Historic changes in Public Health Our approach in Kent

1. Historic changes in Public HealthOur approach in Kent Graham Gibbens Cabinet member Adult Social Services and Public Health Meradin Peachey Director of Public Health Andrew Scott-Clark Director of Health Improvement

2. Our approach in Kent • We have a substantial and experienced public health workforce in Kent consisting of 9 Public Health consultants who we all work with • KCC and NHS keen to start moving responsibility for Public Health to members this year ahead of the timetable • Recognise the importance of local action to improve inequalities in health so plan to keep money with districts • Working with GPs – we are already meeting with the GP Consortia • Working with Districts now that elections are over • The need to work with other agencies eg; Police, Fire etc to use resources together to address issues around Prevention and Health Inequalities

3. What we do know the Public Health reforms • Historical move of Public health back to Local Government but very different this time • DPH the champion of healthy living working with communities managing a ring fenced budget • Health and Well-Being board will be the driver for integrated better quality services across health and social care and reducing health inequalities • Joint Strategic Needs Assessment and the HWBB responsibility of upper tier authorities • Public Health England established responsible to the Secretary of State • Public Health cabinet sub committee established

4. What we do knowpublic health reforms • Commissioning health improvement moves to Local Authority • Health Protection responsibilities for Local Authority • Health Care responsibilities for Local Authority • Command paper expected July 11 to confirm MODERNISE THE WAY WE COMMUNICATE HEALTH MESSAGES

6. What Young People Think….. “House has helped me cut down smoking and stop drinking” Gravesend “Its useful to gain info about health risks” “It’s helped me quit smoking” “it’s a great place to go with friends and gain helpful information” “They have helped me by talking to me about sexual health” “I’ve come to House to have fun and sort my problems out” “It’s a welcoming environment….. and opened my eyes to diversity” “House has helped to keep me out of trouble” “made me aware of c card and chlamydia”

7. What does Public Health currently do in Kent • Health Improvement • Health Protection • Health Care (and social care) • All supported with Public Health Intelligence www.kmpho.nhs.uk • We support everyone in the system!

8. The Timetable • Public Health coming together as one Kent team June 2011 • Memorandum of Understanding between KCC and the NHS to full Council July 2011 • Shadow Public Health England June 12 (dependent on command paper) • Shadow Public Health in LAs April 12 • Shadow budgets for LAs April 12 • Transfer of budgets and responsibilities for Public Health April 13

9. Local Authority Proposed Responsibilities • Sexual health services (apart from contraceptive services) • School immunisation programmes • Local initiatives to reduce seasonal mortality excess deaths • Local initiatives such as falls prevention services • Mental health promotion, mental illness and suicide prevention • Local activity to promote physical activity • Local programmes to prevent/address obesity • Drug & alcohol misuse services, prevention and treatment • Tobacco control

10. Local Authority Proposed Responsibilities • NHS Health Check Programme (assessment & lifestyle intervention only) • Local initiatives to promote health in the workplace • Reducing and preventing birth defects (jointly with PHE) • Campaigns and services to promote prevention & early presentation of cancer and long-term conditions • Dental public health (supported by PHE for coordination of surveys) • Specialist domestic violence services • Support for families with multiple problems • Health intelligence and information (jointly with PHE)

11. Public Health: Commissioning and Funding Routes

12. What allocation might we get in Kent? • Likely to be around 4% of PCT Total Budgets • In Kent the total amount is likely to be around £60-70m • PCTs going through an iterative financial process to ensure we get the PH funding returns as accurate as possible • Internal consistency check for Kent and Medway

13. The Kent Public Health Prevention Budget for 11/12 • Budget for PH prevention in Kent is approx £17m • Budget covers provision of specific services and individual lifestyle behavioural support including: • Sexual health services • Sexual Health promotion • Healthy Weight interventions • Stop smoking • Health trainers • Healthy schools • Further money also spent on other Public Health prevention programmes including:

14. Current Situation • Differences in the approach between Eastern and Coastal Kent and West Kent PCTs • Services currently commissioned through the new Kent Community Health Care NHS Trust • Amalgamation of West Kent Community Services and Eastern and Coastal Kent Community Services. • Each service has a contract with work now focussed on bringing Eastern and Coastal Kent and West Kent contracts together to ensure consistency. • No plans to change what is already being commissioned.

15. Opportunities How do we reflect local needs in taking forward health improvement and what would the governance look like? • Commission county wide services (to gain efficiency of provision) but set local targets to reflect need: • Range of smoking prevalence 15% to 30% per District • Quit targets to be based on this prevalence (NICE recommendation) • Potential to segment targets for smaller populations • Decommission some programmes and recommission jointly with County/Districts/GPCC. • How do you want to progress locality commissioning?