Healthy Lives, Healthy People A Strategy for Public Health in England

1. Healthy Lives, Healthy PeopleA Strategy for Public Health in England 28 January 2011 Healthy Lives, Healthy People Mark Dickinson

2. Rationale • “it is simply not possible to promote healthier lifestyles through Whitehall diktat and nannying about the way people should live … one-size-fits-all solutions are no good when public health challenges vary from one neighbourhood to the next. But we cannot sit back while … so many people are suffering … ill health and … health inequalities” Healthy Lives, Healthy People

3. Key Messages • “new approach that empowers individuals” • “local communities at the heart of public health” • “end central control” • “financial incentives to reward progress” • “simplifying the way we organise things nationally” • “work with industry and other partners” Healthy Lives, Healthy People

4. White Paper Structure • Seizing opportunities for better health • A radical new approach • Health and wellbeing throughout life • A new public health system • Making it happen Healthy Lives, Healthy People

5. Seizing Opportunities Healthy Lives, Healthy People

6. Seizing Opportunities • Starting well - Improve maternal health to give children a better start in life • Developing well - Improve child health and development to improve educational attainment and health in later life • Living well - Change adult behaviour to reduce premature death and illness • Working well – Being in work is good for health and good health is good for the economy • Ageing well – e.g. Prevent excess winter deaths Healthy Lives, Healthy People

7. Seizing Opportunities • “it is not better treatment but prevention … which is likely to deliver greater overall increases in life expectancy” • Importance of health inequalities and the social gradient of health is acknowledged Healthy Lives, Healthy People

8. Seizing Opportunities • Strategic focus on the outcomes that matter most • Focus on what works to make the biggest difference • Harness efforts across society • Local government in a leadership role Healthy Lives, Healthy People

9. A Radical New Approach Healthy Lives, Healthy People

10. New Approach • Public health system must: • Reach out – address root causes and involve individuals, families and communities • Be responsive - owned and shaped by communities • Be resourced – ring fenced funding and incentives to improve • Be rigorous – professionally led, evidence based, efficient and effective • Be resilient – protecting against current and future health threats Healthy Lives, Healthy People

11. New Approach • Health Protection must be led by central government with “a strong system to the front line” • Beyond that, local leadership and wide responsibility is key • A ‘ladder’ of interventions will be used to decide the least intrusive approach possible • Voluntary approaches before regulation Healthy Lives, Healthy People

12. Reaching Out • Individuals be in the ‘driving seat’ • Local government is best placed to influence many of the wider determinants of health • NHS continues to have a crucial role • Voluntary sector makes a vital contribution • Businesses must take more responsibility Healthy Lives, Healthy People

13. Being Responsive • There have been too many central initiatives and targets • Time to free up local government and communities to determine local action with the NHS and partners • New freedoms and funding for local government • Outcomes framework and a ‘Health Premium’ Healthy Lives, Healthy People

14. Being Resourced • Public Health budgets have been squeezed • Need to prioritise Public health • Ring-fenced funding from within the overall NHS budget • Still subject to running cost reductions and efficiency improvements • Allocated to local authorities Healthy Lives, Healthy People

15. Being Rigorous • System has let the workforce down • Public Health England will be established • “uniting force for a wider family of professionals” • Need to build and apply the evidence base • Improve the use of evidence and evaluation Healthy Lives, Healthy People

16. Being Resilient • Current Health protection system is fragmented • Need a stronger, more integrated system: • ‘enhanced’ functions of the Secretary of State” • Clearer accountabilities • Public Health England leading Healthy Lives, Healthy People

17. Health & Wellbeing Throughout Life Healthy Lives, Healthy People

18. Health & Wellbeing Throughout Life • Empower local government • Take a coherent approach to different stages of life and key transitions instead of tackling risk factors in isolation • Give every child the best start in life • Make it pay to work • Design communities for active ageing and sustainability • Work collaboratively with business and the voluntary sector Healthy Lives, Healthy People

19. Public Health Responsibility Deal • Collaboration with business and the voluntary sector • Five networks: • Food • Alcohol • Physical activity • Health at work • Behavioural change Healthy Lives, Healthy People

20. A New Public Health System Healthy Lives, Healthy People

21. New Public Health System • Devolved responsibilities, freedoms and ring-fenced funding • New Director of Public Health role • Public Health England • Public Health Outcomes Framework • School for Public Health Research • Policy Research Unit on Behaviour and Health Healthy Lives, Healthy People

22. New Public Health System • Public Health will be part of the NHS Commissioning Board’s mandate • Public health support for national and local commissioning • Incentives for GPs to play an active role in Public Health • CMO will be the leading advocate for Public health “within, across and beyond government” Healthy Lives, Healthy People

23. Directors of Public Health • Employed by local government and jointly appointed by Public Health England • In upper-tier local government and unitary authorities • Strategic leaders for Public health and health inequalities in local communities • Work in partnership with the local NHS and across the public, private and voluntary sectors Healthy Lives, Healthy People

24. Directors of Public Health • Critical Tasks: • Promoting health and wellbeing in local government • Providing and using evidence • Advising and supporting GP consortia • Developing a local approach to improving health and reducing health inequalities • Working closely with Public Health England Health Protection Units Healthy Lives, Healthy People

25. Public Health England • To be created within the Department of Health • Will: • “maintain the principles and practice of independent scientific and public health advice” • Support local action through funding, provision of evidence and data and professional leadership • Lead Health Protection (including current HPA functions) and have local Health Protection Units Healthy Lives, Healthy People

26. Public Health England • Will include: • Elements of Public health currently within DH and Strategic Health Authorities • Public Health Observatories • Cancer Registries • Protected budget: • Will be subject to a “planned reduction of one-third of non front line administration costs, while protecting front line services” Healthy Lives, Healthy People

27. Local Government Role • Existing communicable disease role will remain • Upper tier and unitary local authorities will have a duty to “take steps to improve the health of their population” • Partners in statutory local Health and Wellbeing Boards Healthy Lives, Healthy People

28. Funding for Public Health • National Public Health Budget • Public Health England could be responsible for over £4bn • Details still to be worked out • Local Public Health Budget • Public Health England will allocate ring-fenced budgets to local authorities • “weighted for inequalities” Healthy Lives, Healthy People

29. Funding for Public Health • ‘Public Health Premium’ • To incentivise action to reduce inequalities • Will apply to the part of local Public health budgets for health improvement • Baseline weighted to areas with most need • Incentive payments to reward improvement Healthy Lives, Healthy People

30. Funding for Public Health • Separate consultation paper on “the funding and commissioning routes for public health” Healthy Lives, Healthy People

31. Public Health Outcomes Framework • Separate consultation paper • Aims to: • Use indicators which are meaningful to the public • Focus on major causes and impacts of illness and inequalities • Take legal duties into account • Take a ‘life course’ approach Healthy Lives, Healthy People

32. Public Health Outcomes Framework • Aims to interlink and align with the NHS and Adult Social Care Outcomes Frameworks • Vision: “To improve and protect the nation’s health and to improve the health of the poorest, fastest” Healthy Lives, Healthy People

33. Public Health Outcomes Framework • Based on 5 Domains • Health Protection and Resilience • Tacking the wider determinants of health • Health improvement • Prevention of ill health • Healthy life expectancy and preventable mortality Healthy Lives, Healthy People

34. Making it Happen Healthy Lives, Healthy People

35. Making it Happen • White Paper published November 2010 • Health Bill published January 2011 • Consultation to end March 2011 • Papers on specific topics during 2011 • Public Health England in shadow form from 2011 and to be established 2012 • New local authority legal duties and functions from 2013 • Whole process in alignment with wider NHS reform Healthy Lives, Healthy People

36. Questions, Concerns and Implications Healthy Lives, Healthy People

37. Questions and Concerns • The funding has not been calculated or identified • Will there be enough resources? • Will local authorities receive additional funding to match additional responsibilities • Is the proposed role of Director of Public Health doable? Healthy Lives, Healthy People

38. Concerns Identified by the HPA Board • How to ensure independence of scientific and public health advice, nationally and locally? • How to maintain income generation? • How will the relationship between Public Health England and the DsPH work? • How will emergency preparedness, response and resilience be maintained and strengthened? Healthy Lives, Healthy People

39. Implications for Public Health Wales • Access to independent advice • Cohesion of cross border emergency preparedness and response • Divergence in the roles and responsibilities of public health • Implications for training • Implications for career mobility • Expectations of local government Healthy Lives, Healthy People

40. Consultation Questions Healthy Lives, Healthy People

41. Consultation Questions • Role of GPs and GP practices in public health: Are there additional ways in which we can ensure that they will continue to play a key role in areas for which Public Health England will take responsibility? • Public health evidence: What are the best opportunities to develop and enhance … information and intelligence? Healthy Lives, Healthy People

42. Consultation Questions • Public health evidence: How can Public Health England address gaps such as: • Insights of behavioural science • Tackling wider determinants • Achieving cost effectiveness • Tackling inequalities? Healthy Lives, Healthy People

43. Consultation Questions • Public health evidence: What can wider partners contribute to improving evidence? • Regulation of public health professionals: We would welcome views on Dr Gabriel Scally’s report. Which organisation would best provide a system of voluntary regulation Healthy Lives, Healthy People