Changes to Public Health in the NHS, how will it work in the future?

1. Changes to Public Health in the NHS, how will it work in the future? Dr Mark Kroese UKGTN Public Health Advisor Genetic Alliance UK 22nd Annual General Meeting 1 November 2011

2. Outline • Introduction to Public Health • Current Public Health structures in England • Proposed new structures for Public Health in England • Example of possible impact with specific reference to population screening services • Conclusion

3. Public Health is….. “The Science and Art of preventing disease, prolonging life and promoting health through the organised efforts of the society” (Sir Donald Acheson, Public Health in England: Report of the Committee of Inquiry into the Future Development of the Public Health Function, 1988 )

4. Health Improvement Improving Health and Social Services Health Protection Three Key Domains

5. Health Protection • Infectious diseases • Chemicals and poisons • Radiation • Emergency response • Environmental health hazards Surveillance

6. Health Improvement • Smoking • Alcohol • Obesity • Healthy eating • Physical activity • Sexual health

7. Improving Health Services • Clinical effectiveness • Efficiency • Service planning • Audit and evaluation • Clinical governance • Equity

8. Wider determinants of health

9. The Current Structure Secretary of State for Health Department of Health and NHS Executive Monitor Strategic Health Authorities Strategic Direction and Performance Management Specialised services GPs (PBC) Primary Care Trusts Commissioning / Planning / Agreement of Secondary Care PCT Provider Services GPs, Dentists Optometrists, Pharmacists Walk-in Centres, NHS Direct Social Care Ind’ Sector Care Trusts Mental Health Trusts NHS Trusts Ambulance Trusts Foundation Trusts Provision of all local health and care services

10. The Current Structure Secretary of State for Health CMO PH team Department of Health and NHS Executive Monitor Strategic Health Authorities Strategic Direction and Performance Management RDPH PH team Specialised services GPs (PBC) Primary Care Trusts Commissioning / Planning / Agreement of Secondary Care DPH PH team PCT Provider Services GPs, Dentists Optometrists, Pharmacists Walk-in Centres, NHS Direct Social Care Ind’ Sector Care Trusts Mental Health Trusts NHS Trusts Ambulance Trusts Foundation Trusts Provision of all local health and care services

11. In addition • Health Protection Agency • Public Health Observatories • National NHS bodies e.g. NICE • Department for International Development • Universities

12. NHS White Paper Equity and Excellence (DH 2010) states that PCT responsibilities for local health improvement will transfer to local authorities (LAs) NHS White Paper Healthy Lives, Healthy People (DH 2011)reiterated that each upper tier/unitary authority will lead a statutory Health and Wellbeing Board (HWB). Power and responsibility for commissioning services devolved to the healthcare professionals closest to patients: GPs and their practice teams working in consortia.

13. Upper tier local authorities will have a role across the three domains of public health. Prescribed functions to be delivered by local authorities will include: • appropriate access to sexual health services • Director of Public Health has a duty to ensure there are plans in place to protect the health of the population; • ensuring NHS commissioners receive the public health advice they need • the National Child Measurement Programme • NHS Health Check assessment • elements of the Healthy Child Programme

14. Proposed Structure

15. Proposed Structure

16. New integrated public health service – Public Health England - will include • Health Protection Agency (HPA) • National Treatment Agency for Substance Misuse (NTA) • Public Health Observatories • Cancer Registries

17. Public Health England will have three principal routes for funding services • granting the public health ring-fenced budget to local government; • asking the NHSCB to commission services, such as screening services, and the relevant elements of the GP contract; and • commissioning or providing services directly, for example national purchasing of vaccines, national communication campaigns, or health protection functions

18. Roles in the new Public Health System • Duty to improve health • Brings together holistic approach to health and wellbeing • Employ DPH • Ringfenced PH budget • Mandated services Local Authorities • Core offer to the NHS, including PH advice on health services CCGs/NHS CB • Commissioning healthcare • Commissioning some public health services PHE (local units) • Local Health Protection Services (functions in development) Health and Wellbeing Board • Coordinates local strategy through • JSNA • Review of commissioning plans

19. UK National Screening Committee • criteria for appraising the viability, effectiveness and appropriateness of a screening programme • developed policies on screening for dozens of conditions • overseen the successful introduction of a number of national screening programmes in England • raised the profile of screening within the NHS and with the general public

22. Issues to consider in future regarding screening • NSC will exist as part of PHE • Commissioning of screening services by NHSCB • Antenatal screening services part of maternal care which will be commissioned by CCGs • Local responsibility for population screening programmes remains unclear

23. Timeline End of 2010: White paper: Healthy Lives, Healthy People July 2011: White paper response, confirming new public health system structure By end 2011: complete the operational design of the new system, including the PHE Operating Model, how the local system will work, and their links into the NHS. Spring 2012: chief executive and senior team for Public Health England appointed. April 2012: start of transition year April 2013: Public Health England established April 2013: Local authorities take on their new public health responsibilities

24. Thank you