26th May Bchwp Networking Event

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Third sector learning session on NHS Reforms, Public Health reforms and getting ready for new world


  • 1. BCHWP Networking Event 26 thMay 2011 Jim McManus Joint Director of Public Health Public Health Futures: Challenges and Opportunities


  • Health inequalities
  • Need to rebalance hospital and community led care
  • Self Care
  • Infant mortality
  • Lifestyle issues as the basis for
    • six biggest killers smoking , obesity, alcohol, physical activity, alcohol misuse, drug misuse
    • Heaviest burden of long term conditions
    • Diabetes
    • Life expectancy heart disease, cancer, COPD
  • Against backdrop ofChanges to commissioning, Big Society and Localism

4. Life Expectancy at birthof persons by train station across the West Midlands 5. A New Public Health System

  • Public Health England- new national Public Health Service, directly accountable to Secretary of State for Health
  • Return of Public Health leadership toLocal Government
  • Dedicatedresources for Public Healthat local and national levels
  • Focus onoutcomes and evidencebased practice supported by a strong information & intelligence system
  • Maintaining a strong relationship with the NHS, social care and civil society Health & Wellbeing Boards
  • Set out in the Health and Social Care Bill published January 2011.

6. A New Public Health System Local Leadership for Public Health

  • Directors of Public Health- Proposed role
    • Jointly appointed by Local Authority/PHE & employed by LA, with accountability to members and through them to the public
    • Principal adviser on health to LA, members & officers on the full range of LA functions that impact on health
    • Joint lead - Joint Strategic Needs Assessment & Joint Health & Wellbeing Strategy, with Ds of Adult & of Child Services
    • Play a key role in the proposed new Local Authority functions to promote integrated working
    • Advocate for the publics health in the community
    • Produce an authoritative independent Annual Report on health of local population


  • Statutory health and wellbeing boards in every upper-tier local authority established in April 2013 with a minimum membership, including elected representatives, DPH, DASS,DCS, GP consortia, local HealthWatch etc
  • Duty to promote integrated workingbetween NHS and local government, includingservices that impact on wider health determinants (e.g. housing or education).
  • Duties on GP Consortia and local authorities to prepare the joint strategic needs assessment but through the health and wellbeing board.
  • New joint health and wellbeing strategy , prepared by the health and wellbeing board and based on the needs identified in the JSNA , with requirement to consider the use of health act flexibilities (such as pooled budgets) and all local public sector spend in developing the strategy.
  • NHS and local authority commissioners required to have regard to the JSNA and joint health and wellbeing strategywhen developing commissioning plans
  • Local authorities to determine how best to discharge scrutiny powers

A New Public Health System Local Leadershipfor Public Health 8. Public Health Funding & Commissioning Local communities Department of Health including Public Health England NHS Commissioning Board Local Authorities GP Consortia Providers Key Route for funding Route for accountability 9. PH Funding and Commissioning

  • Allocations and the Health Premium
  • Allocations:From April 2013
  • PHE will allocate ring-fenced budgets, weighted for inequalities, to upper-tier and unitary authorities
  • Shadow allocations to LAs in 2012/13 (to help plan)
  • Independent advice to DH on how the allocations are made.
  • Health premium
  • LAs will get an incentive payment, or health premium built on the baseline allocation
  • Based on progress on health improvement & reducing health inequalities (Public Health Outcomes Framework).
  • The premium will be simple and driven by a formula developed with key partners incl. LG representatives, PH experts and academics.

10. PH Funding and Commissioning

  • Accountabilities
  • Secretary of State:
    • Allocation of resources to health and social care
    • Strategy, and legislative and policy framework
    • Progress against national outcomes
  • PHE:Accountable to the Secretary of State
  • Local government
    • Accountable to PHE for public health grant according to conditions
    • Accountable to local populations for outcomes
    • HWBBs charged with assessing and agreeing local priorities
  • Data(from PHE) - performance against outcomes, including:
    • Comparison by local area
    • Incentivisation of improvements
    • Tracking national progress towards health improvement

11. Public Health OutcomesFramework: VISION

  • Domain 1 - Health Protection and Resilience:Protecting the populations health from major emergencies and remain resilient to harm
  • Domain 2 - Tackling the wider determinants of health:Tackling factors which affect health and wellbeing and health inequalities
  • Domain 3 - Health Improvement:Helping people to live healthy lifestyles, make healthy choices and reduce health inequalities
  • Domain 4 - Prevention of ill health:Reducing the number of people living with preventable ill health and reduce health inequalities
  • Domain 5 - Healthy life expectancy and preventable mortality:Preventing people from dying prematurely and reduce health inequalities
  • Consultation question:
  • Do you agree with the overall framework and domains?

To improve and protect the nations health and to improve the health of the poorest, fastest 12. Public Health Outcomes Framework ALIGNMENT WITH NHS AND ASC Adult Social Care Public Health NHS Adult Social Care and Public Health: Maintaining good health and wellbeing. Preventing avoidable illhealth or injury, includingthrough reablement or intermediate care services and early intervention. Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeatemergency admissions. Supporting carers andinvolving in care planning. ASC, NHS and Public Health: The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches.NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants. Awareness and early detection of major conditions

  • Consultation question:
    • Is this the right approach to alignment across the NHS, Adult Social Care and Public Health frameworks?

13. Summary timetable Summary timetable (subject to Parliamentary approval of legislation)Date

  • Consultation on:
  • specific questions set out in the White Paper;
  • the public health outcomes framework; and
  • the funding and commissioning of public health.

Dec 2010March 2011Set up a shadow-form Public Health England within the Department of Health Start to set up working arrangements with local authorities, including the matching of PCT Directors of Public Health to local authority areasDuring 2011Develop the public health professional workforce strategyAutumn 2011Public Health England will take on full responsibilities, including the functions of the HPA and the NTA. Publish shadow public health ring-fenced allocations to local authoritiesApril 2012Grant ring-fenced allocations to local authoritiesApril 2013 14. Overall Transition

  • Accountability for delivery in 2011/12 will continue to rest with SHAs and PCTs.
  • In addition, SHAs will be responsible for the overall transition process in their regions during 2011/12 with co-ordination and leadership for public health from DH.
  • As part of this, Regional Directors of Public Health (RDsPH) will lead the transition for the public health system at the regional and local level.

15. Key Issues wider than PublicHealth

  • Issues
  • Changed NHS
  • Smaller local government
  • Comprehensive Spending Review
  • The Localism agenda
  • Big Society
  • JSNA
  • Stakeholders
  • DsPH
  • GP Consortia/Federations
  • Local Govt
  • Health & Wellbeing Boards
  • Scrutiny
  • HealthWatch
  • Public Health England
  • NHS Commissioning Board

16. What