healthy lives, healthy people the public health white paper

www.worcestershire.gov.uk

Healthy Lives, Healthy People

The Public Health White Paper

Karen Wright, Older Adults Lead, Public Health

www.worcestershire.gov.uk

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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 Children’s 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 Let’s 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

12The NHS White Paper

e.g. (?) screening, immunisations, QOF,

health visiting

e.g. (?) drug & alcohol, smoking & obesity, sexual

health, school nursing

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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

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• 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

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• 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 public’s 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 children’s 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