Healthy Lives, Healthy People

Our strategy for public health in England

Another White Paper on Public Health...

• This is not the first ever White Paper on public health:

– Health of the Nation: a strategy for health in England (1992)

– Saving lives: our healthier nation (1999)

– Choosing Health: making healthier choices easier (2004)

– Healthy lives, healthy people: our strategy for public health in England (2010)

• Why do we need another White Paper on public health?

The white paper Healthy Lives, Healthy People set out a powerful case for reforming the public health system:

• two out of three adults are overweight or obese

• inequalities in health remain: people in the poorest areas live on average 7 years fewer than those in the richest

• We face major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents.

We need a new approach to meet these and other public health challenges of the twenty-first century.

A powerful case for change

Healthy Lives, Healthy People

• Healthy lives, healthy people sets out a framework for tackling some of the most intractable social issues

• The White Paper: – starts from the evidence base (Chapter 1)– Articulates a radical new approach to public health, including

the concept of a “ladder of interventions” (Chapter 2) – Takes a life course approach, rather than focusing on specific

policy areas such as smoking or obesity (Chapter 3)– Sets out a new organisation for public health, including a critical

role for local government and a new clarity to central government’s role (Chapter 4)

A New Public Health System

• Public Health England – a national public health service

• A return of public health leadership to Local Government

• Professional leadership nationally and locally

• Dedicated resources for public health at national and local levels

• Focus on outcomes and evidence based practice supported by a strong information & intelligence system

• Maintaining a strong relationship with the NHS, social care and civil society

• Set out in the Health and Social Care Bill

Public Health England

• The new integrated national public health service

• Part of the Department of Health

• Bringing the HPA, NTA, observatories, cancer registries and some DH and SHA functions into a new organisation

• Leadership nationally on key issues and functions

• Maintaining a strong relationship with local government, the NHS and a range of stakeholders

• DsPH jointly appointed by PHE and their local authority

The Local Public Health System: the Role of the Director of Public Health

The DPH will:

• be jointly appointed by the relevant local authority and Public Health England and employed by the local authority with accountability to locally elected members and through them to the public

• be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population

• play a key role in the proposed new functions of local authorities in promoting integrated working

• Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children’s Services)

• continue to be an advocate for the public’s health within the community

• produce an authoritative annual report on the health of the local population

The Local Public Health System: the Health and Wellbeing Board

The Health and Social Care Bill:

• Sets up the boards as Committees of local authorities• Establishes a core membership, with flexibility to expand locally• Puts mutual obligations on councils and NHS commissioners to

undertake Joint Strategic Needs Assessment (JSNA) and joint health and wellbeing strategies (JHWS) undertaken in partnership

• Sets expectation that HWBs are involved throughout the NHS commissioning process, so commissioning plans are in line with the JHWS

• Promotes joint commissioning and integrated provision • Gives HWB a role in annual assessment of clinical commissioning

groups (also a non-statutory role in their initial authorisation)• Sets a duty for HWB to involve users and the public in JSNA and

JHWS• Keeps scrutiny functions separate from HWBs

Public Health Funding and Commissioning - Public Health and the NHS

• The NHS will commission some public health services, with funding passed from the public health budget

• In addition, the NHS will have an ongoing role in certain services with public health aspects – for example the Department expects that public health will continue to be an integral part of primary care services.

• Public health expertise will inform the commissioning of NHS funded services, facilitating integrated pathways of care for patients. This will be underpinned:

– locally by ensuring DsPH are able to advise the GP consortia; and

– nationally via the relationship between the Secretary of State/ Public Health England and the NHS Commissioning Board.

• The policy paper will say more about this

Public Health Funding and Commissioning - Allocations and the Health Premium

Allocations

• From April 2013, ring-fenced budgets, targeted for inequalities, will be allocated to upper-tier and unitary authorities in local government. Shadow allocations will be issued to LAs in 2012/13, providing an opportunity for planning.

• We propose to move to actual allocations from current spend towards the target allocations over a period of time.

• We will take independent advice on how the allocations are made.

Health premium

• Building on the baseline allocation, LAs will receive an incentive payment, or ‘health premium’, that will depend on the progress made in improving the health of the local population and reducing health inequalities, based on elements of the Public Health Outcomes Framework.

• The premium will be simple and driven by a formula developed with key partners, representatives of local government, public health experts and academics.

Public Health Outcomes Framework- the Vision

• Domain 1 - Health Protection and Resilience: Protecting the population’s health from major emergencies and remaining resilient to harm

• Domain 2 - Tackling the wider determinants of health: Tackling factors which affect health and wellbeing and health inequalities

• Domain 3 - Health Improvement: Helping people to live healthy lifestyles, make healthy choices

• Domain 4 - Prevention of ill health: Reducing the number of people living with preventable ill health

• Domain 5 - Healthy life expectancy and preventable mortality: Preventing people from dying prematurely

The mission: to improve and protect the nation’s health and to improve the health of the poorest, fastest

Reducing health inequalities is a thread which runs through the whole Outcomes Framework

White Paper Consultation and Response

• Government consulted on a number of issues, including:

• How to improve public health evidence and information

• The scope and commissioning routes for the new public health system

• The Public Health Outcomes Framework

• Consultation closed on 31 March.

• Successful engagement process: over 2,100 written responses, many substantive and detailed, offering new insights and thoughts

• We are publishing our response imminently

White Paper Consultation and Response – Key Themes

• welcome for strengthening focus on public health in central government, new public health responsibilities for local government and focus on Marmot

• general welcome for outcomes framework; some lobbying for particular indicators. Respondents asked why three outcomes frameworks instead of one

• commissioning routes largely welcomed, but concerns about fragmentation in some parts of the system (eg children's public health)

• concerns about loss of independence and political interference both at the national level, with the HPA joining DH, and the local level, with DsPH becoming employees of local government

• worries that uncertainty over terms and conditions and final shape of public health within local government will lead to the loss of public health expertise

• uncertainty about some key aspects of the new system, notably public health advice to the NHS and responsibilities of the key players in incidents and emergencies

• size and distribution of the ring-fenced grant (ie, will PHE swallow up much of the money leaving local government with very little)

Listening Exercise and the NHS Future Forum

• NHS Future Forum was not focused on public health – but public health concerns were raised

• The Future Forum report emphasised the powerful message that public health is everyone's business

• We originally proposed that Public Health England should be a core part of the Department of Health. However, there have been concerns that this could risk undermining the independence of expert advice. We have announced that we intend to establish Public Health England as an executive agency of the Department of Health, subject to completing the normal government approval processes for establishing new bodies.

• The Government has set out how commissioners should be able to access advice and support from public health professionals on new clinical senates

Programme Timescales – Public Health

Oct - Dec

2011

Jan – Mar

2012

Apr – Jun

2012

Jul – Sep

2012

Oct – Dec 2012

Jan – Apr

2013

▲Announce

LA shadow PH budget allocations

▲Publish PH outcomes framework and health premium formula

▲Agree transition plans for transition of local PH responsibi-lity from PCTs to LAS

▲Shadow PH LA budgets in operation

▲PHE Chief Executive and top team in place

▲PH Workforce strategy published

▲LA allocations announced

▲April: PH LA allocations in operation and PH resource transfers

▲April. PHE established

Conclusion

• Healthy Lives, Healthy People is not just another White Paper

• The Government has put in train a wide-ranging reform of the public health system, with localism at its heart, a new central source of expertise in Public Health England and a new approach to improving the nation’s health

• The Minister for Public Health will now describe the Government’s vision for public health in more detail