Who’s Who in the Public Health landscapeProf Paul Johnstone

Director of Public Health NHS North of EnglandRegional Director (designate), Public Health England-

NorthInform Voluntary Sector Event

28th Feb 2013

Outline

1.The health challenges in 21st C2.The Future3.Understanding the new landscape (PH and

NHS), 4.What this means to the VCS.

1. The health challenges in 21st C• Living longer than ever before

– but higher rates of premature deaths compared to EU• Inequalities gap remains challenging

– levelled and in some places reduced– wider causes on inequality remain -poverty, income inequality,

environment, and poor empowerment, low engagement and aspiration especially children and young people

• Lifestyles/ behaviours– Some improvements but still a major cause of disease and

disability• Disability

– long term conditions like diabetes, heart conditions, mental health, high rates, high inequalities and high and unnecessary dependency on hospital emergency care

On preventing premature mortality (ie avoidable deaths before 75), UK does

badly than our peers• Out of 19 similar ranked countries to UK in

Europe and elsewhere• Sweden, Italy, Spain, Norway, NL, Germany, France, Ireland,

Greece, Fin, Belgium, Portugal, Denmark• USA, Canada and Australia

• Heart Disease, 14th

• Lung Cancer , 12th

• Stroke 13th

• Breast cancer 18th

• Other cancers between 16-19th

The lifestyle causes of premature mortality in the UK

Causes of the causes of ill health(eg low income/poverty, housing, environment, education..)

Child poverty- huge inequality

Source: HM Revenue and customs 2011 - National Indicator 116

0%

20%

40%

60%

Kingston upon Hull UA (33%)

Percentage of children living in poverty: 2008 by England's local authorities

The proportion of children living in families in receipt of out of work benefits or in receipt of tax credits where their reported income is less than 60 per cent of median income

Harrogate DC (9%)

England average (22%)

Local authorities in Yorkshire and the Humber

Source : GP Patient Survey

Living with disability (eg poor mobility, mental illness and diabetes): Big variation in quality of life

Impact on public and 3rd sector services

• Rising – costs– demand– expectations– life expectancy but with – years of disability in some areas= inequality– threats to health (pandemics, terrorism)– public sector debt

– system malaise/ lack of democratic accountability/ Francis/Mid Staffordshire/ re-organisations

2. The Future

Recent past and future- WHO

- Alma Ata Declaration- Health For All. 1978. Community health volunteers (as a social movement)

- Ottawa Charter 1986- Marmot (2008)

- UK- Health of the Nation (1992)- Choosing health (2006)- Marmot (2010)

- Rising role of Local Govt and health - LG Act 2000. Duty of Well being, joint NHS-LG Directors of Public Health, JSNA- 2011 Localism Act – role of ‘place’

- Community and user power/ empowerment- 2012 Health and Social Care Act

- Asset based community development (ABCD) - (John McKnight), build on assets rather and plug gaps/needs

- 5 Waves of Public Health

Social Movements: 5 waves of public health since Victorian times

Four waves of public health Hanlon et al/Afternow

Fifth wave: well being, living well

Internal: Self responsibility, MindfulnessExternal: Systems and society, sustainability, cohesion, volunteering,

ACTIVE CITIZENSHIP

3. Understanding the new landscape (Public Health and NHS),

Overview of the changes

• PCTs and SHAs abolished April 2013 • Clinical Commissioning Groups (CCGs) authorised• 80% of commissioning budget managed by CCGs• Remainder (20%) managed by NHS Commissioning Board

– (specialised services, family practitioner services, some public health)

• Public health responsibilities transfer to Local Authorities, who are also responsible for HealthWatch locally

• Health and Wellbeing boards to develop – Joint Strategic Needs Assessment and – Joint Health and Wellbeing Strategy, co-ordinate work on public

health, social care and health services

Public Health Landscape in Yorkshire and Humber

• 15 Local Authorities with DsPH and teams ‘local authorities to use their new responsibilities and

resources to put health and wellbeing at the heart of everything they do’

‘health in all policies’

• One PHE Centre. – ‘front door of PHE’– Director: Dr Stephen Morton

• Part of PHE North Region. Director: Paul Johnstone

The geographical distribution of Public Health England

PHE Centres(Duncan Selbie Feb 2013)

• Front door of PHE

• Will assure services and expertise provided are truly focused on local needs. – information and intelligence– support commissioning – Services for health protection, communications

• ‘Director is– a full partner in the local public health system, – which includes the voluntary and community sector, ‘

• Each Centre will provide leadership and support across all three domains of public health – health protection, health improvement and healthcare public health. This will include

– supporting local government in their leadership of the local public health system; – supporting DsPH to access specialised advice and support; – working with NHS Commissioning Board to support it in its role as a direct commissioner of key

services, including specialist services and national public health programmes; – and providing leadership in responding to emergencies where scale is necessary.

PHE Regions • Are co-terminus with those of the NHS CB and

other national partners and they also happily map onto the nine regional local government groupings.

• will nurture, assure and support the local public health system and maintain an overview of the whole system’s progress in implementing the Public Health Outcomes Framework.

• They will have a special responsibility for workforce development and we will be publishing our strategy for this in March.

Health and wellbeing boards• Vehicle for councillors,

commissioners and communities to shared leadership of local health and care systems, and to work with wider partners to address the determinants of health, and better the health and wellbeing outcomes of the people in their area.

• Key roles:– develop a Joint Strategic Needs

Assessment (JSNA) for the locality

– agree a joint heath and wellbeing strategy ensure individual commissioning plans (health, public health and social care) align with the joint heath and wellbeing strategy

Statutory minimum membership:

• At least one elected member• A representative from each clinical

commissioning group (CCG)• A representative from HealthWatch• The Director of Public Health (DPH)• The Director of Adult Social Services

(DASS)• The Director of Children’s Services

(DCS)

Real work goes on in groups beneath the statutory board

4. What this means to the VCS Personal views

- As providers- As Strategic community partners, champions

and co-producers

My messages to the VCS as providersThe days of grants are over – it is all about commissioning

• Organise yourselves so you have the support/infrastructure to be able to tender for business – (eg Wakefield via the web http://wakefieldwellbeing.org.uk/)

• You will be required to give performance reports to the commissioner – ensure that targets you agree are challenging but realistic (under-promise and over-deliver!)

• Demonstrate how you add social value – it is now a legal requirement on commissioners to include social value in their assessments (http://www.navca.org.uk/social-value-bill). VCS may need to remind commissioners of this. VCS should have a big advantage over other providers in this regard.

My messages to VCS as providers-2• Establish a dialogue with commissioners

– How can VCS tender to have a fair chance? • outcomes based commissioning, payment by results and large contracts can all

disadvantage small community groups – Contact commissioners , your DPH or Health and Wellbeing Boards chair.

• Partner with another statutory/other providers in tendering – this creates a win-win-win. – VCS may be more likely to get the business, statutory providers able to

demonstrate social return and commissioners get a better, more integrated service.

• Glass half full! Even in the face of huge cutbacks there are opportunities through commissioning to get business. – Eg all public health contracts (~£15m) in Wakefield will be reviewed over the

next 3 years with a view to re-tendering. • More guidance being developed

– Eg NW and Oxford Brookes and NW (web link. ..)– DH supported learning sites

http://www.commissioningboard.nhs.uk/2013/01/30/learn-sites/

• Acknowledgement to Dr Andrew Furber DPH Wakefield

My messages to VCS as strategic partners

• Organise your organisation’s role for the local ‘place’ to be the champion and advocate (ideally separately from provider role)

• Engage with HealthWatch• Build alliances with the new Health Team and others in the

council.• You are or have access to communities and community

structures and have invaluable knowledge and intelligence for PH and healthcare. Promote this as advocates researchers and lobbyists.

• Engage as a co producer, in the process of formulating the JSNA, to planning the Local health and wellbeing strategy, to promoting and using it.

My messages to statutory sector (Councils, NHS)

1. Openly invite VCS to join HWWB public meetings (eg York)2. Use your Health and Wellbeing Board and Strategy as a social

movement- not just consult but actively ‘co produce’.3. Engage VCS through every opportunity, healthwatch, scrutiny, etc4. For Foundation NHS trusts and providers -develop your memberships

with VCS and its role in place (employer, investor and procurer). 5. For CCGs/ commissioners, be a ‘place player’, be proud of your

contribution to your town, city or area.6. For CCGs use you DPH as your ambassador in LG and on HWWB to

engage with VCS7. Healthwatch should develop its relationship with local VCS– they will be

key in your role of the public’s advocate and have access to local intelligence

8. Make all health data accessible to public and VCS, esp JSNAs, NHS performance and quality of care.

Finally

• Dialogue with 3 Northern Regions VCS organisation to further support ‘who’s who’ and what we can to do help.

Contacts Resources and References for Information

David Hockney: Bigger Trees Near Warter or/ou Peinture Sur Le Motif Pour LeNouvel Age Post-Photograpique 2007,

Acknowledgements (to complete)• Paul Moore (YH Public Health Group, PHE YH Team)• Dr. Andrew Furber (DPH Wakefield)• Cllr Jonathan Owen (East Riding)• Tony Hunter (Cex NE Lincs Local Authority)• Philip Lewer (independent consultant)• Mark Gamsu (independent consultant)• Ginny Edwards (DH)• Tracey Sharp (Deputy Director PHE North (designate))• Diane Bell (PHE YH Team)• Alison Patey (PHE North team)• Paul Wheeler (NW PH Group)

More information on the health of local areas

• Yorkshire and Humber Public Health Observatory– www.yhpho.org.uk– Email: yhpho-info@york.ac.uk– Tel: 01904 567740

• Local Director of Public Health/ Local Authority web site

• NICE support for Local Government– www.nice.org.uk/localgovernment/Localgovernment– Tobacco, workplace health, physical activity, health

inequalities, PH Outcomes, Alcohol, Behaviour change, walking and cycling

HEALTH & WELLBEING BOARD

What services do we need to commission (or de-commission), provide and shape; both separately and

jointly? – commissioning plans

What does our population & place look like? –evidence and collective insight

So what does that mean they need, now and in the future and what assets do we have? – a narrative on the evidence - the JSNA

So what are our priorities for collective action, and how will we achieve them together? – the JHWS

What are we doing now, how well is it working and how efficient is it? - a analysis on our progress

Engagement with users and

the public

Explicit link from evidence to

service planning

JSNAs and joint health and wellbeing strategies – tools for shared leadership

HWB provides forum for repositioning JSNA as truly jointly owned and leading to joint commissioning decisions to serve the whole population.

The intention of JSNA is to link local needs with commissioning decisions – by adding the layer of the JHWS this link is being made easier for local areas to understand.

• Some good web links on local work• http://www.york.gov.uk/info/200170/

health_and_wellbeing/341/york_health_and_wellbeing/3

• http://www.commissioningboard.nhs.uk/2013/01/30/learn-sites/

• http://www.regionalvoices.org/