Healthy Lives, Healthy People The Public Health White Paper

1. Healthy Lives, Healthy People The Public Health White Paper Karen Wright, Older Adults Lead, Public Health

2. [Slideshow Title - edit in Headers & Footers]

3. Summary • Public health is a priority for this government • The challenges remain the same - but the delivery system will be different • “…we cannot sit back while so many people are suffering lifestyle-driven ill health and health inequalities…” • Over prescriptive central planning and lack of a dedicated budget has stifled progress • Local government will take the lead for improving the health of their populations - and there will be responsibility across society with everyone, including citizens, playing a part

4. Policy context • Coalition values: Freedom, Fairness & Responsibility • Drive towards localism and ‘Big Society’ • Benefits of good health on economy • Importance of prevention in ensuring sustainability of NHS

5. NHS and social care reforms • ‘Equity and Excellence: Liberating the NHS’ • Independent NHS Commissioning Board • GP Commissioning Consortia – NB: 3 in Worcestershire • SHAs and PCTs to be abolished • Healthcare providers to be independent • Transfer of responsibility for public health • Health and Well-being Boards • ‘A Vision for Adult Social Care: Capable Communities and Active Citizens’ • Personalised prevention services, tailored to local communities

6. Background • High burden of lifestyle related disease: • Smoking claims 80,000 lives - costs NHS £2.7bn annually • Among highest levels obesity in the world – costs NHS £4.2bn annually • 1.6mn people are dependent on alcohol • Mental health is a vital component of well-being: • Mental ill-health contributes ¼ total burden of ill health • Persistent inequalities in health outcomes: • Life expectancy 7 years less in poorest than richest areas. • Range of social, economic, environmental and behavioural influences on health and on choices • Ongoing significant threats to health - CBRN

7. Approach • 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

8. Ladder of interventions

9. Coherent life course approach (1) • Giving every child the best start in life: • Eradicate child poverty by 2020 • Free nursery care for pre-school children • Increase number of Health Visitors • Extend Family Nurse Partnerships • Refocus SureStart Children’s Centres • Big role for schools – including Healthy Schools, PHSE, PE & Bikeability • New service vision for school nurses • Promote mental health and early treatment - including talking therapies • Strengthen self esteem and reduce susceptibility to harmful influences • Making it pay to work: • Apprenticeships, careers advice and National Citizen Service • Comprehensive welfare reforms • New jobs through local growth • Employers as champions of better health

10. Coherent life course approach (2) • Designing communities for active ageing and sustainability: • Improve community sports facilities and access to green spaces • Active travel • Walking for Health and Let’s Get Moving • Health Checks • Lifetime Homes and Warm Front • Winter fuel allowance and free bus travel • Collaboration with business and the voluntary sector through the Public Health Responsibility Deal: • Better information for consumers and socially responsible retailing • Agreements on reduction of salt and trans-fat in food • Maintain smoke free legislation – and consider extension to plain packaging and ban on point of sale display • Reform Licensing Act including ban on alcohol sales below cost

11. System - national • Public Health England: • Part of DH and accountable to SoS - ring fenced budget around £4bn • Achieve measurable improvements in health outcomes and protect against health threats • National and sub-national infrastructure for health protection, emergency preparedness, resilience and response - working closely with NHS • Commissioning of health improvement interventions - via NHSCB or devolved budgets to local authorities • Helping citizens take care of their own health • Intelligence function - PH observatories and cancer registries • Developing the evidence base – including NIHR school for PH research • Upholding excellence in PH practice and develop PH workforce • NHS role: • Embedded in the mandate SoS sets for NHSCB and thence to GPCC

12. The NHS White Paper Commissioning arrangements e.g. (?) drug & alcohol, smoking & obesity, sexual health, school nursing e.g. (?) screening, immunisations, QOF, health visiting

13. System - local • Local government • GPCC and GP practices – and wider NHS • DPH • Health and Wellbeing Board • Voluntary sector and local business • Mobilising and supporting communities

14. Local government • Health and Social Care Bill will give unitary and upper tier local authorities a duty to improve the health of their population • Ring-fenced budget • Ability to bring to bear wider social, economic and environmental influences on health • Facilitate and empower voluntary sector, businesses and individuals to play their part • Personalise interventions to ensure they are relevant to communities

15. GPCC and GP practices • Public health outcomes to feature in GPCC performance framework • Expected to maximise opportunities for preventive health within commissioning portfolio • Quality of primary care contribution to public health will be measured and published • Advice and support from local DPH

16. DPH • Requirement for all unitary and upper-tier local authorities • Jointly appointed by local authority and PHE • Professionally regulated and accountable to CMO • Responsibilities: • “Strategic leader for public health in local communities” • Principal adviser on all health matters to their local authority • Jointly lead development of the JSNA and JHWS • Advocate for the public’s health • Independent annual report • Ensure local preparedness, resilience and response in the face of threats to health • Support GPCC to secure better health outcomes, better quality of care and better value for money

17. 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

18. Outcomes • New framework - overlap with NHS and social care outcomes • Transparency and accountability across public health system • For local authorities subset linked to a ‘health premium’ • Five domains: • Health protection and resilience • Tackling wider determinants of ill health • Health improvement • Prevention of ill-health • Healthy life expectancy and preventable mortality

19. Transition and timetable • Legislative basis will be Health and Social Care Bill - Jan 2011 • Consultation until March 2011 – including additional papers on outcomes and commissioning/funding arrangements • Accountability in rests with SHAs and PCTs until transferred • PHE established ‘shadow’ 2011/12 – statutory from 2012/13 • Budgets ‘shadow’ 2012/13 – then ‘real’ from 2013/14 • RDsPH will lead transition at regional and local level • Detailed work on functions/structures and transition ‘roadmap’ • ‘Assignment’ of staff under HR framework • PH workforce strategy Autumn 2011

20. Opportunities for Worcestershire • Build on a solid foundation: • Political ownership at both tiers of local government • History of partnership working • In the vanguard of devolved decision making and personalised health improvement services: HIF, CLFH, development of voluntary sector, commissioning with tariffs • Strong local professional team • Strengthen political leadership: • Raises profile and priority for Members • Basis for further engagement with communities • Re-energise partnerships: • Central role for Health and Well-being Board • Integrated Health and Well-being strategy • Re-define respective roles and responsibilities

21. Next steps for Worcestershire • Conversation and consultation with partners • Clarity re: scope and budgets • National and regional transition process • Establishment of Health and Well-being Board • PH Excellence and Efficiency programme: • Prioritisation of resources • New working arrangements and structures • Transfer of PH staff • Strategy development and roll-out

22. Healthy Lives, Healthy People The Public Health White Paper Karen Wright, Older Adults Lead, Public Health