Oldham Borough Council: working for a co-operative borough

Oldham has invested in capacity to implement a wide-range of in-depth health and wellbeing initiatives which operate across the council, with Oldham clinical commissioning group (CCG) and with other local partners.

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Initiatives are evaluated, and where they prove effective are supported in the long term. It has undertaken re-commissioning exercises that have resulted in efficiency savings allowing public health services to largely be maintained despite overall funding cuts to the council.

Background

The borough of Oldham is in the north west of England and forms part of the Greater Manchester (GM) sub-region. Oldham lies five miles from Manchester city centre, but almost a quarter of the borough is in the Peak District National Park. It has a population of around 227,000 and the population is made up of diverse communities with a range of backgrounds and cultures. Oldham is one of the 20 per cent most deprived districts/ unitary authorities in England, with around 29

per cent of children (around 15,000) living in low income families. Overall, people’s health is generally worse than the England average, and within the borough there is a difference of 11.1 years in life expectancy for men and 9.8 years for women between the most and least deprived areas.

Organisation

Oldham Public Health moved to the council in advance of the formal transfer and, after a year of bedding in, began a restructuring process. The aims were to:

  • focus strategic planning and responsibility in a small management team of director of public health and two consultants (one part funded by the CCG) and a head of public health service
  • augment the capacity to drive a wide range of health and wellbeing initiatives across all council functions and with other partners through programme managers, currently 16 posts.

As well as the public health team, the director of public health (DPH) is responsible for leisure services and heritage, libraries and arts. Public health sits in the health and wellbeing directorate, which also includes adult social care, and works to the executive director for health and wellbeing.

Oldham is part of Greater Manchester devolution agreement, which promotes the implementation of an integrated health and social care strategy across GM. Each area has developed a locality plan to transform health and care at a local level. Oldham has identified four transformational programmes that will impact on health and wellbeing across the life course:

  • starting well – early years, children and young people
  • living well – resilient communities and early help
  • mental health – central to good health
  • establishing an integrated care organisation.

The initiatives described below contribute to these programmes.

Health and wellbeing initiatives

The first two initiatives promoted by public health were designed early in the transfer and continue to flourish: Get Oldham Growing and Warm Homes Oldham. They were identified as cross-council and CCG developments which met local priorities and were likely to be ‘early wins’ to demonstrate the potential of public health in the council. 

Warm Homes Oldham

Tackling fuel poverty was a priority for Oldham, where around 15 per cent of households (13,557) are classed as being fuel poor and there are an average of 100 excess winter deaths a year, many of which are preventable. Warm Homes Oldham is intended to make homes warmer, improve health and reduce the cost to the NHS and social care. Warm Homes Oldham is funded by partners in Oldham – the council, CCG and Housing Investment Partnership – who signed the country’s first ‘Joint Investment Agreement’ to tackle fuel poverty. An innovative feature of the agreement is that it was based on a payment by results model.

For every individual lifted out of fuel poverty, Oldham CCG allocated £250 and Oldham Council £50 to fund the future project. During the first three years fuel poverty targets have been met, so the £300,000 payment by results for year three was made available for reinvestment in year four.

Warm Homes Oldham is delivered by a private and voluntary sector partnership and is a universal service for anyone struggling to heat their home. Support provided includes energy efficiency improvements and advice; help switching providers, help getting off prepayment/card meters, benefits checks, referral to other partners such as food banks. Financial help may also be available to help people clear debt and manage in a crisis.

Evaluation is built into the scheme, both by Oldham Council and independently by the Centre for Regional Economic and Social Research at Sheffield University.

In its first three years of operation, 2013-2016:

  • 3,544 people were helped out of fuel poverty (against a target of 3,400)
  • over £3.3 million of utility grant funding was brought in through the scheme
  • nearly £282,000 of extra benefits were secured
  • nearly £140,000 worth of trust fund grants secured for homes not on benefits, for
  • example, white goods or fuel/water debts wiped.

The scheme topped the ‘Sustainability’ category at the 2016 Guardian Public Service Awards. A key improvement currently underway is to increase the number of referrals from front line staff in primary care. Another issue is to explore whether it is feasible to remotely monitor NHS interventions (with householder consent) to directly measure impact on health.

Growing Oldham: Feeding Ambition

Oldham has made healthy food a strategic priority. The Growing Oldham: Feeding Ambition Partnership and the community-led Oldham Food Network work in partnership to coordinate food activity, support local communities and increase food education and skills. Public health plays an important role in this work, funding Get Oldham Growing, a community engagement project which has expanded rapidly in four years of operation. Results include:

  • five growing hubs with two more in development
  • three schools are part of the growing entrepreneur scheme
  • nine people employed
  • 50 people developed growing skills
  • more than 250 people attended a conference and a community festival
  • partnership with Oldham College and Oldham hospitals.

The Growing Oldham: Feeding Ambition Partnership has been shortlisted for the Local Government Chronicle awards 2018 under the community involvement category. Results will be announced in March 2018.

Public health in primary care

Oldham’s GP practices work in five clusters which each support different populations with varying health needs and assets. The clusters provide opportunities for promoting health and wellbeing through primary care and locality-based multi-disciplinary teams. Oldham Intelligent Learning Lab is a continuing professional development (CPD) project, accredited by Manchester University, in which a mix of participants from primary care, adult social care, public health and housing providers in each cluster develop public health understanding and skills.

After the course has finished, participants continue to work together to develop a locality plan which builds resilience in communities and harnesses their assets. A prevention fund has been set up so participants can bid to fund asset-based activity within their cluster. For example, one cluster is working with community groups to identify solutions to local problems and has identified local takeaway establishments as community assets in this respect.

Improving performance on NHS Health check

In 2013/14 performance on NHS Health Checks was below the Greater Manchester and England average. Oldham was the poorest performer in the North West and 11th worst nationally, with only 6.5 per cent of eligible residents being offered an NHS Health Check as opposed to the target of 20 per cent. 

An improvement plan was set in place and by 2016/17 there was a significant improvement, with performance above the GM and England average; this continues to rise in 2017-18. Improvement measures include:

  • a public health programme manager was appointed to improve operational management by supporting and engaging with GP practices, developing a best practice pathway, supporting engagement, training and communications, and developing clinical governance and quality assurance
  • a steering group to coordinate and oversee the improvement plan with representation from communications, business intelligence, commissioning, public health procurement and Oldham CCG
  • developing a community model and a pharmacy model for delivering health checks
  • a health equity audit.

In 2017 the NHS Health Checks strategy is undergoing a refresh with a renewed focus on clinical outcomes and quality, and enhanced work with GPs and CCGs business managers at cluster level.

Right Start integrated early years offer

A new integrated delivery model for early years services was commissioned in 2016. The model covers health visiting, the Healthy Child Programme ages 0-5 and 5-19, oral health and children’s centres, all working to a single outcomes framework. A range of disparate contracts were brought into one contract with a single provider with the aim of providing integrated support, with staff able to work flexibly across the service. The procurement resulted in a financial saving.

The first year has been a time of establishing new arrangements such as new staff roles, IT and care pathways. However, performance on the key outcomes has either been maintained or improved, with improvements in take-up of two-year-old entitlement.

The council and the provider are continuing to refine how the model operates, including improving the performance framework by gathering data to track children’s development and bringing teams together on co-located sites.

Improving mental health

MH:2K

In 2016, Oldham Council, Oldham CCG and the Welcome Foundation funded the organisations ‘Involve’ and ‘Leaders Unlocked’ to pilot MH:2K, a youth-led model for engaging young people in conversations about mental health. In this innovative project, local 14-25 year-olds become ‘citizen researchers’, identifying the key mental health challenges facing young people and working with key local decision-makers to make recommendations for change.

Forty-seven roadshow events were attended by 600 young people, and 90 decision makers and researchers from 27 different organisations took part in at least one of the events. The project was overseen by a local expert panel chaired by the DPH. Issues identified in Oldham include the environment and culture of schools, self-harm, stigma, family and relationships, and professional practice. In July 2017, a report was produced with recommendations to improve the mental health and emotional wellbeing of young people in the borough. These include changes to mental health prevention, support and services; work on implementation through a task and finish group is underway.

Four further local authority areas have commissioned the MH:2K approach, commencing in September 2017.

Mental health in schools

Schools and colleges in Oldham responded well to an invitation to be involved in health and wellbeing initiatives, and helped to shape a single framework for improved mental health which was launched this summer. This

involves local guidelines, an action pack and school-based action plans. 

Mental health through heritage

Libraries and arts services have been enthusiastic about the opportunities to promote health and wellbeing through their work, and over the past few years there have been many examples of theatre productions, story-telling, and arts workshops both in Oldham and across Greater Manchester. For example, Oldham Library Service has just received funding to produce a graphic novel to help young people understand and tackle mental health problems. The DPH has been involved in a recent Association of Directors of Public Health (ADPH) publication on arts

and health.

Fit for Oldham is a programme of health and wellbeing activity to inspire staff in the council to be more physically active and look after their mental health. Examples include a choir, walking groups, and mindfulness training. Fit for Oldham has its own brand and evidence-based materials and has been well established for over 18 months to assure staff it is not a ‘flash in the pan’. 

The first-year evaluation found that more than 396 staff had attended at least one session and, overall, people who attended the programme are more likely to indicate higher levels of wellbeing and lower levels of anxiety than those who did not. Sickness absence reduced by 11 per cent in the first year of operation, although this cannot be directly attributed to the programme.

The programme is now managed through Oldham’s business support section with support from public health. It will continue to be developed within the council with a particular focus on making better connections with sickness absence. Other local organisations are interested in the model, such as the Royal Oldham Hospital, and the model will also feed into wider work on workplace health across Greater Manchester.

Making Every Contact Count

There is an active Making Every Contact Count (MECC) programme across Oldham, and this is aligned with Fit for Oldham, with staff training to make brief interventions/ signposting with colleagues, family and friends and the public. So far the MECC programme has:

  • trained 670 council employees
  • established 20 MECC champions who meet to share good practice
  • developed a series of bespoke MECC resources for adults, young people, and young children in schools and community settings
  • delivered training to 15 local dental practices
  • made MECC training available to councillors, voluntary and community sector organisations that support council functions, lifelong learning tutors and school governors
  • been delivered in libraries and mosques to contact groups at high risk of developing type 2 diabetes who might not access primary care.

Future plans for MECC include brief training sessions at staff meetings to reach more employees/services and embed small health changes into daily activity.

Future plans and challenges

A significant challenge facing public health in Oldham has been to maintain levels of service and a varied programme of activity within overall decreasing national resources available to the council. To a large extent, and up to now, this has been achieved, with funding released through measures such as more cost-effective commissioning. Public health funding has also been made available to support and develop activity in other directorates that contribute to public health outcomes through a transformation fund.

Future plans include providing health and wellbeing support to Oldham’s emerging integrated care organisation. Also aligning activity with GM’s health, care and wellbeing population plan on sub-regional developments. A specific area of development is an integrated approach to wellness services.

A chief executive’s perspective: Dr Carolyn Wilkins, OBE

Oldham Council is working to become a cooperative borough in which the council, its workforce, its partners, communities and individuals work together to develop an inclusive economy, thriving communities and cooperative services. In Oldham we encourage everyone to do their bit to improve their lives, their communities and their environment.



For example, Oldham has won a Britain in Bloom award for eight years running. In 2017 the award was for the community involvement programme, known as Bloom and Grow, in which many people of all ages from across Oldham were committed to creating a growing city. Public health has made a major contribution to the transformation the council is working to achieve. It has brought a focus on health and wellbeing across all council functions, and contributes vision, expertise and resources to creating sustainable change. This can be seen in the range of areas covered in this case study – tackling poverty and health inequalities, workforce wellbeing, improving mental health, supporting healthy behaviour change – and many others. 



Public health’s focus on early intervention, prevention and health protection have also been vital to the work taking place within Oldham and across Greater Manchester to integrate health and social care, and to scale-up resilience to tackle risks to population health.

Key messages

  • Programme mangers bring flexible expertise to a range of health and wellbeing issues, and have proved effective in identifying and responding to opportunities to develop a HiAP approach across the council and beyond. A single point of coordination means that activity can be readily monitored, evaluated and improved. This takes place in all programmes and is particularly noticeable in the turnaround approach to NHS health check.
  • Where programmes are found to perform well, Oldham’s approach is to stick with them, rather than dropping them to move onto other initiatives. This long-term approach is helpful in that people come to recognise and trust health and wellbeing programmes.

Contact

Katrina Stephens, Acting Director of Public Health

Email: [email protected]

Documents and links

Available from the contact or to download: