Public Health Wales / Public Health Strategic Frameworks

12.6

Public Health Strategic Frameworks Briefing Paper
Author:Nathan Jones, Planning and Performance Manager
Date:10 June 2011 / Version:1
Distribution:
  • Public Health Wales Board

Purpose and Summary of Document:
A key action identified within Our Healthy Future was the requirement for every NHS Wales organisation to develop a (Local) Public Health Strategic Framework (framework). Eachframeworkis intended to provide an assurance that the organisation is making an effective contribution to achieving the national public health priorities, which are detailed in Our Healthy Future,theNHS Wales Annual Quality Framework and Fairer Health Outcomes for All- Reducing Inequities in Health Strategic Action Plan.
As part of this process, Public Health Wales is required to develop a Public Health Strategic Frameworkin parallel with, and in support of, the localframeworks developed by the Health Boards. The Public Health Wales framework will be informed by the priorities identified within the local framework and also detail the roles that will be played by Public Health Wales in contributing towards achieving the aims and objectives set out in the individual local frameworks.
The purpose of this paper is to brief the Public Health Wales Board on the content of the local framework and outline the process for the development of Public Health Wales’ Public Health Strategic Framework.
Sponsoring Executive Director:
Mark Dickinson, Executive Director of Planning and Performance
Who will present:
Mark Dickinson, Executive Director of Planning and Performance
Documents attached:
None
Date of Board meeting:
13 June2011
Committee/Groups that have received or considered this paper:
None
Please state of the paper is for:
Discussion / x
Decision
Information / x
Date: 10/06/11 / Version: 1 / Page: 1 of 15
Public Health Wales / Public Health Strategic Frameworks

12.6

1Introduction

Public Health Wales is required to develop a Public Health Strategic Framework (framework) in parallel with, and in support of, the Local Public Health Strategic Frameworks being developed by the Health Boards. The Public Health Wales framework will be informed by the priorities identified within the local frameworks and also detail the roles that will be played by Public Health Wales in contributing towards achieving the aims and objectives set out in the individual local frameworks.

As part of the development of the Public Health Wales framework, an analysis of the Health Board frameworks was undertaken. The analysis aimed to identify the priorities highlighted by each to enable Public Health Wales to identify where it is able to make significant contributions.

The purpose of this paper is to brief the Public Health Wales Board on the content of the local frameworks and outline the process for the development of Public Health Wales’ Public Health Strategic Framework. In addition, the paper outlines the process and timescales in relation to the development and approval of the Public Health Wales framework.

2Background

A key action identified within Our Healthy Future was the requirement for every NHS Wales organisation to develop a (Local) Public Health Strategic Framework. Each framework is intended to provide an assurance that the organisation is making an effective contribution to achieving the national public health priorities, which are detailed in Our Healthy Future,theNHS Wales Annual Quality Framework and Fairer Health Outcomes for All - Reducing Inequities in Health Strategic Action Plan.

The frameworks provide organisations with a planning, resource and performance management tool and allow them to consider their overall approach to the management and development of public health services. This aims to ensure the prioritisation and coordination of work at a national and local level.

3Local Public Health Strategic Frameworks

Through the Director of Public Health, each Health Board has been required to develop a Local Public Health Strategic Framework. The frameworks set out the services and activity required to meet identified local population needs, priority activities and outcomes. Each framework outlinesthe Health Board’s overall approach to the management and development of public health services, including the prioritisation of activity. In addition, it details those activities and services that will be undertaken in partnership with Public Health Wales, local authorities and the voluntary sector.

As part of the development of Public Health Wales’ framework, consideration needs to be given to the priorities identified within Health Board frameworks. Therefore, Public Health Wales undertook an analysis of the Health Board frameworks.The analysis aimed to identify the priorities highlighted by each to enable identification of the roles that will be played by Public Health Wales in addressing each priority. In addition, the priorities were mapped against those identified within Our Healthy Future.

Working in support of the Directors of Public Health, as part of a unified public health system, Public Health Wales, through its Local Public Health Teams and other programmes, teams and services, had a key role in supporting the development of each of the local frameworks and will continue to play important roles in their implementation.

4Approaches Taken

As no standard model, template, or detailed specification of contents, was provided by WAG or agreed collectively within the public health system,the Directors of Public Health have adopted varying approaches,structures and public health models and conceptual frameworks in developing their local frameworks. This has resulted in significantly different final documents. These differences go beyond any differences in the assessment of relative priorities and descriptions of local circumstances.

Two frameworks are based on a ‘life course stages’ approach (although they vary in the number of stages detailed). Within these frameworks, relevant wider determinants, risk factors, settings, interventions and measures of progress are considered separately for each life course stage. This approach is in line with that being taken in the ReproductiveandEarlyYearsHealth:PathfinderProject.

Threeframeworksarebased around the identification of priority‘risk factors’(e.g. smoking and alcohol use) and other topics (e.g. workplace health). Within these frameworks, issues and interventions at different life course stages are considered separately under each topic heading.

One framework acts as the delivery plan for the second year of Our Healthy Future and as a response to the AQF.

In addition to the above differences in models used and structures adopted, there are also differences in:

  • some of the priorities identified (although most are common)
  • baseline measures, outcome indicators and measures of performance(even within priorities that are common to many frameworks)
  • the structure and content of the driver diagrams used in many frameworks to illustrate the connections between public health actions and outcomes

The varying approaches taken, priorities identified and resulting requirementsfor support and information, haveimplications for Public Health Wales’ ability to support the implementation of the frameworks.

5Common Themes

In spite of differing approaches and structures, it has been possible to identify a number underpinning themes, which are common to all frameworks.

Unsurprisingly, each of the frameworks has identified and highlighted the importance of reducing health inequalities, particularly in relation to the wider determinants of health. It is recognised within the frameworks that disadvantage can start before birth and accumulate through the life course. Therefore, action to reduce health inequalities must also begin before birth and continue through the life course. While various approached are detailed, all frameworks highlight the need for action within this area.

Another common theme within the frameworks is the need to develop and strengthen public health capacity. It is proposed that this could be achieved through making Health Boards public health practicing organisations, which would involve embedding public health approaches within all areas of the organisation.

All frameworks also emphasise theimportance of working in partnershipacross organisational boundaries in order to improve public health. Action to improve health outcomes will require support from a variety of statutory, community and voluntary organisations, and a commitment to multi-agency working.

The vast majority of areas for action identified require Health Boards to work in partnership with:

  • Public Health Wales
  • Local authorities
  • Third sector
  • Community partnerships

The importance of local formal strategic partnerships, such as Health Social Care and Wellbeing (HSCW) and Children and Young People’s Partnerships (CYPP) are also emphasised within the frameworks. These partnerships are able to work strategically to improve the health and wellbeing of local populations.

The frameworks also highlight and demonstrate the overlap between the priorities that they contain and those identified as part of the NHS Wales Five Year Plan Prevention and Promotion Programme.

6Common Priorities

A number of priorities are common to all (or almost all) of the local frameworks, all of which are also priorities within Our Healthy Future and the NHS Wales Five Year Prevention and Promotion Programme.

All the frameworks highlighted the followingsix areas as key priorities (although thereis variation in the level and nature of the actions proposed and life course stages prioritised in relation to each):

  • Physical activity/nutrition/obesity (considered either separately or in combination)
  • Smoking/Tobacco
  • Substance misuse (including alcohol and drugs)
  • Teenage pregnancy (and, to a lesser extent, other aspects of sexual health)
  • Workplace health (often with a particular emphasis on NHS staff)
  • Accidents, injuries and falls (with a variable focus on children and young people and/or the elderly)

In addition, most of the frameworks also highlighted:

  • Vaccination and immunisation
  • Mental health and wellbeing

7Summaries of Local Public Health Strategic Frameworks

7.1Abertawe Bro Morgannwg Public Health Strategic Framework

The Abertawe Bro Morgannwg University Health Board (ABMU) Public Health Strategic Framework identifies upstream policy intervention as the most effective way to reduce avoidable health inequalities and improve health across the whole population. The framework identifies the long terms benefits of early interventions, which aim to prevent the development of risk health behaviours and chronic conditions. In addition, the framework highlights the business case for upstream prevention, which is demonstrated through the evidence base for smoking cessation as a cost-effective approach to addressing health inequalities.

The framework identifies a number of risk behaviours in line with the priorities identified in Our Healthy Future. The priorities were developed through a comprehensive needs assessment, which was undertaken in each locality. The needs assessment was used to support the development of the Health Social Care and Wellbeing Strategy (HSCW) and Children and Young Peoples Plan (CYPP).

The framework aims to address the priorities in a number of specified settings, which will allow resources to be focused where they can best achieve the identified public health outcomes. The settings include:

  • Schools
  • Community First Areas
  • Primary care settings
  • Workplace settings in ABMU Health Board

The following priority areas are identified within the framework. Under each priority area, examples are given of the actions that will be undertaken during 2011/12:

  • Obesity (physical activity and nutrition)
  • Development of an obesity action plan
  • Substance Misuse (including alcohol)
  • Delivery of Substance Misuse Action Team strategies and action plans
  • Locality specific initiatives, such as Swansea Healthy Nightlife
  • Tobacco Control
  • Development of smoke free Health Board strategic action plan
  • Sexual Health
  • Development of sexual health delivery plan
  • Injuries and Falls
  • Pilot primary care based falls risk screening programme in Bridgend locality
  • Workplace Health
  • Health board health and wellbeing action plan

For each of the priority areas identified, baseline information is provided, which details the current situation in each local authority and provides an explanation for why those areas have been chosen as priorities. In addition, a driver diagram is used to highlight the primary and secondary drivers. This illustrates the factors which need to be targeted through programmes of work.

7.2Aneurin Bevan Public Health Strategic Framework

The Aneurin Bevan Public Health Strategic Framework takes a life course stage outcomes based approach, which recognises that disadvantage starts before birth and accumulates throughout the life course.The approach aims to support the Health Board with its vision of ‘a healthy Gwent for all’. The vision is supported by a number of aspirations, which link to the various life stages. These are:

  • Babies are born healthy
  • Pre-school children are safe, healthy and develop their potential
  • Children and young people are safe, healthy and equipped for adulthood
  • Working age adults live healthy lives for longer
  • Older people age well into their retirement
  • Frail people are happily independent

For each life stage the framework identifies the most important outcome indicators and underlying determinants, which form the prioritised public health action detailed within the document. This includes actions in relation to:

  • Accident and injuries
  • Improvement of child safety in the home by promoting use of appropriate equipment, education etc
  • Work with key partners to minimise hazards in play and leisure environments
  • Support for the development of evidence based approach for falls prevention in the community.
  • Immunisations
  • Promotion of the completion of MMR vaccine course in young women
  • Promotion of the uptake of full childhood immunisation programme
  • Support for and promotion of influenza and other relevant immunisations for over 65s
  • Inequalities
  • Support for targeted action in deprived communities and specific vulnerable groups to address child poverty targets
  • Extension of Caerphilly Healthy Hearts Project
  • Support for the FAST campaign
  • Mental health
  • Increase in targeted social support for vulnerable women
  • Review of the evidence base regarding maternity and health visiting services
  • Support for the role of Healthy Schools in extending programme into further education
  • Development of a coordinated approach to mental health training
  • Nutrition
  • Ensuring adequate nutrition through nutritional support and regular dentition checks in residents of nursing homes
  • Obesity
  • Development of targets weight management interventions for parents of pre-school children
  • Work with partners to develop and implement whole school food and fitness policies
  • Engagement in development of Local Creating an Active Wales Action Plans
  • Oral health
  • Leadership of the development of Oral Health Promotion Group to implement the Gwent Oral Health Promotion Strategy
  • Provision of specialist public health advice to the Dental Contract Group
  • Smoking
  • Implementation of a Smoke Free Environment Policy for NHS premises
  • Support for a programme of brief interventions for smoking cessation training for a range of professionals
  • Incorporation of smoking cessation within care bundles for cardiac disease and stroke
  • Substance misuse
  • Support for ongoing development of Gwent wide needle exchange service
  • Scoping of the development of routine screening for alcohol misuse and provision of brief alcohol advice
  • Provision of guidance to locality partnerships on evidence based approaches to prevention, education and training
  • Teenage conceptions
  • Development of a profile of teenage conceptions and abortions
  • Implementation of a Condom Card Scheme
  • Establishment of an enhanced Gwent Sexual Health Forum
  • Screening
  • Support for uptake of neonatal screening

For each priority, specific actions have been prioritised on evidence of effectiveness and to reflect the local and national priorities within the Health Board’s Annual Plan, Children and Young People’s Plan and AQF. The framework uses driver diagrams to provide a clear line of sight between activity and population health improvement.

7.3Betsi Cadwaladr Public Health Strategic Framework

Betsi Cadwaladr Public Health Strategic Framework also adopts a life course approach, which recognises that, for many, disadvantage begins before birth and accumulates throughout life. The Health Board have adopted a Triple Aim concept to guide the development of their various strategies and action plans. This was developed by the Institute for Healthcare Improvement, aims to simultaneously accomplish three critical objectives:

  • Improving the health of our population
  • What people who use our services experience
  • The cost of delivering services

The life course approach is designed to support the Health Board’s aim that people in North Wales will have increased years of healthy life and fairer outcomes. It recognises that differences in health and wellbeing can stem from:

  • Early life experiences
  • The quality of education children and young people receive
  • The jobs people secure and their working conditions
  • The lifestyle choices people make
  • The level of mental wellbeing people develop and their emotional resilience
  • Where people live in terms of housing conditions, the wider environment and whether they are able to be part of a caring and supportive community

Therefore, the framework details public health action under the following life stages:

  • Babies are born healthy
  • Completion of Director of Public Health Annual Report focusing on Early Years
  • Development of a local plan to implement the NICE guidance on Pregnancy and Complex Social Factors
  • Ensuring implementation of the BCU obesity in pregnancy clinical pathway
  • Pre-school children are safe, healthy and develop their potential
  • Partnership working in relation to targeted interventions and projects for vulnerable families
  • Ensuring that alcohol misuse prevention is included as a priority within each Children and Young Peoples Plan in North Wales
  • Continued involvement in ‘Breaking the Cycle’ project
  • Children and young people are safe, healthy and equipped for adulthood
  • Provision of schools with consistent messages to support a 'whole school' approach to alcohol misuse prevention
  • Systematic development of “Talk to Me” suicide and self-harm prevention strategies in each local authority area
  • Implementation of theAction Plan to increase Childhood Immunisation uptake
  • Working age adults live healthy lives for longer
  • Development of a North Wales Obesity Pathway Project Board Action Plan with key partners
  • Work with Community First partnership to engage local communities in physical activity and community food initiatives
  • Support for Local Authorities across North Wales to implement the Creating an Active Wales
  • Older people age well into their retirement
  • Completion and implementation of the Flu Vaccination Campaign Action Plan
  • Building the capacity of communities to support healthy eating and prevent malnutrition
  • Standardisation of Falls Risk Assessment Tools across North Wales

During 2011/12, the following priorities have been identified as areas for action: