The public health reforms and local government: background and opportunities

1. The public health reforms and local government: background and opportunities • Dr Frances Howie, Assistant Director of Public Health, • NHS Worcestershire. [Slideshow Title - edit in Headers & Footers]

2. Policy background • Marmot review ‘Fair Society, Healthy Lives’; • A Vision for Adult Social Care: Capable Communities and Active citizens; • Equity and Excellence: Liberating the NHS; • Healthy Lives, Healthy people: our Strategy for Public Health in England; • Themes of: dramatic increases in avoidable disease; persistence and widening of health gap; better understanding of social determinants of health and unprecedented economic pressures.

4. What is public health? • ‘The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society;’ • Three domains: health improvement (lifestyles and structural determinants); • Health protection (infectious diseases, environmental hazards, emergency preparedness; • Health care services (services planning, design etc)

5. Coalition Approach to public health services • 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

6. Ladder of interventions

7. The new public health system new roles and responsibilities leadership role for local authorities supported by a new integrated public health service, Public Health England working alongside the NHS, with its continuing role promoting health through clinical services clear priorities stronger focus on health outcomes, supported by the Public Health Outcomes Framework public health as a clear priority for Government, backed by ring fenced resources

8. Local government’s new functions - New duty to improve the health of the population: • commissioning services from a range of providers • working with Clinical Commissioning Groups to integrate care pathways • using health and wellbeing board to integrate commissioning approaches • providing population healthcare advice to the NHS • duty to ensure plans in place to protect health. - Local political leadership critical to making this work.

9. Role of the Director of Public Health • Leadership role within the local authority for the DPH and their team, to exercise these new functions: • DPH should be the lead officer for health and championing health across the whole of the authority's business • we expect there to be direct accountability between the director of public health and the local authority chief executive for the exercise of the local authority’s public health responsibilities • the DPH should have direct access to elected members • Produce an annual report • Statutory member of Health and Wellbeing Board – and engaging across the health and wellbeing system. • DPH appointments process in transition published Jan 12. Further work to follow on appointments post April 13.

10. 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

11. Public health outcomes framework • 2 outcomes: • Increased healthy life expectancy; • Reduced differences in life expectancy and health life expectancy between communities [Slideshow Title - edit in Headers & Footers]

12. Public health outcome framework: 4 domains • Improving the wider determinants of health; • Health improvement – people are helped to live healthy lifestyles, make healthy choices, and reduce health inequalities; • Health protection; • Healthcare public health and preventing premature mortality – reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities. [Slideshow Title - edit in Headers & Footers]

13. 66 Indicators! • Utilisation of green space for exercise/health reasons; • proportion of physically active and inactive adults; excess weight in 4-5 and 10 -11 year olds; and excess weight in adults; • Reoffending; • mortality from all cvd, cancer, all causes considered preventable, etc; • Fuel poverty; excess winter deaths; • Falls and injuries in the over 65s; • Etc, etc, etc. • . [Slideshow Title - edit in Headers & Footers]

14. Funding • PH ring-fenced grant: mandated spend, (NCMP, NHS health checks, PH advice to NHS commissioners, sexual health and health protection) and local priorities; • CCGs, NHS still has a full role to play; • Social care and personalisation; • Context of £20billion gap and protection of the front line. [Slideshow Title - edit in Headers & Footers]

15. Opportunities for upper tier local government • To receive devolved budgets from DH; • to work more closely with NHS commissioning and bridge the gaps between health and social care; • To have powerful leadership to bring people together, and to all share a common vision of improved health and play a part in realising it. [Slideshow Title - edit in Headers & Footers]

16. And the districts?? • For local determination, to build on what is working, and to be closely involved; • The upper tier duty cannot be solely delivered by the upper tier; • Strategically, to have a part in the HWB Board; • Tactically, to be positioning themselves as key delivery arms of the new public health system; • Building new and stronger relationships with NHS commissioners and public health local authority commissioners.

17. Actions for Districts?? • Developing Member engagement; • Producing local health and well-being profiles and identifying priorities for action; • Understanding how local public health delivery identified priorities fit with other DC priorities; • Ensuring the HIC work is embedded in the DC business programme; • Considering the resource of the consultant; • Linking AOHN work, community asset-building and co-production to improved health outcomes; • And…..