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Healthy Lives, Healthy People the new public health system December 2011

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Title: Healthy Lives, Healthy People the new public health system December 2011


1
Healthy Lives, Healthy People the new public
health system December 2011
2
The new public health system
  • What we are trying to achieve
  • Who does what locally
  • How Public Health England fits in
  • The public health workforce
  • Making it happen

3
  • What we are trying to achieve

4
There remains a powerful case for change
  • We face significant challenges to the publics
    health
  • two out of three adults are overweight or obese
  • smoking costs the NHS 2.7 billion per year. And
    there are wider economic and social costs from
    preventable ill-health drug use and smoking cost
    over 10 billion per year
  • major health threats, ranging from the risk of
    new pandemics to the potential impact of
    terrorist incidents
  • inequalities in health remainin 2008-2010, the
    gap between local authorities with the highest
    and lowest life expectancy was nearly 12 years
    for males and just under 11 years for females.

5
The health inequalities challenge by
socio-economic classes
  • Condition by socio-economic group (rate per
    1,000 reporting long-standing condition by
    socio-economic group of household reference
    person General Household Survey 2006)

6
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.

Following extensive consultation, further details
published in July 2011s Update and Way Forward
December 2011 finalising key elements of the
design of the new public health system
7
The new public health system
leadership role for local authorities
new roles and responsibilities
supported by a new integrated public health
service, Public Health England
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
clear priorities
public health as a clear priority for Government,
backed by ring fenced resources
8
  • Who does what locally

9
Local government leadership
Local government should lead for public health
because of its
  • population focus, as the democratically
    accountable stewards of local health and
    wellbeing
  • role as the shapers of place
  • ability to address many of the wider social
    determinants of health, and
  • experience of, and ability to tackle,
    inequalities in health.

Factsheet local government leading for public
health
10
Local governments 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.

Factsheet local governments new public health
functions
11
Local authority commissioning responsibilities (1)
  • Tobacco control smoking cessation
  • Alcohol and drug misuse
  • Services for children 5-19
  • National Child Measurement Programme
  • Obesity and weight management
  • Local nutrition services
  • Increasing physical activity
  • NHS Health Checks
  • Public mental health services
  • Dental public health services
  • Injury prevention
  • Birth defect prevention
  • Behavioural and lifestyle campaigns to prevent
    LTCs
  • Local initiatives on workplace health
  • Support and challenge of NHS services (imms and
    screening)
  • Public health advice to NHS
  • Sexual health services
  • Seasonal mortality initiatives
  • Local role in health protection incidents
  • Community safety
  • Social exclusion

Indicates mandated services
12
Local authority commissioning responsibilities (2)
  • Changes and further work
  • Abortion services provisionally concluded that
    these should remain within the NHS. Consultation
    to follow.
  • Sexual Assault Referral Centres NHS
    Commissioning Board.
  • Early diagnosis role for PHE and NHS CB.
  • Healthy Child Programme - pregnancy to 5 NHS CB
    in first instance, while health visiting
    workforce is increased. Aim is to unify in local
    government by 2015.

Factsheet commissioning responsibilities
13
Role of the Director of Public Health
  • Leadership role within the local authority for
    the DPH and their team, to exercise these new
    functions
  • DPH should be the lead officer for health and
    championing health across the whole of the
    authority's business
  • we expect there to be direct accountability
    between the director of public health and the
    local authority chief executive for the exercise
    of the local authoritys public health
    responsibilities
  • the DPH should have direct access to elected
    members
  • Produce an annual report
  • Statutory member of Health and Wellbeing Board
    and engaging across the health and wellbeing
    system.
  • Further work to follow on transition process and
    appointments, building on Faculty of Public
    Health standards

Factsheet role of the Director of Public Health
14
Local leadership for health protection
  • Secretary of State responsible for health
    protection via PHE
  • Local authority under a duty to ensure plans are
    in place to protect the local population

Local authority role
How the role will work
  • Ensuring plans in place for
  • outbreaks and emergencies and preventing them
    occurring
  • immunisation and screening
  • infection control
  • DPH leadership, rather than managerial role to
    highlight, advise, challenge and advocate.
  • Supported by PHE expertise and infrastructure
  • NHS commissioners duty to cooperate
  • Lead DPH to coordinate Local Resilience Forum
    emergency planning and response
  • DPH challenge and advice to NHS on local
    screening and immunisation plans
  • Professional relationship between DsPH and the
    Chief Medical Officer

Factsheet commissioning responsibilities
15
Population health advice to the NHS
Local authorities will provide population
healthcare advice to the NHS
  • To support healthcare commissioners, including
    via the JSNA, with strategic population data from
    many sources
  • Applying skills to interpret data
  • Advice at all stages of the commissioning cycle
    alongside
  • advice from new commissioning support
    organisations, which will focus on processes and
    clinical systems
  • PHE role through information and intelligence
    service to LAs e.g. by providing baseline data
  • Further work on role for supporting the NHS
    Commissioning Board and how this advice will meet
    the needs of CCGs

Factsheet public health advice to NHS
commissioners
16
  • How Public Health England
  • fits in

17
PHEs mission and role
Mission to improve and protect the health and
wellbeing of the population, and to reduce
inequalities in health and wellbeing
outcomes. Role work with partners to provide
evidence and intelligence, and the cost-benefit
analysis that will enable local government, the
NHS, and the voluntary, community and social
enterprise sector, among others to
  • invest effectively in prevention and health
    promotion
  • protect the public by providing a comprehensive
    range of health protection services
  • commission and deliver safe and effective
    healthcare services and public health programmes
    across the life course and pathways
  • ensure interventions and services meet the needs
    of different groups in society, advance equality
    of opportunity and reduce inequalities.

Factsheet PHE mission and values
18
PHE will work in partnership
Local government PHE will support local
authorities by providing services, expertise,
information and advice to ensure action is taken
on best available evidence
NHS Commissioning Board PHE will provide advice
and service to support commissioning, support
delivery of service, and ensure prevention and
health promotion are systematically addressed
Expert partners worldwide PHE will work with
partners to identify, understand and develop
approaches to tackle health threats, foster
innovation and draw on behavioural sciences
Devolved administrations PHE will coordinate
nationwide action to tackle threats to health and
enable effective UK-wide emergency, resilience
and response arrangements
19
PHEs culture and values
PHEs chief executive designate and new senior
team will lead the process of developing its
culture and values.
  • PHE will demonstrate these values
  • advocacy for public health across all of its work
  • commitment to open, respectful and constructive
    partnership working
  • culture of subsidiarity
  • scientific and analytical rigour, dedicated to
    providing impartial and objective advice,
    evidence and expert judgement
  • forward looking, flexible, innovative approach
  • strong financial discipline, and commercial
    expertise to enable generation of income
  • valuing staff, inclusive culture, commitment to
    equality and fair opportunity
  • transparency and accountability in the way it
    delivers its functions.

20
PHE will have three functions
  • deliver specialist public health services to
    national and local government and the NHS
  • deliver information and intelligence service to
    support effective action, locally and nationally
  • support the commissioning and delivery of
    effective health and care services and public
    health programmes
  • design and deliver nationwide communications and
    interventions to support the public to protect
    and improve their health

delivering services
  • encourage transparency and accountability across
    the system
  • support public health policy development through
    evidence and advice on the best operational means
    to achieve strategic goals
  • allocate its budget and manage relationships
    effectively to
  • work with partners to build the evidence base
    about what works in improving and protecting
    health and wellbeing
  • act for public health science and delivery on
    the international stage

leading for public health
  • Public Health England will support the
    development of the specialist and wider public
    health workforce

workforce
Factsheet PHE functions
21
PHEs organisational design
National Office (incl. hubs and supported by
national centres)
Units
Specialist distributed networks
Factsheet PHEs organisational design
22
PHEs National Office
  • PHEs national office will act as the service
    centre for the organisation and provide
    leadership, strategic direction and support the
    overall public health system.
  • PHE will build the current systems centres of
    professional, scientific and analytical expertise
    with national centres of expertise and
    excellence.
  • PHE will distribute a small number of national
    office functions across four geographical hubs
    that are coterminous with the NHS Commissioning
    Boards sectors and DCLG resilience hubs.
  • Each hub will
  • ensure PHEs emergency preparedness, resilience
    and response plans are in place
  • quality assure services delivered by Units
  • ensure high-quality advice to the NHS
    Commissioning Board
  • support transparency and accountability across
    the system
  • offer professional support to directors of public
    health.

23
PHEs Units
  • Directors of public health are the local leaders
    for public health
  • Alongside this, PHE will deploy expert and
    specialist capacity at a level that allows it to
    understand and respond to local needs and support
    local leaders.
  • The units main areas of work
  • deliver services and advice to local government,
    the NHS and work in partnership to protect the
    public, involving national centres where
    appropriate
  • make an effective contribution to emergency,
    preparedness, resilience and repose system
  • support effective local action to promote and
    protect health, and wellbeing and tackle
    inequalities.
  • PHEs units will develop from the current health
    protection units of the Health Protection Agency.

24
PHEs Units further design work
Early in 2012 we will seek views of local
authorities and other local partners on how PHE
can best prove its responsiveness and expert
contribution to localities.
  • We will consider how
  • PHE might contribute information and advice to
    the Director of Public Healths independent
    report.
  • Directors of Public Health and PHE can work
    together to determine the contribution of PHE to
    health and wellbeing boards.
  • PHE should organise its working relationships
    with NHS clinical commissioning groups, clinical
    senates and providers.
  • The annual work programme for PHE can best be
    informed by
  • locally specific and relevant indicators
  • any cross-local authority priorities that
    have been identified as being delivered more
    effectively in a collaborative way
  • national priorities as expressed in the
    outcomes frameworks
  • national priorities set by Government.

25
PHEs specialist distributed networks
  • Some of PHEs functions, including its quality
    assurance and information and intelligence
    functions will be repeated and consistent across
    the country, but dependent on strong local
    relationships.
  • Some national functions provided through
    geographically distributed arms of PHE,
    accountable to national office.
  • Others will be replicated across the country.
    Focus on supporting interpretation and use of
    information and intelligence by the local public
    health system.

26
PHEs status and accountability
  • Status as an executive agency
  • As an executive agency of DH, PHE will have the
    operational autonomy to advise Government, local
    authorities and the NHS in a professionally
    independent manner. PHE will be operationally
    independent.
  • PHE will demonstrate transparency through
    developing plans openly, publishing expert
    scientific and public health advice, and
    reporting openly on measures set by Government.
  • Accountability
  • Our plan is that PHE chief executive is
    responsible for day-to-day operations of PHE,
    reporting to the DH permanent secretary and
    accountable to the Secretary of State.
  • The Secretary of State is ultimately accountable
    to Parliament for PHEs delivery.
  • We will continue to engage and listen on the
    details of PHEs design.

Factsheet PHEs status and accountability
27
Accountability and governance structure for
Public Health England
28
The NHSs role in public health
  • The NHS will continue to play a key role in
    improving and protecting the publics health. The
    provision of health services and ensuring fair
    access to those services will contribute to
    improving health and reducing inequalities.
  • The NHS will also continue to commission specific
    public health services and will seek to maximise
    the impact of the NHS in improving the health of
    the public, making every clinical contact count.
  • PHE will have a close working relationship with
    the NHS Commissioning Board.
  • The NHS Future Forum is currently considering how
    the NHS can contribute to improving the health of
    the public. Its interim findings have been
    published on the DH website.

29
  • The public health workforce

30
Public health workforce
The success of the new system depends on the
skills and energies of public health staff
including building relationships to make public
health everyones business.
  • We have a diverse workforce, working for a wide
    range of employers. Through transition, we need
    to ensure all staff are treated fairly and have
    access to exciting opportunities.
  • We are working closely with staff representatives
    and local government to ensure fair and
    transparent process and appropriate terms and
    conditions.
  • We have published an HR Concordat setting out key
    principles. Local Government Group guidance and
    an initial People Transition Policy for PHE to
    follow. The final People Transition Policy will
    follow agreement on terms and conditions.
  • Maintaining a vibrant professional workforce into
    the future will underpin the success of the
    reforms. The workforce strategy will be key to
    this and will be subject to consultation.

Factsheet establishing PHE
31
  • Making it happen

32
Timeline
End 2010 White paper Healthy Lives, Healthy
People July 2011 White paper response,
confirming new public health system structure Dec
2011 Complete major elements of the design of
the new system
  • Jan 2012 Publish the Public Health Outcomes
    Framework, finance information and a workforce
    strategy for consultation
  • Jan 2012 Building a PHE People Transition Policy
    published
  • Jan 2012 Local Government HR local transition
    guidance published
  • Mar 2012 Local transition plans completed
  • Apr 2012 Chief executive designate for PHE
    appointed.
  • Jun 2012 PHE People Transition Policy published,
    with terms and conditions
  • Jul-Oct 12 Confirm PHE employment pools for
    transfers and redeployments. Run pre-transfer
    appointments process to match posts to new PHE
  • Oct 2012 Formally consult with staff and unions
    on PHE transfer process
  • Dec 2012 Review and agree PHE People Transition
    Policy for phase two
  • Apr 2013 Local authorities take new
    responsibilities. PHE established.

33
Public health system updates
The new public health system factsheets are
available at http//healthandcare.dh.gov.uk/publi
chealth Sign-up to our regular Transforming
Public Health bulletin http//phbulletin.dh.gov.u
k/ Contact the DH Public Health England
transition team PublicHealthEngagement_at_dh.gsi.gov
.uk Contact the DH Public Health Development
Unit PublicHealthDevelopmentUnit_at_dh.gsi.gov.uk
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