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Enterprising venture: the organised efforts of society and the third sector. Mr Abdul Razzaq Joint Director of Public Health, Trafford. Maturity Model: Public Health Timeline. 19 th Century Towns were characterised by overcrowding , poor housing, bad water and disease. 19 th Century

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Enterprising venture the organised efforts of society and the third sector

Enterprising venture: the organised efforts of society and the third sector

Mr Abdul Razzaq

Joint Director of Public Health, Trafford

Maturity Model: Public Health Timeline

19th Century

Towns were characterised by overcrowding, poor housing, bad water and disease

19th Century

1848 Public Health Act

Smallpox vaccination

Slum clearance, clean air and water

20th Century

Free School Milk Act

Beveridge – Welfare State

5th July 1948 - NHS

21st Century

Ageing population

Chronic diseases

Rising costs









Our health and wellbeing today
Our Health and Wellbeing Today

  • We are living longer than ever before with dramatic changes in the nature of health over the last 150 years

    • infectious diseases now account for only 2% of deaths

    • 4 in every 5 deaths occur after the age of 65

    • clean air, water, and environmental protection

  • BUT: success brings new challenges

    • circulatory diseases account for 34% of deaths

    • cancers 27% and respiratory diseases 14%

    • rising prevalence of mental ill-health

    • persistence of long-term conditions

  • Lifestyles and behaviours influence our outcomes and inequalities

    • 21% of the adult population still smoke

    • 61% of adults are overweight or obese

    • Fewer than 40% of adults meet physical activity guidelines

    • 2.4 million adults regularly drink more than recommended

Fair Society: Healthy Lives:

6 Policy Objectives

  • Give every child the best start in life

  • Enable all children, young people and adults to maximise their capabilities and have control over their lives

  • Create fair employment and good work for all

  • Ensure healthy standard of living for all

  • Create and develop healthy and sustainable places and communities

  • Strengthen the role and impact of ill health prevention

Mobilising the assets of the third sector
Mobilising the Assets of the Third Sector

  • There are 900,000 voluntary sector organisations (by which we mean charities, social enterprises, housing associations, mutuals, research organisations, co-operatives and other non-profit organisations) in the UK, with a combined annual turnover of £157 billion, a workforce of 1,600,000, combined assets of £244 billion, and the capacity to mobiliseover a quarter of the population to volunteer formally at least once a month.

  • It has immense associative power: the ability to bring together coalitions for change, people from one profession or many, agencies across different silos within a locality, communities and the state.

  • The voluntary sector is, in effect, ‘organised civil society’, or organisedcommunity action. It is therefore a heterogeneous but hugely significant economic and social force, one which is at the heart of the current Government’s overarching ‘Big Society’ vision for Britain

Asset Models: Key Roles for the Third Sector

Social attitues & public opinion


Innovation & person centred

Fairness and social value

The third sector plays a

particularly important role in giving voice to less well-served groups, and thereby

reducing health inequalities.


The voluntary sector brings unique expertise to population health policy-making, often

having a depth of understanding of particular issues or areas

Third sector plays an important role in designing and delivering frontline services, but also in delivering second-tier services (such as training)

Third sector acts as a social force for improved health

Improved population health

Leadership and Collaboration

Designing and delivering and supporting services

Informing and shaping policy and stratgey

Leadership, voice and advocacy

Harnessing the Potential

Four Steps to Releasing the Potential

The need to have an approach to evidence-gathering that is more collaborative, more cross sector and more person- and community-centred.

Government formulates population health policy in a way that is:

•more cross-governmental

•more open and cross-sectoral, and less of a closed, bureaucratic process

Stepping up to the mark

Improving population health needs to be based on “the organised efforts of society”, and on genuine partnership between the state and the voluntary sector. It is recognised that it is not just Government

that needs to change – the voluntary sector will need to step up to the mark as


A new social market for population health

A fully functioning market in which effective commissioners

purchase the best services available from a variety of providers, but also a

genuinely social market in which both commissioners and providers collaborate as well as competing

Cross government, cross sectoral policy making

Collaborative approach to evidence







  • commissioning of population health-related activity should be joined-up across Government


  • commissioning should be based on a long-term strategy of shifting resources from acute care to prevention and population health and longer term contracts


Stimulate demand and supply

  • stimulate the growth of new providers in the market, and

  • ensure that the market is backed up by a new social finance architecture

Joining Up

Long Termism

Your own footer

Your Logo



  • Many are highly adept at gathering information together for policy-making design of public services.

  • Some are less good at seeing information as an asset, less good at gathering data or convincing others.


  • Many voluntary sector organisations are highly adept at engaging with policymakers in order to bring about positive change for their beneficiaries – others not

Selling services to commissioners

Enggaing with policy makers


Gathering & sharing evidence

  • Many voluntary organisations have become highly adept at selling their services to commissioners, demonstrating the business case for why a commissioner should invest in what they do.

Case study green gym
Case Study: Green Gym

  • The BTCV Green Gym® is a scheme which inspires to improve both health and the environment at the same time. Experienced leaders guide you through a range of practical projects, giving you the opportunity to tackle physical jobs in the outdoors – improving your strength and stamina, boosting your practical skills and confidence and benefitting your local green spaces.

  • An independent evaluation by Oxford Brookes University has proven the mental and physical health benefits of Green Gym, and a separate evaluation based on NICE costing models has shown the service’s cost-effectiveness: over a four year period the Green Gym delivered 132 Quality Adjusted Life Years (QALY) at a cost of £4,031 per QALY. This is substantially less than the £30,000 ceiling usually applied by NICE in deciding cost-effectiveness. Over four years the Green Gym delivered savings to the health service of £1,359,453 (based on life cost averted savings).


Route for funding

Route for accountability

Public Health funding and commissioning

Local communities

Local Authorities

GP Consortia


Department of Health including Public Health England

NHS Commissioning Board

Public Health Outcomes Framework: alignment with the NHS AND Adult Social Care – Missing Link to the Third Sector?

Public Health

Adult Social Care and Public Health:

Maintaining good health

and wellbeing.

Preventing avoidable ill

health or injury, including

through reablement or

intermediate care services

and early intervention.

NHS and Public Health:

Preventing ill health

and lifestyle diseases

and tackling their


Awareness and early detection of major conditions

Adult Social Care and NHS:

Supported discharge from

NHS to social care.

Impact of reablement or

intermediate care services

on reducing repeat

emergency admissions.

Supporting carers and

involving in care planning.

Adult Social Care


ASC, NHS and Public Health:

The focus of Joint Strategic Needs Assessment: shared local

health and wellbeing issues for joint approaches.

But: Adult Social Care – Missing Link to the Third Sector?

Marmot on Public Health Challenges in Current Climate

  • Giving local communities control is challenging when they face budget cuts of 20-25%;

  • “responsibility deals”

    • Evidence from history suggests that public health advances – clean water, reduction of air pollution, healthier working conditions, reduction in drink-driving – have come to greater degree from action by local and central government than by voluntary agreements with industry.

  • While the Public Health White Paper picked up five of the six domains of recommendations from the Marmot Review it was silent on ensuring a healthy standard of living for all.

  • It is still possible to make progress and measure using indicators.

Public Sector Reinvention: Role of the Third Sector Adult Social Care – Missing Link to the Third Sector?

19th Century

Poor health and living conditions


Introduction of the Welfare State and the NHS

20th Century

Scientific and technological advancemnets

21st Century

Reinvention as an alternative scenario to decline