Public Health Matters

1. Public Health Matters Dr Sohail Bhatti Interim Director of Public Health City of London Corporation & London Borough of Hackney

3. Commissioned by PH England via NHS England • Screening Programmes • NHS Infectious Diseases in Pregnancy Screening Programme • NHS Down’s Syndrome Screening (Trisomy 21) Programme • NHS Fetal Anomaly Screening Programme • NHS Sickle Cell and Thalassaemia Screening Programme • NHS Newborn Blood Spot Screening Programme • Newborn Hearing Screening Programme • NHS Newborn and Infant Physical Examination Screening Programme • NHS Diabetic Eye Screening Programme • NHS Abdominal Aortic Aneurysm Screening Programme

4. Commissioned by PH England via NHS England • Immunisation Programmes • Neonatal Hepatitis B immunisation programme • Neonatal BCG immunisation programme • Respiratory syncytial virus (RSV) immunisation programme • Immunisation against diphtheria, tetanus, poliomyelitis, • pertussis and Hib • Meningitis C (MenC) immunisation programme • Hib/MenC immunisation programme • Pneumococcal immunisation programme • DTaP/IPV and dTaP/IPV immunisation programme • Measles, mumps and rubella (MMR) immunisation programme • Human papillomavirus (HPV) immunisation programme • Td/IPV (teenage booster) immunisation programme • Seasonal influenza immunisation programme • Planned new immunisation programmes for: • Rotavirus, Shingles, Extension of seasonal ‘flu (to children)

5. Commissioned by PH England via NHS England • Cancer Screening Programmes • Breast Screening Programme • Cervical Screening • Bowel Cancer Screening Programme • Children’s Public Health Services (pregnancy to age 5) • Healthy Child Programme and Health Visiting (universal offer) • Family Nurse Partnership (nationally supported targeted offer) • Child Health Information Systems • Public health services for people in prison and other places of detention, including those held in the Young People’s Secure Estate • Sexual assault referral services

6. Jeremy Hunt & Duncan Selbie Letter10th January, 2013 “The allocation covers both services mandated through regulation and all other services that you may wish to commission locally. These will be prioritised according to need in your area and we have left it for you to decide what proportion of spending should be devoted to different services. Currently, on average, about one third of spending is connected to mandated services, leaving a significant opportunity to commission services that meet the needs of your population. “Services not currently covered by the mandating regulations include obesity, smoking cessation and substance misuse. This is a major opportunity for you to work with local partners, such as the voluntary sector, Police and Crime Commissioners and the private sector, to deliver these critical services resulting in better outcomes for your population”

7. Jeremy Hunt & Duncan Selbie Letter10th January, 2013 “Supported by your Director of Public Health, you will be the local leader of the new public health system. You are best placed to understand the needs of your community and it will be your responsibility to tackle the wider determinants of health at a local level, putting people’s health and wellbeing at the heart of everything you do - from adult social care to transport, housing, planning and environment. The money you receive will allow you to transform the lives of local people through commissioning a wide range of innovative services. “

8. Local Authority Mandatory Services • Sexual health services - STI testing and treatment • Sexual health services – Contraception • NHS Health Check programme • Local authority role in health protection • Public health advice to CCG (core offer) • National Child Measurement Programme

9. Local Authority Non-Mandatory Services • Sexual health services - advice, prevention and promotion • Obesity – adults • Obesity – children • Physical activity – adults • Physical activity – children • Drug misuse – adults • Alcohol misuse – adults • Substance misuse (drugs and alcohol) - youth services • Stop smoking services and interventions • Wider tobacco control • Children 5-19 public health programmes

10. Local Authority Non-Mandatory Services - Miscellaneous • Non-mandatory elements of the NHS Health Check programme • Nutrition initiatives • Health at Work • Programmes to prevent accidents • Public mental health general prevention activities • Community safety, violence prevention & social exclusion • Dental public health • Fluoridation • Local authority role in surveillance and control of infectious disease • Information & Intelligence • Any public health spend on environmental hazards protection • Local initiatives to reduce excess deaths from seasonal mortality • Population level interventions to reduce and prevent birth defects (supporting role)

11. Public Health Priorities • Health & Wellbeing Board Strategy • Reducing Childhood Obesity • Tobacco Control & Smoking Cessation • Adult *working age* Mental Health • Dementia

12. Hackney Similar local authorities: Best | 6th out of 15 National: Worst | 128th out of 150 Population 247,182 Total premature deaths 1,587 2009–2011 Around 2/3 or premature deaths are avoidable

13. What is Avoidable Mortality? • Avoidable mortality includes deaths that are; • Amenable to medical care - deaths that could be avoided through good quality medical care • Preventable - deaths which could be avoided through public health action in a broad sense

15. Premature Mortality

16. Next Steps • Review JSNA in the light of 2011 Census • Develop PH priorities – 66 PH Outcomes • Devise a Commissioning Strategy in the light of Needs and Assets