Healthy Lives, Healthy People The Public Health White Paper

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Healthy Lives, Healthy People The Public
Health White Paper

• Karen Wright, Older Adults Lead, Public Health

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(No Transcript)
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Summary

• Public health is a priority for this government
• The challenges remain the same - but the delivery
  system will be different
• we cannot sit back while so many people are
  suffering lifestyle-driven ill health and health
  inequalities
• Over prescriptive central planning and lack of a
  dedicated budget has stifled progress
• Local government will take the lead for improving
  the health of their populations - and there will
  be responsibility across society with everyone,
  including citizens, playing a part

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Policy context

• Coalition values Freedom, Fairness
  Responsibility
• Drive towards localism and Big Society
• Benefits of good health on economy
• Importance of prevention in ensuring
  sustainability of NHS

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NHS and social care reforms

• Equity and Excellence Liberating the NHS
• Independent NHS Commissioning Board
• GP Commissioning Consortia NB 3 in
  Worcestershire
• SHAs and PCTs to be abolished
• Healthcare providers to be independent
• Transfer of responsibility for public health
• Health and Well-being Boards
• A Vision for Adult Social Care Capable
  Communities and Active Citizens
• Personalised prevention services, tailored to
  local communities

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Background

• High burden of lifestyle related disease
• Smoking claims 80,000 lives - costs NHS 2.7bn
  annually
• Among highest levels obesity in the world costs
  NHS 4.2bn annually
• 1.6mn people are dependent on alcohol
• Mental health is a vital component of well-being
• Mental ill-health contributes ¼ total burden of
  ill health
• Persistent inequalities in health outcomes
• Life expectancy 7 years less in poorest than
  richest areas.
• Range of social, economic, environmental and
  behavioural influences on health and on choices
• Ongoing significant threats to health - CBRN

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Approach

• Responsive owned by communities and shaped by
  their needs
• Resourced with ring-fenced funding and
  incentives to improve
• Rigorous professionally-led and focused on
  evidence efficient and effective
• Resilient strengthening protection against
  current and future threats to health
• Least intrusive measures possible
• Coherent approach to different stages of life
  instead of tackling risk factors in isolation -
  with cross government committee to co-ordinate
  policy

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Ladder of interventions
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Coherent life course approach (1)

• Giving every child the best start in life
• Eradicate child poverty by 2020
• Free nursery care for pre-school children
• Increase number of Health Visitors
• Extend Family Nurse Partnerships
• Refocus SureStart Childrens Centres
• Big role for schools including Healthy Schools,
  PHSE, PE Bikeability
• New service vision for school nurses
• Promote mental health and early treatment -
  including talking therapies
• Strengthen self esteem and reduce susceptibility
  to harmful influences
• Making it pay to work
• Apprenticeships, careers advice and National
  Citizen Service
• Comprehensive welfare reforms
• New jobs through local growth
• Employers as champions of better health

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Coherent life course approach (2)

• Designing communities for active ageing and
  sustainability
• Improve community sports facilities and access to
  green spaces
• Active travel
• Walking for Health and Lets Get Moving
• Health Checks
• Lifetime Homes and Warm Front
• Winter fuel allowance and free bus travel
• Collaboration with business and the voluntary
  sector through the Public Health Responsibility
  Deal
• Better information for consumers and socially
  responsible retailing
• Agreements on reduction of salt and trans-fat in
  food
• Maintain smoke free legislation and consider
  extension to plain packaging and ban on point of
  sale display
• Reform Licensing Act including ban on alcohol
  sales below cost

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System - national

• Public Health England
• Part of DH and accountable to SoS - ring fenced
  budget around 4bn
• Achieve measurable improvements in health
  outcomes and protect against health threats
• National and sub-national infrastructure for
  health protection, emergency preparedness,
  resilience and response - working closely with
  NHS
• Commissioning of health improvement interventions
  - via NHSCB or devolved budgets to local
  authorities
• Helping citizens take care of their own health
• Intelligence function - PH observatories and
  cancer registries
• Developing the evidence base including NIHR
  school for PH research
• Upholding excellence in PH practice and develop
  PH workforce
• NHS role
• Embedded in the mandate SoS sets for NHSCB and
  thence to GPCC

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Commissioning arrangements
e.g. (?) drug alcohol, smoking obesity,
sexual health, school nursing
e.g. (?) screening, immunisations, QOF, health
visiting
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System - local

• Local government
• GPCC and GP practices and wider NHS
• DPH
• Health and Wellbeing Board
• Voluntary sector and local business
• Mobilising and supporting communities

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Local government

• Health and Social Care Bill will give unitary and
  upper tier local authorities a duty to improve
  the health of their population
• Ring-fenced budget
• Ability to bring to bear wider social, economic
  and environmental influences on health
• Facilitate and empower voluntary sector,
  businesses and individuals to play their part
• Personalise interventions to ensure they are
  relevant to communities

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GPCC and GP practices

• Public health outcomes to feature in GPCC
  performance framework
• Expected to maximise opportunities for preventive
  health within commissioning portfolio
• Quality of primary care contribution to public
  health will be measured and published
• Advice and support from local DPH

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DPH

• Requirement for all unitary and upper-tier local
  authorities
• Jointly appointed by local authority and PHE
• Professionally regulated and accountable to CMO
• Responsibilities
• Strategic leader for public health in local
  communities
• Principal adviser on all health matters to their
  local authority
• Jointly lead development of the JSNA and JHWS
• Advocate for the publics health
• Independent annual report
• Ensure local preparedness, resilience and
  response in the face of threats to health
• Support GPCC to secure better health outcomes,
  better quality of care and better value for money

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Health and Well-being Board

• Statutory from 2013/14
• Core membership from local authorities and GPCC -
  additional membership from others who influence
  health and well-being
• Principle overarching forum for partnerships to
  improve health and well-being
• Integrate commissioning across NHS, public
  health, social care, related childrens and other
  services
• JSNA as a statement of population needs
• JHWS as a summary of how these are to be
  addressed.
• Ensure that commissioning is consistent with the
  JSNA/JHWS
• Support joint commissioning and pooled budgets

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Outcomes

• New framework - overlap with NHS and social care
  outcomes
• Transparency and accountability across public
  health system
• For local authorities subset linked to a health
  premium
• Five domains
• Health protection and resilience
• Tackling wider determinants of ill health
• Health improvement
• Prevention of ill-health
• Healthy life expectancy and preventable mortality

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Transition and timetable

• Legislative basis will be Health and Social Care
  Bill - Jan 2011
• Consultation until March 2011 including
  additional papers on outcomes and
  commissioning/funding arrangements
• Accountability in rests with SHAs and PCTs until
  transferred
• PHE established shadow 2011/12 statutory from
  2012/13
• Budgets shadow 2012/13 then real from
  2013/14
• RDsPH will lead transition at regional and local
  level
• Detailed work on functions/structures and
  transition roadmap
• Assignment of staff under HR framework
• PH workforce strategy Autumn 2011

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Opportunities for Worcestershire

• Build on a solid foundation
• Political ownership at both tiers of local
  government
• History of partnership working
• In the vanguard of devolved decision making and
  personalised health improvement services HIF,
  CLFH, development of voluntary sector,
  commissioning with tariffs
• Strong local professional team
• Strengthen political leadership
• Raises profile and priority for Members
• Basis for further engagement with communities
• Re-energise partnerships
• Central role for Health and Well-being Board
• Integrated Health and Well-being strategy
• Re-define respective roles and responsibilities

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Next steps for Worcestershire

• Conversation and consultation with partners
• Clarity re scope and budgets
• National and regional transition process
• Establishment of Health and Well-being Board
• PH Excellence and Efficiency programme
• Prioritisation of resources
• New working arrangements and structures
• Transfer of PH staff
• Strategy development and roll-out

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Healthy Lives, Healthy People The Public
Health White Paper

• Karen Wright, Older Adults Lead, Public Health