Checking delivery, checking progress October 11 2013

1. Checking delivery, checking progressOctober 11 2013 Tim Baxter, Public Health Policy and Strategy Unit, Department of Health

2. The Vision: Local Authorities Leading for Public Health “It is time to free up local government and local communities to decide how best to improve the health and wellbeing of their citizens, deciding what action to take locally with the NHS and other key partners, without undue interference from the centre” [Healthy Lives, Healthy People (November 2010), Para 2.7]

3. Health and Social Care Act 2012: the Public Health Dimension Broadly speaking, the Act gives responsibility for health protection to the Secretary of State and for health improvement to upper tier and unitary local authorities (LAs) These LAs also have to put in place a health and wellbeing board with a small number of statutory members Section 30 requires LAs to appoint a director of public health (DPH), acting jointly with the Secretary of State. It gives the DPH responsibility for the local authority’s new public health functions. Under section 31 each DPH must produce, and the relevant LA must publish, an annual report on the health of the local population Under section 18 the Secretary of State can use regulations to delegate his health protection duties to local authorities or to require LAs to undertake their health improvement duties in particular ways The Act abolishes the Health Protection Agency but does not mention Public Health England – in statutory terms PHE as an executive agency is indistinguishable from the Secretary of State.

4. The New Public Health System The new delivery structure: an integrated whole system approach • Local authorities • New public health functions integrated into their wider role, helping to tackle the wider social and economic determinants of health. • Leading for improving health and coordinating locally for protecting health • Promoting population health and wellbeing • Government • DH responsible to Parliament, with clear line of sight through system • Working across Government to embed public health into Whitehall agendas • CMO to continue to provide independent advice to Government • NHS • Delivering health care and tackling inequalities • Making every contact count • Specific public health interventions, such as screening and immunisation programmes • Public Health England • New, integrated national body • Strengthened health protection systems • Supporting the whole system through expertise, evidence and intelligence

5. The Government’s role Obtains and allocates resources - £5.46bn to local authorities over 2013-14 and 2014-15 Works across Whitehall and national bodies to promote the public’s health Sets outcomes not targets – for example the Public Health Outcomes Framework Sets national strategies – for example the Secretary of State’s priority on reducing premature mortality Accounts for the performance of the whole system Acts as steward of the system, facilitating and supporting high performance, and intervening only if absolutely necessary The Government continues to provide oversight to the whole system, but seeks to avoid micro-management. It:

6. The Role of Public Health England • PHE support to national bodies • Advising Government on the delivery of its policy and strategy for public health, including content of Mandate and 7A • Publishing performance against the PH Outcomes Framework • Supporting Devolved Administrations on UK wide issues (including chemical hazards and radiological protection) • Supporting Science and Research to develop and improve the PH evidence base • Development of the intelligence and analysis to support advances in PH delivery • Learning from and contributing to international experience and research. • Contributing expert resource to public health emergencies elsewhere in the world DH and OGDs Devolved Administrations Science and Research International partners • PHE’s support to the local PH delivery system • Supporting the development of evidence based improvement initiatives through: • Provision of Data, Analysis, Intelligence, Evidence and Expertise • Identification, cataloguing and coordination of best practice • Professional support for the PH workforce (including appointments and professional accountability) • Nationwide PH improvement campaigns including behavioural science and insight • National delivery of health protection including expertise and co-ordination for incidents • Publication of local PH outcomes Local Authorities CCGs/ NHS England PHE (Local Centres)

7. The Public Health Role of the NHS NHS England is responsible for delivering £2.2bn worth of key public health services, including immunisation and screening services The details are set out in an agreement between DH and NHS England (7A agreement) signed in November 2012 The next 7A agreement will be signed alongside the Mandate in Autumn 2013 The first Mandate to NHS England included an objective to make measureable progress by 2016 towards reducing our mortality rates to the level of the best in Europe A key part of this will be focusing the NHS on encouraging staff to use contacts with patients as opportunities to promote healthy behaviour

8. The Leadership Role of the Local Authority Local government has a long and proud history in promoting and protecting the public’s health. Restoring its pre-eminent local leadership role reflects its: population focus, as the democratically accountable steward of local health and wellbeing role as the shaper of place ability to address many of the wider social determinants of health, and Experience of, and ability to tackle, health inequalities LAs have a small number of mandatory functions, but otherwise have discretion to invest in local priorities, as determined by the JSNA Thus far there has been great enthusiasm in local government for taking on this new responsibility For its part Government is investing in public health at the local level: £2.66bn allocated to local authorities for 2013-14 and £2.79bn for 2014-15

9. An effective local delivery system for improving and protecting health and wellbeing RATIONALE LOCAL ROLE • Local Authorities: • Have a duty to improve health • Bring together a holistic approach to health and wellbeing across full range of their responsibilities • Receive ring-fenced PH budget • Lead commissioning of public health services • DPH has specific functions to: • Bringtogether the local PH system • Deliver LA functions • advise on health protection arrangements • Provide “core offer” to NHS • Produce DPH report • Advise Health and Wellbeing Board LAs take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and Health and Wellbeing Board Local Authorities • NHS commissions some PH services within national GP contract or delegated under S7A agreement • children’s services 0-5 until 2015, including Health Visitors CCGs/ NHS England PHE provides local public health services, including EPRR service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents PHE (Local Centres) • CCGs and NHS England: • Commission healthcare • Commission specific PH services (eg Immunisations, Screening, and Prison public health) • Coordinates local strategy through: Joint Strategic Needs Assessments (JSNAs) • Joint Health and Wellbeing Strategies (JHWSs) • Review of LA, NHS England and CCG commissioning plans Health & Wellbeing Board • PHE local centres are part of local delivery system: • Providing health protection service and expert advice • Specialist EPRR function

10. Checking Delivery, Checking Progress • Transition on the whole has gone well – a testament to a huge amount of work by many people across the country • In the creation of Public Health England we have a huge opportunity to drive forward delivery of evidence-based public health • We are making good progress on a sector-led improvement programme for health and wellbeing boards, public health and local healthwatch • The challenge now is transformation: embedding the improvement of the public’s health throughout the work of the local authority • Transformation can only take place at the local level Enter the presentation's title using the menu option View > Header and Footer