it your services do to encourage dependence and demand?

• What is it they could do to reduce and avoid demand?

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Mainstreaming Prevention

Consider impact of

everything you do on

prevention

Consider what you can do

individually and together

Population

needing fewer

specialist

resources

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Its BOTH business Know How and Science

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Block 3: The Big Ticket Opportunities

• What are the big things we could do to make a radical shift in areas of high cost avoidable need?

– Family Safeguarding

– Adults with mental health needs and employment

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Phasing and Layering

• You don’t approach this like a blunderbuss

• Use scientific and business principles to identify what will have greatest impact in what timescale

• Phasing the interventions across time to produce results and yield

• Layering the interventions across populations to produce results and yield

• Still need to do primary prevention, but that’s long term

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How?

• Mindset

• Establish clear priorities

• Timescales – short, medium, longer term

• Everyone’s business

• Pathways

• Redesign

• Population Approach

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So what could be done? Examples

Levels of

Prevention

Crime and

Disorder

Mental Health Cancer

Prevent/Stop

harm or need

Reduce alcohol

related injuries

and violence

Reduce drug

related crime

Prevent lost

productivity by

workplace ill-

health

Routine physical

activity for

everyone to

retain balance

and mobility

Reverse harm

or need

Physical activity

for rehabilitation

Reduce/Mitigate

harm of need

Cheaper

alternatives?

(social groups for

lonelines)

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What can the science do

• Science of behaviour change

– Behaviour insights “nudge” on council tax payment and recycling behaviour

– Behaviour change backed

• Much better clinician push on prevention, self care and responsibility

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Quick wins in the system - 1

• Drug testing on arrest and early referral in

• Using “behavioural insights” on council tax notices and letters and on recycling

• Leisure centres and services

• Early intervention to prevent slips, trips and falls

• Using “behavioural insights” in recycling

• Resilience in employment

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Quick wins in the system - 2

• Night time economy work on alcohol with retailers

• Routine, universal, physical activity

• Physical activity and social contact for people isolated

• Behavioural contracts with offenders

• Mental Health First Aid

• Getting people temporarily sick back into work

• Getting people with one long term condition doing physical activity

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Hertfordshire and West Essex

Sustainability and Transformation PlanPrioritising Prevention – the Decision Cycle

What population?

What issue/need?

What outcomes do

we want?

Which

interventions fit

best?

How do we know

it’s working?

(Evaluation)

1. Service cost and

demand

2. Needs (JSNA)

Define the outcomes clearly

so you can really assess

feasibility

1. Financial Assessment

2. Evidence Assessment

3. Logic mode where

evidence silent

1. Financial Assessment

2. Outcome Assessment

Questions to ask Tools for HCC

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Desired Outcome

• An appropriate prevention plan which models savings achievable from prevention

• A plan underpinned by evidence and a logic model

• Clear articulation of who needs to deliver what to achieve it

• System wide expectations

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For your sector

• What could it look like?

• Improve physical health?

• Social referrals to health shop?

• Get more GPs referring in?

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Success is possible: Steve Atwell