healthy lives, healthy people government’s vision for an improved public health system
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Healthy Lives, Healthy People Government’s vision for an improved public health system Public Health Policy & Strategy Unit July 12. The challenge : what we are facing and the rationale for change. We face significant challenges to public health …. - PowerPoint PPT PresentationTRANSCRIPT
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Healthy Lives, Healthy PeopleGovernment’s vision for an improved
public health system
Public Health Policy & Strategy UnitJuly 12
We face significant challenges to public health …
•England has one of the highest rates of obesity in the developed world.
•Two thirds of adults are overweight or obese, a leading cause of type 2 diabetes and heart disease
•In 2008-10, the gap between areas with the highest and lowest life expectancy was around 12 years
•Smoking claims over 80,000 lives a year.
•1.6 million people are dependent on alcohol.
•Over half a million new sexually transmitted infections were diagnosed in 2010
•Major health threats persist, ranging from risk of new pandemics to the potential impact of terrorist incidents.
• Drug related crime costs £13.9bn per year• Smoking costs the NHS £2.7bn a year• Obesity costs the NHS £4.2bn a year• Dementia costs the UK £17bn a year• Sexual health treatment costs NHS £1.2bn a year
The challenge: what we are facing and the rationale for change
… with significant costs to health and to the economy
The response
• Health & Social Care Act 2012 makes provision for wholesale system change across health and social care– NHS reform– Refocusing on public health and prevention– Localism– Focusing on outcomes not targets
Vision / OutcomesHow do we
see the future?
Mission What does
the PH system have
to do?
• Focused on outcomes: improve and protect health and wellbeing for all the people of England and reduce health inequalities
• We will have succeeded if, as a nation, we are living longer, and in better health; and if the gap in health between rich and poor is reducing.
• Improving outcomes for all at all stages of the life-course
We will improve and protect health and wellbeing – through:
• Empowering local leadership and encourage wide responsibility across society to improve health and wellbeing, and tackle the wider factors that influence it
• Strengthening self-esteem, confidence and personal responsibility
• Positively promoting healthier behaviours and lifestyles
• Adapting environments to make healthy choices easier
• Protecting the public from health threats – with a strong nationally integrated system that offers expert advice to the NHS, local government and the public
The new Public Health System will build on existing success
The new delivery structure: an integrated whole system approach
The New Public Health System
Government
• DH responsible to parliament, with clear line of sight through system
• Cabinet sub-committee and significant contribution from across departments to improve health outcomes
• CMO to continue to provide independent advice to Government
Public Health England
• New, integrated national body
• Strengthened health protection systems
• Supporting the whole system through expertise, evidence and intelligence
NHS
• Delivering health care and tackling inequalities
• Making every contact count
• Specific public health interventions, such as cancer screening
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
Accountable and transparent
Focused on outcomes
• Sets out shared priorities for public health
• Focuses on outcomes not targets
• There is alignment & integration across public health, the NHS and social care
• Takes a life-course approach
• Designed to address the causes of the causes of ill health
• The intention is to incentivise local progress on some indicators
A new Public Health Outcomes Framework that;
At
a gl
ance
- P
ub
lic
Hea
lth
O
utc
om
esF
ram
ewo
rk
Ove
rvie
w o
f ou
tcom
es
and
indi
cato
rs
Ob
ject
ive
Ind
icat
ors H
ealth
care
pub
lic h
ealth
and
pr
even
ting
prem
atur
e m
orta
lity
4
Red
uced
num
bers
of p
eopl
e liv
ing
with
pr
even
tabl
e ill
hea
lth a
nd p
eopl
e dy
ing
prem
atur
ely,
whi
lst r
educ
ing
the
gap
betw
een
com
mun
ities
Inf
ant m
orta
lity
Too
th d
ecay
in c
hild
ren
aged
5 M
orta
lity
from
cau
ses
cons
ider
edpr
even
tabl
e M
orta
lity
from
all
card
iova
scul
ar d
isea
ses
(incl
udin
g he
art d
isea
se a
nd s
trok
e) M
orta
lity
from
can
cer
Mor
talit
y fr
om li
ver
dise
ase
Mor
talit
y fr
om r
espi
rato
ry d
isea
ses
Mor
talit
y fr
om c
omm
unic
able
dis
ease
s
(Pla
ceho
lder
) E
xces
s un
der
75 m
orta
lity
in a
dults
with
se
rious
men
tal i
llnes
s (P
lace
hold
er)
Sui
cide
Em
erge
ncy
read
mis
sion
s w
ithin
30
days
of
disc
harg
e fr
om h
ospi
tal (
plac
ehol
der)
Pre
vent
able
sig
ht lo
ss H
ealth
-rel
ated
qua
lity
of li
fe fo
r ol
der
peop
le
(Pla
ceho
lder
) H
ip fr
actu
res
in o
ver
65s
Exc
ess
win
ter
deat
hs D
emen
tia a
nd it
s im
pact
s (P
lace
hold
er)
Ind
icat
ors
Ob
ject
ive
Hea
lth p
rote
ctio
n3
The
pop
ulat
ion’
s he
alth
is p
rote
cted
from
m
ajor
inci
dent
s an
d ot
her
thre
ats,
whi
lst
redu
cing
hea
lth in
equa
litie
s
Air
pollu
tion
Chl
amyd
ia d
iagn
oses
(15
-24
year
olds
) P
opul
atio
n va
ccin
atio
n co
vera
ge P
eopl
e pr
esen
ting
with
HIV
at a
late
sta
ge o
f in
fect
ion
Tre
atm
ent c
ompl
etio
n fo
r T
B P
ublic
sec
tor
orga
nisa
tions
with
boa
rd
appr
oved
sus
tain
able
dev
elop
men
t m
anag
emen
t pla
ns C
ompr
ehen
sive
, agr
eed
inte
r-ag
ency
pla
ns
for
resp
ondi
ng to
pub
lic h
ealth
inci
dent
s (P
lace
hold
er)
Ob
ject
ive
Ind
icat
or
s
Hea
lth im
prov
emen
t
2
Peo
ple
are
help
ed to
live
hea
lthy
lifes
tyle
s,
mak
e he
alth
y ch
oice
s an
d re
duce
hea
lth
ineq
ualit
ies
Low
bir
th w
eig
ht o
f te
rm b
abi
es
Bre
ast
feed
ing
Sm
okin
g s
tatu
s a
t tim
e o
f de
liver
y U
nde
r 1
8 co
nce
ptio
ns C
hild
de
velo
pm
ent a
t 2 –
2.5
ye
ars
(P
lace
hold
er)
Exc
ess
we
ight
in 4
-5 a
nd
10
-11
yea
r o
lds
Ho
spita
l ad
mis
sio
ns c
aus
ed
by
uni
nte
ntio
nal a
nd
del
iber
ate
inju
ries
in u
nde
r 18
s E
mot
ion
al w
ell-b
ein
g o
f loo
ked
afte
r ch
ildre
n (P
lace
hol
der)
Sm
okin
g p
reva
len
ce –
15
year
old
s (P
lace
hold
er)
Ho
spita
l ad
mis
sio
ns a
s a
res
ult
of s
elf-
har
m D
iet (
Pla
ceh
olde
r) E
xce
ss w
eig
ht in
adu
lts P
rop
ortio
n o
f ph
ysic
ally
act
ive
and
ina
ctiv
e a
dults
Sm
okin
g p
reva
len
ce –
adu
lts (
ove
r 18
s) S
ucce
ssfu
l com
ple
tion
of d
rug
trea
tme
nt P
eopl
e en
terin
g p
riso
n w
ith s
ubst
ance
dep
end
ence
is
sues
who
are
pre
viou
sly
no
t kno
wn
to c
om
mu
nity
tr
eat
me
nt R
eco
rded
dia
bete
s A
lco
hol-r
ela
ted
ad
mis
sio
ns t
o h
osp
ital
Ca
nce
r d
iagn
ose
d a
t st
age
1 a
nd 2
(P
lace
hol
der)
Ca
nce
r sc
ree
ning
co
vera
ge
Acc
ess
to n
on
-ca
nce
r sc
ree
ning
pro
gra
mm
es T
ake
up
of th
e N
HS
Hea
lth C
heck
pro
gra
mm
e –
by
thos
e e
ligib
le S
elf-
repo
rted
wel
l-bei
ng F
alls
and
fall
inju
ries
in th
e o
ver
65s
Ob
ject
ive
Ind
icat
or
s
Impr
ovin
g th
e w
ider
det
erm
inan
ts
of h
ealth
1
Impr
ovem
ents
aga
inst
wid
er fa
ctor
s w
hich
af
fect
hea
lth a
nd w
ellb
eing
and
hea
lth
ineq
ualit
ies
Chi
ldre
n in
pov
erty
Sch
ool r
eadi
ness
(P
lace
hold
er)
Pup
il ab
senc
e F
irst t
ime
entr
ants
to th
e yo
uth
just
ice
syst
em 1
6-18
yea
r ol
ds n
ot in
edu
catio
n,
empl
oym
ent o
r tr
aini
ng P
eopl
e w
ith m
enta
l illn
ess
and
or d
isab
ility
in
settl
ed a
ccom
mod
atio
n P
eopl
e in
pris
on w
ho h
ave
a m
enta
l illn
ess
or s
igni
fican
t men
tal i
llnes
s (P
lace
hold
er)
Em
ploy
men
t for
thos
e w
ith a
long
-ter
m
heal
th c
ondi
tion
incl
udin
g th
ose
with
a
lear
ning
diff
icul
ty /
disa
bilit
y or
men
tal i
llnes
s S
ickn
ess
abse
nce
rate
Kill
ed a
nd s
erio
usly
inju
red
casu
altie
s on
E
ngla
nd’s
roa
ds D
omes
tic a
buse
(P
lace
hold
er)
Vio
lent
crim
e (in
clud
ing
sexu
al v
iole
nce)
(P
lace
hold
er)
Re-
offe
ndin
g T
he p
erce
ntag
e of
the
popu
latio
n af
fect
ed b
y no
ise
(Pla
ceho
lder
) S
tatu
tory
hom
eles
snes
s U
tilis
atio
n of
gre
en s
pace
for
exer
cise
/ he
alth
rea
sons
Fue
l pov
erty
Soc
ial c
onne
cted
ness
(P
lace
hold
er)
Old
er p
eopl
e’s
perc
eptio
n of
com
mun
ity
safe
ty (
Pla
ceho
lder
)
VIS
ION
To
imp
rove
an
d p
rote
ct t
he
nat
ion
’s h
ealt
h a
nd
wel
lbei
ng
an
d im
pro
veth
e h
ealt
h o
f th
e p
oo
rest
fas
test
Out
com
e 1)
Inc
reas
ed h
ealth
y lif
e ex
pect
ancy
, i.e
. tak
ing
acco
unt o
f the
hea
lth q
ualit
y as
w
ell a
s th
e le
ngth
of l
ifeO
utco
me
2) R
educ
ed d
iffer
ence
s in
life
exp
ecta
ncy
and
heal
thy
life
expe
ctan
cy b
etw
een
com
mun
ities
(th
roug
h gr
eate
r im
prov
emen
ts in
mor
e di
sadv
anta
ged
com
mun
ities
)
Ou
tco
me
mea
sure
s
With a ring-fenced resource
• A ring-fenced budget for public health at national and local levels
• Estimated baseline spend for public health = £5.2 billion
• Of this we estimate approximately:
– £2.2 billion will go to local authorities
– £2.2 billion will go to the NHS CB
– £800 million will go to PHE
• Incentives for improvements
– To reward local areas that make progress against key outcomes
– That do not create additional burden or perverse incentives
– Policy to be developed in partnership with local government
• Actual grants announced for 2013/14 in late 2012
The role of the NHS CB
• The NHS CB will be responsible for delivering key public health services. These are:– Immunisation services– Cancer screening services– Non-cancer screening services– Children’s public health services for 0-5 year olds (until
2015)– Child Health Information Systems (CHIS) – Public health services for those in custody settings– Sexual Assault Referral Centres
• The details of this will be set out in an agreement between DH and the NHS CB
Local Authorities
CCGs/NHS CB
PHE (Local)
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 (incl 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
With national expertise – The role of Public Health England
DH and OGDs
International partners
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 DAs 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
Devolved Administrations
Science and Research
Local Authorities
CCGs/NHS CB
PHE (Local)
Health & Wellbeing
Board
An effective local delivery system in improving and protecting health and wellbeing
PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents
Coordinates local strategy through:
• JSNAs• Joint health and wellbeing
strategy• Review of commissioning
plans• Receives and reviews PHE’s
programme for its locality
LOCAL ROLE RATIONALE
NHS will continue to commission PH services where:• within GPC contract• integral part of pathway• 0-5 services and Health Visitors
CCGs and NHS CB will • Commission healthcare• Commission specific PH services (eg
QoF, Immunisations, Military and Prison health)
PHE local units will be part of local delivery system:
• Providing health protection service and expert advice
• Specialist EPRR function
LAs will take the lead role in PH, commissioning majority of services and assuring and
coordinating through DPH and HWBB
Local Authorities will: • Have a duty to improve health• Bring together holistic approach to
health and wellbeing across full range of their responsibilities
• Receive ring-fenced PH budget• Lead commissioning of public health
services (health improvement, drugs, sexual health)
DPH has specific functions to:• Bring together the local PH system• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB
PHE local units will be part of local delivery system:
• Providing health protection service and expert advice
• Specialist EPRR function
Local Authorities
CCGs/NHS CB
PHE (Local)
Health & Wellbeing
Board
An effective local delivery system in improving and protecting health and wellbeing
PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents
Coordinates local strategy through:
• JSNAs• Joint health and wellbeing
strategy• Review of commissioning
plans• Receives and reviews PHE’s
programme for its locality
Local Authorities will: • Have a duty to improve health• Bring together holistic approach to health
and wellbeing across full range of their responsibilities
• Receive ring-fenced PH budget• Lead commissioning of public health
services (health improvement, drugs, sexual health)
DPH has specific functions to bring together the local PH system:
• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB
LOCAL ROLE RATIONALE
NHS will continue to commission PH services where:• within GPC contract• integral part of pathway• 0-5 services and Health Visitors
CCGs and NHS CB will • Commission healthcare• Commission specific PH services (eg
QoF, Immunisations, Military and Prison health)
LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB
Local Authorities
CCGs/NHS CB
PHE (Local)
Health & Wellbeing
Board
An effective local delivery system in improving and protecting health and wellbeing
PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents
Coordinates local strategy through:
• JSNAs• Joint health and wellbeing
strategy• Review of commissioning
plans• Receives and reviews PHE’s
programme for its locality
Local Authorities will: • Have a duty to improve health• Bring together holistic approach to health
and wellbeing across full range of their responsibilities
• Receive ring-fenced PH budget• Lead commissioning of public health
services (health improvement, drugs, sexual health)
DPH has specific functions to bring together the local PH system:
• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB
LOCAL ROLE RATIONALE
NHS will continue to commission PH services where:• within GPC contract• integral part of pathway• 0-5 services and Health Visitors
CCGs and NHS CB will • Commission healthcare• Commission specific PH services (eg
QoF, Immunisations, Military and Prison health)
PHE local units will be part of local delivery system:
• Providing health protection service and expert advice
• Specialist EPRR function
LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB
Local Authorities
CCGs/NHS CB
PHE (Local)
Health & Wellbeing
Board
An effective local delivery system in improving and protecting health and wellbeing
PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents
Coordinates local strategy through:
• JSNAs• Joint health and wellbeing
strategy• Review of commissioning
plans• Receives and reviews PHE’s
programme for its locality
Local Authorities will: • Have a duty to improve health• Bring together holistic approach to health
and wellbeing across full range of their responsibilities
• Receive ring-fenced PH budget• Lead commissioning of public health
services (health improvement, drugs, sexual health)
DPH has specific functions to bring together the local PH system:
• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB
LOCAL ROLE RATIONALE
NHS will continue to commission PH services where:• within GPC contract• integral part of pathway• 0-5 services and Health Visitors
CCGs and NHS CB will • Commission healthcare• Commission specific PH services (eg
QoF, Immunisations, Military and Prison health)
PHE local units will be part of local delivery system:
• Providing health protection service and expert advice
• Specialist EPRR function
LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB
We have completed the broad policy design for the new system
1Policy Updates issued in December set out the broad design of the new PH system and roles and responsibilities for the Bodies
Updates issued as a short, CE focused narrative, with linked factsheets for details. Well received for both content and ease of communication. Covered role and function of PHE and local authorities, established commissioning responsibilities
3Baseline public health estimates for public health system published
Key issue for LAs. Publication critical first step. But significant concern over variation and future allocation policy
Next step is to engage on ACRA formula and implications
Update on Public Health Funding published on 14 June
4 The overarching HR framework for the transition programme is in placeHR Concordat and LGA Guidance
Awaiting future policy on pensions
Building a People transition Policy for PHE
Direction for PHE terms and conditions established – negotiations due to conclude in June
PH Outcomes Framework published in January setting out key outcomes for the public health system
2
Implementation activity is underway
1PCTs required to complete plans for the transfer of PH to LAs by 31 March 2012 as part of the NHS planning round
Initial plans received from PCTs. Robust processes in place with Cluster SHAs to assure progress.
Final plans required by 31 March to cover the transfer of responsibilities and staff to Local Authorities
Almost every local area has set up their shadow Health and Wellbeing Board, of which public health is part.
2Appointment of PHE CE completed
PHE Transition Team progressing design and transition process for PHE.
Next steps
• Enabling legislation on;– Arrangements for charging arrangements for LAs– London Health & Wellbeing Board– Mandatory functions for LAs– The role of the DPH in emergency planning and
health protection
• Final advice from ACRA on LA financial allocations and formula for the reward element of the health premium
19
Public health system updates
The new public health system factsheets are available at
http://healthandcare.dh.gov.uk/publichealth
Sign-up to our regular Transforming Public Health bulletin
http://phbulletin.dh.gov.uk/
Contact the DH Public Health England transition team
Contact the DH Public Health Policy and Strategy Unit