Setting the Scene : Public Health in Plymouth

Sarah Lees Consultant in Public Health

Healthy Lives Healthy People : our strategy for public health in England

The Government aims to ; • Empower local leadership to strengthen health and

wellbeing • Support self esteem, increased confidence and

personal responsibility • Promote healthier behaviour and lifestyles • Change the environment to support healthier

choices • Protect the public from threats to health

The new Public Health System

• Public Health England – a national public health service • A return of 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 supported by

a strong information & intelligence system • Maintaining a strong relationship with the NHS, social care

and civil society

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leadership role for local authorities

working alongside the NHS, with its continuing role promoting health through clinical services

stronger focus on health outcomes, supported by the Public Health Outcomes Framework

supported by a new integrated public health service, Public Health England

public health as a clear priority for Government, backed by ring fenced resources

The new public health system

new roles and responsibilities

clear priorities

The new Public Health System

Local Authorities

CCGs/NHS CB

PHE Units

• Duty to improve health • Brings together holistic approach to health and wellbeing

• Employ DPH • Ring-fenced PH budget • Mandated services

•Commissioning healthcare •Commissioning some public health

services

•Functions in development (inc health protection services)

•Core offer to the NHS, including PH advice on health services

Health and Wellbeing Board

Coordinates local strategy through •JSNA •JSHWS •Review of commissioning plans

Roles in the new Public Health System

The new approach

• Reach out and reach across – addressing the route causes of poor

health and wellbeing, reaching out to those who need the most support

• 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 and will focus on improving the health of the poorest fastest

The Marmot Approach

Starting well: enabling good health in mothers before, during and after pregnancy and good parenting

Developing well: encouraging healthy habits and avoiding harmful behaviours

Growing up well: identifying, treating and preventing mental health problems and creating resilience and self-esteem

Living and working well: choosing lifestyles and behaviours that influence health and productivity

Ageing well: supporting resilience through social networks and activity and providing protection from preventable ill-health

Local Government’s new functions

• New duty to improve the health of the population: – commissioning services from a range of providers – working with Clinical Commissioning Groups to

integrate care pathways – using health and wellbeing board to integrate

commissioning approaches – providing population healthcare advice to the NHS – duty to ensure plans in place to protect health.

• Local political leadership critical to making this

work.

Health and Wellbeing Boards

• Committees of upper tier LAs • Develop Joint Strategic Needs Assessment and Joint

Health & Well-being Strategy • Forum for public accountability of NHS, public health,

social care for adults and children & other commissioned services directly related to health & well-being

• Join up commissioning across the NHS, social care, public health and other relevant services

Purpose of Public Health in Plymouth

To improve and protect Plymouth’s health and wellbeing, and improve the health of the poorest fastest

Public Health in Plymouth

• Office of the Director of Public Health to discharge the Council’s new Public Health responsibilities

• Hosted within the People Directorate • Mandate to work across all Directorates • Small team of expert Public Health Consultants and

Practitioners with a support team • Health Improvement delivery part of Public Health

transferring to Plymouth Community Healthcare

Office of the Director of Public Health

• The DPH and their specialist public health team will be well placed to work alongside colleagues in the Council to: – tackle the wider determinants of health – promote better health and wellbeing across the life-course, e.g.

through early years services, education, culture, sports and leisure, spatial planning, transport, housing, economic development and regeneration.

• The DPH and their specialist public health team will also be involved with Council colleagues in promoting health-supporting behaviours across the full spectrum of interventions: – from health education and promotion in schools, workplaces

and communities, to regulation for alcohol, tobacco, buildings and environmental protection.

Ten key functions (1 – 5)

1. Providing strategic leadership for improving health and well-being and working with partners to reduce the health inequalities that exist in and between neighbourhoods and communities.

2. Ensuring that Local Public Health Intelligence data, analysis and evidence for the new public health functions across the Council is provided, i.e., for strategic leadership for health, developing health and wellbeing strategies and publishing Director of Public Health independent Annual Reports etc.

3. Jointly identifying public health needs and using research and evidence of what works to improve the health of the whole population.

4. Working with others to influence and address the social determinants of health.

5. Working with colleagues to reduce the level of ill-health and reduce the number of deaths from preventable diseases.

Ten key functions (6 – 10)

6. Advocating for the quality of life for all and ensure that the greatest improvement in quality of life is experienced by those who have the greatest public health needs.

7. Protecting the whole population from hazards and threats to health arising from public health emergencies and being prepared and well equipped to respond to emerging threats to health.

8. Ensuring the public receives the best value for money on public health by regularly reviewing the effectiveness of the ODPH Teams’ business work-plan.

9. Assuring that public health activity is safe, delivered to the highest standards and is led by a qualified and regulated public health workforce.

10. Being a Severn Deanery registered Public Health Training department and participating in the five year training programme for Speciality Registrars in Public Health.

Public Health Outcomes

Public Health Outcomes Framework increased healthy life expectancy

reduced differences in life expectancy and healthy life expectancy between communities

Improving the wider determinants of health

Objective:

Improvements against the wider factors that affect health and well-

being, and health inequalities

Health

Improvement Objective:

People are helped to live healthy lifestyles, make healthy choices

and reduce health inequalities

Health Protection Objective:

The population’s health is protected from major

incidents and other threats,

while reducing health inequalities

Healthcare public health and preventing premature

mortality Objective:

Reduce the number of people living with

preventable ill health and people dying prematurely,

while reducing the gap between communities

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4

Mandatory functions

Mandatory Functions (5) • Comprehensive sexual health services • Health Protection of population • NHS Health Check Assessment • National Child Measurement Programme • Public Health Advice to NHS Commissioners

Discretionary Functions

• Discretionary but highly recommended functions (15 areas)

• Public health services for children and

young people aged 5-19 (including healthy child programme 5-19) and in the longer term all public health services for children and young people

• Interventions to tackle obesity • Accidental injury prevention • Dental public health services • Public mental health services • Tobacco Control & Smoking Cessation • Increasing levels of physical activity • Alcohol and drug misuse services • Locally-led nutrition initiatives • Population level interventions to reduce

and prevent birth defects

• Behavioural and lifestyle campaigns to prevent

cancer and long-term conditions • Local initiatives on workplace health • Public health aspects of promotion of community

safety, violence prevention and response • Supporting, reviewing and challenging delivery of

key public health funded and NHS delivered services

• Public health aspects of local initiatives to tackle social exclusion

• Reduce excess deaths as a result of seasonal mortality

• Initiatives that reduce public health impacts of environmental risks

Other Key Functions

• Commissioning Health Improvement • Public Health intelligence • Joint health and well-being strategy • Joint strategic health needs assessment • Emergency preparedness • Contract(s) management • Partnership working • Workforce development • Team Audit and Review • Team Development • Research and Development • Academic Public Health/MPH

Public Health Settlement

£37 £43 £46 £48 £49 £49 £52

£59 £61 £62 £63 £65 £66

£75 £78 £79

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£70

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Public Health Settlement per head 2013/14 - similar local authority areas

Average

Public Health and Planning

• Health Impact Assessment – large scale and small scale, independent, support colleagues

• Mental Wellbeing Impact Assessment • Environments that support and promote

health and healthy behaviours • Every decision a healthy decision • Every decision mindful of inequalities

The Inequalities Bus Route