“Making Health Everyone’s Business” Professor Kate Ardern Director of Public Health Wigan Council

Confident Place, Confident People. Wigan Borough

Population of Wigan about 320 000 Nearly 98% of Wigan's population are White British:

• 54.6% of adults are physically active, Significantly worse than average • Higher than average rates of obesity • 65% of the borough population are of working age. • 23% of residents have long term illness. • There are nearly 34,000 carers of which 3,000 are likely to be children. • Nearly 100,000 people in the borough are living in the most deprived quintile. • Rates of homelessness are high 3.63 per 1,000 households compared to 2.48 per 1,000 for England. • 16 excess cancer deaths each for women and men under 75yrs against the England rates 2012-14 (majority are lung cancer deaths) Our population aged 65+ will increase by 30,000 over the 20 years.

“Wigan is developing a culture of giving good people the time and space to do great things. Evidence- based working is important, but evidence can only be achieved in the first place by trying something new.”

Confident Place, Confident People. Statistical Healthy Life Neighbours Expectancy

Value Trend* Gap Change**Valu e Trend* Gap Change**

Wigan 62.5 61.1 37 months 41 months 18 months 17 months

Barnsley 56.2 56.3 11 months 7 months 12 months 13 months

Rotherha 59.0 57.1 m 11 months 7 months 13 months 14 months

Wakefield 62.0 58.1 12 months 16 months 2 months 4 months

Tameside 58.6 57.9 22 months 25 months 5 months 4 months

England 63.9 63.3 4 months 1 month Confident Place, Confident People. *From 2009-11 to 2011-13 **Reduction in gap compared to England Public Service Reform Principles

• A new relationship between public services and citizens, communities and businesses = Do with, not to. • An asset based approach that recognises and builds on the strengths of individuals, families and our communities rather than focusing on the deficits. • Behaviour change in our communities that builds independence and supports residents to be in control • A place-based approach that redefines services and places individuals, families, communities at the heart • A stronger prioritisation of well being, prevention and early intervention. • An evidence led understanding of risk and impact to ensure the right intervention at the right time

Confident Place, Confident People. Making Health Everyone’s Business: The Approach

Staff Health & Wellbeing

Asset-Based Community Developing Development staff skills For Health & confidence

Maximising Health Gain

Developing Investment Leadership/ in health & Culture wellbeing change services

Commissioning levers

Confident Place, Confident People. Confident Place, Confident People. Wigan Locality Plan for Health & Care Reform

Track Record of Transformational Place based Outcomes Delivery Programmes integrated working

A number of place

based MCPs built from Reducing Non Elective Primary Care Population Health Gain Admissions Clustering and used as Financial Heart of Wigan the default place based Sustainability Reducing Health setting for the Inequality implementation of Reduced Acute Activity Transformed existing reform New model of social Community programmes/business Care Based Care cases: Reduced authorisin Institutionalised g Award winning The Wigan • Community Care Integrated Integrated Care Nursing and Neighbourhood Teams Organisation Therapies Improved Care • Outpatients Outcomes Prime Ministers • Reformed Adult Challenge on primary Standardisation of Social Care Residents well Acute Services care access success • New integrated and independent WWL standards based children's model horizontal alignment Best performing GM • Place based PSR Public Services system in 2015/16 addressing wider Orientated winter determinants towards prevention not Benchmark for place Enabling Better Care crisis based public service • Estates Strategy • Aligned Commissioning • ConfidentWorkforce Refor Place,m •ConfidentShare to Car Peoplee . reform in GM 7

Heart of Wigan

1 • North Karelia Whole System CVD Prevention

2 • Heart Start from Seattle

3 • Lessons from Heart of Mersey

4 • RSPH Health Improvement Level 2 (Heart Champions)

5 • Community Defibrillator roll-out

6 • NHS Health Checks ..plus Vascular Dementia risk

Confident Place, Confident People. Success in Attracting Greater Transformation Fund Investment Phase 3 transformation will focus on work streams that afford the greatest opportunity to achieve cumulative outcomes and accelerated impact across a number of clinical and non-clinical areas including: • Planning & Transport, • Green Space • Utilisation, early identification of conditions such as diabetes and chronic kidney disease (‘Finding the Missing Thousands’) - increased development & use of digital solutions, awareness raising and capacity building with communities • Inclusion of primary and secondary prevention interventions into clinical and social care pathways; to reduce duplication, and reduce or delay reliance on costly treatment and support services. • Total investment required for delivery - £558,577 • Overall financial return on investment (ROI) – 2.74 (Commission for the New Economy CBA) • Payback period – 3 years Confident Place, Confident People.

Heart of Wigan Phase 3

HWBS Priority 1. Increase Physical Activity • Embed routine NRT provision within pre- • Review targeted early intervention and operative process for elective surgery prevention, and universal physical activity offer. • Vascular dementia risk awareness programme • Develop programmes targeting key cohorts and support developments of Dementia united (Learning & physical disabilities, mental health and dementia friendly communities. etc). • Maximise the potential of new technology for • Review the weight management offer across Health Improvement eg. Wellness kiosks, Quit-it clinical and community programmes – across app, mobile support offer. start live and age well HWBS Priority 3. Increasing Independence & • Launch “Wigan on the Move” as part of Wigan Resilience WellFest (3rd-11th Sept 2016) • Ensure Health Improvement outcomes are • Borough-wide roll-out of Daily Mile in all incorporated into Deal For Communities primary schools (including ‘Get Wigan Moving’ allocation). HWBS Priority 2 Finding the Missing Thousands • Strategic placement and registering of • Expand Health Check screen to include defibrillators. depression and anxiety • Expansion of CPR training and Heart Champion • Expand Health Improvement Service offer to programme. develop and include effective level 1 alcohol HWBS Priority 4. Transport and Planning reduction and wellbeing offer. • Borough wide strategic cycle plan. • Develop and implement appropriate and • Develop & agree local criteria on Section adaptable wellbeing programme to be 106/community levy investments. delivered by and for WWL staff groups • Broaden the scope of the current ‘greenspace offer’. Confident Place, Confident People.

Smoking rates in Wigan • Smoking Prevalence in adults has reduced from 22.8% in 2011/2012 to 18.7% in 2015 – a reduction of 4.1% over 4 years. Wigan is now ‘not significantly different’ when compared to the England average. • Smoking Prevalence in routine & manual occupations has reduced from 31.4% in 2011/2012 to 24.4% in 2015 – a reduction of 7% over 4 years. Wigan is now below Eng Av of 26.5% (PHE 2015) • Smoking Prevalence at age 15 (current smoker – WAY survey, 2014/2015) is 7.1% and ‘not significantly different’ when compared to the England average

Smoking in Pregnancy (Smoking at time of delivery SATOD) • Locally Smoking at Time of Delivery (SATOD) has reduced from 20% in 2010/2011 to 14.8% in 2015/2016 – a reduction of 5.2%. • Wigan remains ‘significantly worse’ when compared to the England average (10.6%). Confident Place, Confident People.

Heart of Wigan

Reducing early deaths and increasing healthy life expectancy in Wigan Confident Place, Confident People. Health Improvement Services

• Remodelled – integrated health improvement service with one front door • Online booking solutions, text and Apps • Professional referral forms & Opt-out solutions • Front line staff having remote access to technology • High St access

Confident Place, Confident People. “Councillor Saves Life” & Senior Management Get Cardiac Smart

Confident Place, Confident People. Creating a Culture of Health

Our “Health Movement for Change” currently includes: 1350 Health Champions 495 Heart champions 856 Cancer Champions 8,400 Dementia Friends The Community Health champions are: 1. Embedded within existing programmes, 2. Made up of members of the community, front line staff and volunteers from across the public voluntary and private sectors. 3. Recruited through specific targeting of staff groups who share either Public Health outcomes or priority groups or have complimentary objectives within their work programmes. Wigan is the Alzheimer Society Dementia Friendly Town of the Year 2016 Eg: GMFRS, WALH tenancy support, pharmacy assistants, home care workers Confident Place, Confident People. Physical Activity is the Most Effective Drug

• Overall economic & social cost of inactivity in Wigan Borough is estimated at £21,779,819 per 100,000 population, per year. • On average, an inactive person spends 38% more days in hospital than an active person, and has 5.5% more family physician visits, 13% more specialist services and 12% more nurse visits than an active individual. • Referral into physical activity is embedded within the NHS health check • Diabetes pathway redesign - more emphasis placed on early intervention and self-care, aiming to increase referrals to lifestyle services • Integrated Community Nursing and Therapies Services and the Older People’s Pathway developments - Early intervention an prevention and self-care are at the heart of these new approaches • CQUIN for 2016-17: referrals from treatment room staff into Early intervention and lifestyle services

Confident Place, Confident People. Inspiring Healthy Lifestyles

• Range of physical activity services commissioned by Public Health (PCT) provided by the former Wigan Leisure & Culture Trust - Included developments in infrastructure, promotion of population participation and targeted services Eg GP referral scheme • 2015-16 - Realignment of wider leisure services commissioning (leisure centres, destination parks etc) with Public health – maximise wellbeing offer • Broader approach to engaging people in physical activity – ‘The Deal’, Heart of Wigan, Specfit, SHAPE, professional and amateur sports clubs, dementia friendly communities, Deal for communities investment fund – Wigan on the Move. • Wigan Health Walks: Wide range of walks from 40 minute taster walks for beginners to longer 2 hour walks for regular walkers. • Power walks, Nordic walking, hill walks and Workout walks for something more challenging or a variation to their exercise programme. • Over 95% of walks are volunteer led meaning we have created a long term sustainable walking programme which isn’t reliant upon paid members of staff. • Annual cost per head as little as £34 & benchmarked as the most successful walks programme nationally.

Confident Place, Confident People. Confident Place, Confident People. Start Well: Let’s get movin’ …

National Exemplar for Tackling Childhood Obesity • Integrated working • Targeted schools programme • Specialist service • Integral to Wigan’s Deal for Children and Young People. • Impact on oral health • Our service solutions reaching over 7,000 children and families every year – alongside measuring children we provide a preventative intervention for all children and families. • NCMP Reception participation increased from 91% to 96% & Obesity reduced from 13% to 10% • NMCP Yr6 participation increased from 77% to 93% Confident Place, Confident People.

Lose Weight Feel Great: Kieran and Shirley Lloyd & Gary Harris

Confident Place, Confident People. In Conclusion: • Public health is fundamental to system-wide transformation • Improvements to outcomes have accelerated since the transfer • Health, care and wellbeing are tackled on an integrated basis across the council, the NHS and other partners • Staff are given time, space and training to identify flexible solutions. “Wigan is developing a culture of giving good people the time and space to do great things. Evidence-based working is important, but evidence can only be achieved in the first place by trying something new.” Confident Place, Confident People.