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Changes to Public Health in the NHS, how will it work in the future?

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Changes to Public Health in the NHS, how will it work in the future? Dr Mark Kroese UKGTN Public Health Advisor Genetic Alliance UK 22nd Annual General Meeting – PowerPoint PPT presentation

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Title: Changes to Public Health in the NHS, how will it work in the future?


1
Changes to Public Health in the NHS, how will it
work in the future?
  • Dr Mark Kroese
  • UKGTN Public Health Advisor
  • Genetic Alliance UK
  • 22nd Annual General Meeting
  • 1 November 2011

2
  • Outline
  • Introduction to Public Health
  • Current Public Health structures in England
  • Proposed new structures for Public Health in
    England
  • Example of possible impact with specific
    reference to population screening services
  • Conclusion

3
Public Health is..
  • The Science and Art of
  • preventing disease, prolonging life and
  • promoting health through the organised
  • efforts of the society
  • (Sir Donald Acheson, Public Health in England
    Report of the Committee of Inquiry into the
    Future Development of the Public Health Function,
    1988 )

4
Three Key Domains
5
Health Protection
  • Infectious diseases
  • Chemicals and poisons
  • Radiation
  • Emergency response
  • Environmental health hazards
  • Surveillance

6
Health Improvement
  • Smoking
  • Alcohol
  • Obesity
  • Healthy eating
  • Physical activity
  • Sexual health

7
Improving Health Services
  • Clinical effectiveness
  • Efficiency
  • Service planning
  • Audit and evaluation
  • Clinical governance
  • Equity

8
Wider determinants of health
9
The Current Structure
Secretary of State for Health
Department of Health and NHS Executive
Monitor
Strategic Health Authorities Strategic Direction
and Performance Management
Specialised services
Primary Care Trusts Commissioning / Planning /
Agreement of Secondary Care
GPs (PBC)
PCT Provider Services GPs, Dentists Optometrists
, Pharmacists Walk-in Centres, NHS Direct Social
Care
Care Trusts
Mental Health Trusts
NHS Trusts
Ambulance Trusts
Foundation Trusts
Ind Sector
Provision of all local health and care services
10
The Current Structure
Secretary of State for Health
CMO PH team
Department of Health and NHS Executive
Monitor
Strategic Health Authorities Strategic Direction
and Performance Management
RDPH PH team
Specialised services
Primary Care Trusts Commissioning / Planning /
Agreement of Secondary Care
GPs (PBC)
DPH PH team
PCT Provider Services GPs, Dentists Optometrists
, Pharmacists Walk-in Centres, NHS Direct Social
Care
Care Trusts
Mental Health Trusts
NHS Trusts
Ambulance Trusts
Foundation Trusts
Ind Sector
Provision of all local health and care services
11
  • In addition
  • Health Protection Agency
  • Public Health Observatories
  • National NHS bodies e.g. NICE
  • Department for International Development
  • Universities

12
  • NHS White Paper Equity and Excellence (DH 2010)
    states that PCT responsibilities for local health
    improvement will transfer to local authorities
    (LAs)
  • NHS White Paper Healthy Lives, Healthy People (DH
    2011) reiterated that each upper tier/unitary
    authority will lead a statutory Health and
    Wellbeing Board (HWB).
  • Power and responsibility for commissioning
    services devolved to the healthcare professionals
    closest to patients GPs and their practice teams
    working in consortia.

13
  • Upper tier local authorities will have a role
    across the three domains of public health.
  • Prescribed functions to be delivered by local
    authorities will include
  • appropriate access to sexual health services
  • Director of Public Health has a duty to ensure
    there are plans in place to protect the
    health of the population
  • ensuring NHS commissioners receive the public
    health advice they need
  • the National Child Measurement Programme
  • NHS Health Check assessment
  • elements of the Healthy Child Programme

14
Proposed Structure
15
Proposed Structure
16
  • New integrated public health service Public
    Health England - will include
  • Health Protection Agency (HPA)
  • National Treatment Agency for Substance Misuse
    (NTA)
  • Public Health Observatories
  • Cancer Registries

17
  • Public Health England will have three principal
    routes for funding services
  • granting the public health ring-fenced budget
    to local government
  • asking the NHSCB to commission services, such
    as screening services, and the relevant elements
    of the GP contract and
  • commissioning or providing services directly,
    for example national purchasing of vaccines,
    national communication campaigns, or health
    protection functions

18
Roles in the new Public Health System
  • Duty to improve health
  • Brings together holistic approach to health and
    wellbeing
  • Employ DPH
  • Ringfenced PH budget
  • Mandated services

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

CCGs/NHS CB
  • Commissioning healthcare
  • Commissioning some public health services

PHE (local units)
  • Local Health Protection Services (functions in
    development)

Health and Wellbeing Board
  • Coordinates local strategy through
  • JSNA
  • Review of commissioning plans

19
  • UK National Screening Committee
  • criteria for appraising the viability,
    effectiveness and appropriateness of a
    screening programme
  • developed policies on screening for dozens of
    conditions
  • overseen the successful introduction of a
    number of national screening programmes in
    England
  • raised the profile of screening within the NHS
    and with the general public

20
Screening programme
Antenatal screening programmes
Infectious diseases (IDSP)
Fetal anomalies and Downs Syndrome (FASP)
Sickle cell and thalassaemia (SCTSP)
Newborn, infant and children
Sickle cell disease (SCTSP)
Disorders identifiable in newborn bloodspot (NBBSSP) Cystic fibrosis, Medium chain acyl CoA dehydrogenase deficiency (MCADD), Phenylketonuria (PKU), congenital hypothyroidism
Hearing loss (NHSP)
Congenital conditions identifiable through physical examination (NIPESP)
Adult non cancer screening programmes
Diabetic retinopathy (NSPDR)
Abdominal aortic aneurysm (NAAASP)
Adult cancer screening programmes
Breast cancer (BCSP)
Cervical cancer
Bowel cancer
21
(No Transcript)
22
  • Issues to consider in future regarding screening
  • NSC will exist as part of PHE
  • Commissioning of screening services by NHSCB
  • Antenatal screening services part of maternal
    care which will be commissioned by CCGs
  • Local responsibility for population screening
    programmes remains unclear

23
Timeline
End of 2010 White paper Healthy Lives, Healthy
People July 2011 White paper response,
confirming new public health system structure By
end 2011 complete the operational design of the
new system, including the PHE Operating Model,
how the local system will work, and their
links into the NHS. Spring 2012 chief executive
and senior team for Public Health England
appointed. April 2012 start of transition
year April 2013 Public Health England
established April 2013 Local authorities take on
their new public health responsibilities
24
  • Thank you
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