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School of Medicine & Health
The Changing National Context
Presented by David HunterProfessor of Health Policy and Management13th November 2012
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School of Medicine & Health
A Little History
History tells us that local government played the
greatest historical role in the sanitary revolution
during Britain’s rapid industrialisation Improved housing Cleared nuisances Introduced gas lighting Provided public bathing and washing facilities Infectious disease control through MOH
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School of Medicine & Health
Public Health and the NHS: a difficult relationship
While the NHS claimed from the outset to give high priority to the promotion of health…in reality this aspect of the service was never more than weakly developed, notwithstanding claims to the contrary, habitually made in ministerial speeches.
Charles Webster (1996)
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School of Medicine & Health
Local Government: public health’s natural home
Many people in local government believe it is their organisations, rather than health authorities, that are public health authorities.
Tony Elson (1999)
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School of Medicine & Health
New Public Health System (1) A tale of two parts
Return of public health locally to local government
Creation of Public Health England at centre
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School of Medicine & Health
New Public Health System (2) Key drivers ‘Centralisation has failed’ Localism at heart of new system: principle of
subsidiarity Professional ownership and leadership Central government focus on emergency
preparedness and health protection (HPA) More nudge, less shove ‘Responsibility deals’: working with business
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School of Medicine & Health
Making it Happen (1)
Transfer of DsPH to local government (2013)
Health and Wellbeing Boards Health and wellbeing strategy, including
JSNA
Ring-fenced budgets (2013)
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School of Medicine & Health
Making it Happen (2)
‘Health premium’ Clinical Commissioning Groups Creation of Public Health England NHS Commissioning Board Public health outcomes framework
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School of Medicine & Health
Public Health Outcomes Framework4 domains
Improving wider determinants of health Health improvement Health protection Health care public health and preventing
premature mortality
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School of Medicine & Health
Public Health Workforce Issues
Risk of fragmentation of public health workforce with transfer to local government and PHE
LAs lack expertise to plan and support public health specialists
Concerns about fate of multidisciplinary public health
Strategic vision for public health workforce not in place
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School of Medicine & Health
Progress with Health & Wellbeing Boards (1) Face considerable challenge to do things
differently and overcome tribalism Clarity needed about what HWBs want to
achieve: risk of distraction, focus on NHS acute hospitals reconfiguration issues
Central-local tension with HWBs caught in the middle
Risk of re-badging previous partnership arrangements
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School of Medicine & Health
Progress with Health & Wellbeing Boards (2)
Diversity to be expected – need to capture the learning
Risk of another layer adding to an already complex architecture and increasing transaction costs
Tough leadership challenge – do they come more complex or wicked?
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School of Medicine & Health
Strengthening the Evidence Base
NICE public health guidance being given a makeover to be more local government facing
Relationship between NICE and PHE NIHR School for Public Health Research
(SPHR)
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School of Medicine & Health
NICE’s Public Health ‘Offer’ Evidence reviews, briefings, guidance, quality
standards, other evidence based outputs Accreditation of other public health guidance
producers Methodological leadership and support on
optimal ways of reviewing and appraising evidence
QOF for public health
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School of Medicine & Health
Known Unknowns
Changing nature of DPH role Impact of ring-fenced public health budget How effective HWBs will be Nature of links to CCGs Future of public health workforce in NHS
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School of Medicine & Health
More Known Unknowns
What is the nature of the ‘support’ to be provided by Public Health England through its 4 Regions and 15 Centres?
A more evidence-informed culture in local government – role of NICE, PHE and others
Balance between tackling SDH and addressing the ‘nudge’ agenda: where does Marmot figure?
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