One Year On – Have the reforms led to the transformation of the public health system?

Ann GoodwinInterim Head of Health ImprovementPHE East Midlands CentreSeptember 2013Ann.goodwin@phe.gov.uk

Content

- A ‘look back’ on public health transition

- An update on the current structures in the public

health and wider health system

- PHE structures and priorities

- Examples of transformational activity

• Team within PHE transition team

• Worked closely with the LGA

• Briefed Ministers

• Produced guidance and support around areas of concern

- Contract transition

- HR guidance

- Information

• Assured progress and provided support

Supporting Transition

GUIDANCE Planning guide for public health transition From Transition to Transformation Contract Transition Narrative Local Information Factsheets PH Legacy and Handover Checklist

EPRR Scenario testing Lead DPH competencies for LHRP Sexual health FAQs

FAQs on HR workforce/transition Advice on transfer schemes Transitional working arrangements Pensions Statutory and non-statutory guidance on the role, responsibility and context of the DPH

Pension provision post April 2013 Process for transferring staff Guidance on ‘filling of posts in receiving organisations’

Director of Public Health Appointments guidance (transition and after April 13) Guidance to support the transfer of public health functions from PCTs to local authorities

The guide to working in local government ‘Public Health’ CMO & LGA podcast Health protection factsheet

Core Offer Immunisation and Screening Arrangements Template Contract The Quarter and The Year Public Health Workforce Strategy

Public health in LG Factsheets Guidance on ChargingLocal Authority public health allocations

- October stocktake + January review of progress

- Allocation announcements, factsheets, recruitment

- Roles and responsibilities of PHE and NHSE- Small number of areas with additional challenges- DsPH joint confirmation process-Data and Information-Successful transition

Local transitionposition as of 31st March 2013

Structures within the

new health and public

health system

9 Going Live

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http://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england

Public Health England

Chief Executive

Director of HealthProtection and

Medical Director

Director of Healthand Wellbeing

Chief KnowledgeOfficer

Director ofNursing

Chief of Staff

PrivateOffice

Secretariat

InternalAudit

CorporateGovernance

LegalServices

Director ofStrategy

Chief OperatingOfficer

Director ofProgrammes

Finance andCommercial

Director

Director ofHuman

Resources

Director ofCommunications

RegionalDirectors

CentreDirectors

DevelopmentAdvisor

Advisory Board

Microbiology

Our priorities for 2013/14

– Sets out Public Health England’s priorities and actions for the first year of our existence

– Five outcome-focused priorities – what we want to achieve

– Two supporting priorities – how we will achieve it

– 27 key actions to take now

– The start of the conversation – a three-year corporate plan will follow

Priorities

Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet,

poor mental health, insufficient exercise and alcohol.

Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact,

including dementia, anxiety, depression and drug dependency

Protecting the country from infectious diseases and environmental hazards,including the growing problem of infections that resist treatment with antibiotics

Supporting families to give children the best start in life, through working withhealth visiting and school nursing, Family Nurse Partnerships and the

Troubled Families programme

Improving health in the workplace by encouraging employers to support their staff, and those moving into and out of the workforce, to lead healthier lives

Local focus

– Led by the Public Health England regional director

– Ensure quality and consistency and responsiveness of centres’ services and advice

– Support transparency and accountability of the system

– Assurance of emergency planning and response

– Workforce development

– Contribute to the national public health agenda

– Led by a senior public health professional

– Deliver services and advice on three domains of public health

– Support local government and local NHS action to improve and protect health and reduce inequalities with intelligence and evidence

– Deliver the local Public Health England input to emergency preparedness, resilience and response

15 CENTRES 4 REGIONS

– Four regions, fifteen centres

– Eight Knowledge and Intelligence Hubs

– London– South West– South East– West Midlands– East Midlands– North West– Northern and Yorkshire– East

– Other local presence– ten microbiology laboratories– field epidemiology

teams– Centre for Radiation,

Chemicals and Environmental Hazards units

Local focus

From Transition to Transformation

• Integrate services across health and more widely, eg education, housing, community safety

• Develop new approaches to tackling major public health challenges – smoking, obesity, public health threats.

• Greater influence on wider determinants of health – making health and wellbeing everybody’s business

• Join up different local budgets to improve VFM & health e.g. Community Budgets

• More local accountability and involvement of local people in shaping services = Better services + improved outcomes

Transformational opportunities from local authority leadership for

public health

Going Live

From Transition to Transformation resource ‘From Transition to transformation’

http://www.loWeb based resource ‘From Transition to transformation’http://www.local.gov.uk/web/guest/media-centre/-/journal_content/56/10171/3374673/

NEWS-TEMPLATE

Kent public health, led by councillors, is now working with the county’s ‘Mind the Gap’ programme in a real drive to change inequalities patterns in Kent. Local government and the NHS are working with one voice as each of the 12 district councils and the CCGs develop their own ‘Mind the Gap’, based on the JSNA and facilitated by the public health team. To show that the work has made a difference Kent, public health team has worked with experts to develop a single screening tool designed to measure the impact of activities on inequalities in Kent.

Salford has developed a new business model for public health that involves the public health team being integrated into the intelligence, research, policy and strategy function of an Integrated Commissioning Hub which supports commissioning across the council and the clinical commissioning group (CCG). The Hub is progressing well, developing ‘proof of concept’ workstreams which support actions to tackle family poverty and integrated services for young people. The Hub’s role and operating procedures will be tested as part of this process to identify how it can work most effectively.

Case Studies

In Haringey, the DPH’s most recent annual report took a new approach, highlighting a key public health issue – childhood obesity. The public health directorate worked with the council’s media design team to develop an engaging, easy-to understand, high impact poster to take to the wider workforce and residents. Communications staff from both the council and the NHS helped to publicise the issue through the media, including an article in the Sunday Times and an appearance by the DPH on Radio 4’s ‘You and Yours’. This provided an opportunity to present a very positive picture of what the council is doing, for example by tackling the proliferation of fast-food outlets – joint work between public health, planning and licensing. The council’s leader has now added childhood obesity and teenage pregnancy to her list of priority areas

In Lancashire a programme of councillor development in relation to the health reforms and health and wellbeing has been delivered across the two tiers of local government.A network of county and district cabinet members for health and wellbeing and another network for county and district lead officers for health and wellbeing have been established and are supported by Lancashire’s joint health unit. Co-production of public health support to district councils is led by the executive director of public health for central Lancashire.

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Case Studies

In Lincolnshire each of the seven district councils has a public health lead with the aim of developing more consistent approaches to health impact assessment in planning developments that impact on health – eg access to public transport, reducing road accidents for children, increasing cycling and walking routes . Also most of the district councils have a health and wellbeing group which links to the health and wellbeing board. District councils and CCGs are now coming together for joint work, such as a joint project in East Lindsey with the British Heart Foundation, looking at reducing the incidence of coronary heart disease.

Derbyshire has had senior public health staff jointly appointed between the NHSand a number of the county’s eight district councils for several years, and many other staff devote some of their time to working in specific localities. District and borough public engagement mechanisms are an important source of health intelligence. Elected members of district councils are engaged with all the local partnership arrangements for health and wellbeing and there is also a well developed (although non statutory) health scrutiny function at district/borough level looking into issues such as carers, alcohol and young people and inequalities.

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Case Studies

A system of virtual public health networks has been developed in Leicestershire. The lead district council chief executive meets quarterly with the director of public health and the director of adult social services to develop shared approaches and strong networks. A senior public health specialist is co-located with district council staff for part of each week to develop strategic and operational approaches to health improvement and a system of small grants funding is devolved to individual districts. There are member health champions in each district who meet periodically with the chair of the health and wellbeing board, CCG senior managers and the director of public health to build understanding of the potential of the new system, develop skills and knowledge and look at locality priorities and delivery. The precise mechanisms for delivery are different in each district, (for example some have local health forums and some do not) and this flexibility is inherent in the model.

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Case Studies

• Many examples of transformative work underway across the East Midlands

• Focus on relationships, joint working and shared priorities

• PHE East Midlands Centre prospectus – what our offer is to local stakeholders

(Has been sent to all LA CE’s, HWB Chairs and leaders) – launch 14th November

• Work programme and Partnership Agreements

• Any specific support you need eg input into expert networks?

Please email at the address on the front slide

Conclusion and next Steps