1 the best possible health and well being for people in lewisham healthy lives, healthy people...

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The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham

Healthy Lives, Healthy PeopleStrategy for Public Health in England

November 2010

Jane MillerDeputy Director of Public Health

NHS Lewisham

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What is public health?

• ‘The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society’ (Faculty of Public Health definition)

There are three domains to public health;

• Health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health),

• Health protection (including infectious diseases, environmental hazards and emergency preparedness)

• Health services (including service planning, efficiency, audit and evaluation).

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Health Background

Poor mental health is estimated to be responsible for nearly a quarter of the overall burden of long-standing poor health

Smoking claims over 80,000 lives a year

1.6 million people are dependent on alcohol

Britain has amongst the worst levels of obesity in the world

Over half a million new sexually transmitted infections were diagnosed last year, and one in ten people getting an infection will be re-infected within a year

People in the poorest areas expect to live up to 7 years less than people in richer areas

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A Radical New Approach

• representative – owned by communities and shaped by their needs

• resourced – with ring-fenced funding and incentives to improve

• rigorous – professionally-led, focused on evidence, efficient and effective

• resilient – strengthening protection against current and future threats to health.

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Public Health Paper

• Commitment to public health• Inequalities• Recognition of relationship of mental health to physical

health• Recognition of role of local authorities in improving

health and wellbeing• National public health service – Public Health England• Importance of health protection• Intention to protect public health funding• Public Health into GP Commissioning

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A New Public Health System

• Public Health England – a national public health service

• A return to public health leadership to Local Government

• Professional leadership nationally and locally

• Dedicated resources for public health at national and local levels

• Focus on outcomes and evidence based practice

• Maintaining a strong relationship with the NHS, social care and civil society

• Set out in the Health and Social Care Bill

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Working together locally

• Local authorities will lead local action on public health, playing an important new role in promoting people’s health and wellbeing, with new freedoms to make a major impact on health improvement and health inequalities

• Health and Wellbeing Boards - Local authorities will play a leading role in driving collaboration

• Directors of Public Health will be the strategic leaders for public health and health inequalities in local communities, working in partnership with the local NHS and across the public, private and voluntary sectors

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Public Health England

New public health service directly accountable to the Secretary of State for Health with a clear mission to:

• Achieve measurable improvements in public health outcomes; and

• Provide effective protection from public health threats

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Director of Public Health

• Will be the principal adviser on health to the local authority, elected members and officers, on the range of local authority functions and their impact on the health of the local population

• Will be play a key role in the proposed new functions of local authorities in promoting integrated working

• With Directors of Adult Social Services and Directors of Children’s Services and GP Consortia lead the development of the local Joint Strategic Needs Assessment (JSNA) and a Health and Wellbeing strategy

• Will continue to be an advocate for the public’s health within the community

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Director of Public Health

• Will be jointly appointed by local authority and Public Health England and employed by the local authority with accountability to locally elected members and through them to the public.

• Will produce an independent annual report on the health of their local population

• Accountable to the Secretary of State for Health for responsibilities relating to health protection and professionally accountable to the Chief Medical Officer

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Department of Health

Public Health England (within the Department of

Health)

Local authorities

NHS commissioning

architecture(Commissioning

Board and Consortia)

Providers

Commissioning

Commissioning

Commissioning

GPs

NHS budget

Health and wellbeing

boardsJSNA & Joint Strategic Health and Wellbeing

Plans

Public health budget

Ring-fenced public health grant

Funding for commissioning specific public health services

integration integration

Public health funding and commissioning

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Outcomes Framework

Preventing people from dying prematurely and

reduce the gap in health inequalities

Reducing the number of people living with

preventable ill health and reduce the gap in

health inequalities

Helping people to live healthy lifestyles make

healthy choices and reduce the gap in health inequalities

tackling factors which affect health and

wellbeing

DETERMINANTS OF ILL HEALTH OUTCOMES OF ILL HEALTH

To improve and protect the nation’s health and well-being and to improve the health of the poorest fastest. • Increasing healthy life expectancy • Reducing the healthy life expectancy gap between the least deprived and most deprived communities

Domain 2 – Tackling the wider determinants

of health

Domain 3 – health improvement

Domain 4 – prevention of ill-health

Domain 5 - healthy life expectancy and

preventable mortality

Do

ma

ins

Ind

icato

rs

Vis

ion

Domain 1 – Health protection and resilience

Protect the population’s health from major emergencies and remain resilient to harm

Public health indicators (of which, some will be used locally to attract the Health Premium)

• The Domains above set out the high-level goals for public health. Each domain will require a national local balance for delivery, with an onus on local delivery across the NHS, social care services public health and other local partners, and with strong leadership from the Director of Public Health.

• Outcomes for public health will be measured by indicators, which are supported by centrally collated and analysed data sets. This should include indicators that target different age groups, and target communities that experience differential outcomes in health.

• It will be for each local area to determine how they will wish to use these indicators for local transparency in response to local needs identified through their Joint Strategic Needs Assessment, and considered within their local Joint Health and Well-being Strategies.

Figure 2 – A frame work for public health outcomes

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Domain 1: Health protection and resilience: protect the

population’s health from major emergencies and remain

resilient to harm.

• Life years lost from air pollution as measured by fine particulate matter.

• Public sector organisations with a board approved sustainable development management plan.

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Domain 2 – Tackling the wider determinants of ill health:

tackling factors which affect health and wellbeing.

• Children in poverty• School readiness: foundation stage

profile attainment for children starting Key Stage 1

• Rates of adolescents not in education employment or training at 16 and 18 years of age

• Truancy rates• First time entrants to the youth justice

system• Proportion of people in long-term

unemployment• Proportion of people with long-term

conditions

• Housing overcrowding rates• Proportion of people with mental

illness and/or disability in settled accommodation

• Statutory homeless households• Fuel poverty• Access and utilisation of green

space• Killed and seriously injured

casualties on England's roads• Cycling participation

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Summary timetable

(subject to Parliamentary approval of legislation)

Consultation on:

• specific questions set out in this White Paper;

• the public health outcomes framework; and

• the funding and commissioning of public health.

Dec 2010–March

2011

Set up a shadow-form Public Health England within the

Department of Health Start to set up working arrangements

with local authorities, including the matching of PCT

Directors of Public Health to local authority areas

During 2011

Develop the public health professional workforce strategy Autumn 2011

Public Health England will take on full responsibilities,

including the functions of the HPA and the NTA Publish

shadow public health ring-fenced allocations to local

authorities

April 2012

Grant ring-fenced allocations to local authorities April 2013

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