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Healthy Lives, Healthy Peoplethe new public health system

December 2011

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The new public health system

1. What we are trying to achieve

2. Who does what locally

3. How Public Health England fits in

4. The public health workforce

5. Making it happen

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What we are trying to achieve

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There remains a powerful case for change

We face significant challenges to the public’s 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 remain:in 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.

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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)

I -

Professional

& technical

II - Managerial IIIN - skilled

(non-manual)

IIIM - skilled

(manual)

IV - partly

skilled

V - unskilled

Socio-economic class

CHD

(Lung) Cancer

Cancers

Diabetes

Neuroticdisorders

Psychoticdisorders

Asthma

Epilepsy

Stroke

COPD

Renal

Drugdependence

Alcoholdependence

Higher than expected need

Lower than expected need

Expected level of need given

population size

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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.

December 2011: finalising key elements of the design of the new public health system

Following extensive consultation, further details published in July 2011’s Update and Way Forward

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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

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Who does what locally

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Local government leadership

• 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.

Local government should lead for public health because of its:

Factsheet: local government leading for public health

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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.

Factsheet: local government’s new public health functions

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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

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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

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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 authority’s 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

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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

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

Local authority role How the role will work

Factsheet: commissioning responsibilities

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Population health 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

Local authorities will provide population healthcare advice to the NHS

Factsheet: public health advice to NHS commissioners

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How Public Health England

fits in

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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:

PHE’s mission and role

• 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

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Expert partners worldwidePHE will work with partners to

identify, understand and develop approaches to tackle

health threats, foster innovation and draw on behavioural sciences

Devolved administrationsPHE will coordinate nationwide

action to tackle threats to health and enable effective

UK-wide emergency, resilience and response

arrangements

Local governmentPHE will support local authorities by providing

services, expertise, information and advice to

ensure action is taken on best available evidence

NHS Commissioning BoardPHE will provide advice and

service to support commissioning, support

delivery of service, and ensure prevention and health

promotion are systematically addressed

PHE will work in partnership

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PHE’s culture and values

PHE’s 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.

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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

• 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

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

delivering services

leading for public health

workforce

Factsheet: PHE functions

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PHE’s organisational design

National Office (incl. hubs and supported by

national centres)

Units

Specialist distributed networks

Factsheet: PHE’s organisational design

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• PHE’s 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 system’s 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 Board’s sectors and DCLG resilience hubs.

• Each hub will:• ensure PHE’s 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.

PHE’s National Office

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PHE’s 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.

• PHE’s units will develop from the current health protection units of the Health Protection Agency.

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PHE’s 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 Health’s 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.

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• Some of PHE’s 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.

PHE’s specialist distributed networks

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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.

PHE’s status and accountability

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 PHE’s delivery.

• We will continue to engage and listen on the details of PHE’s design.

Factsheet: PHE’s status and accountability

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Accountability and

governance structure for Public Health

England

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The NHS’s role in public health

• The NHS will continue to play a key role in improving and protecting the public’s 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.

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The public health workforce

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Public health workforce

• 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.

The success of the new system depends on the skills and energies of public health staff – including building relationships to make public health everyone’s business.

Factsheet: establishing PHE

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Making it happen

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TimelineEnd 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.

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Public health system updates

The new public health system factsheets are available athttp://healthandcare.dh.gov.uk/publichealth

Sign-up to our regular Transforming Public Health bulletinhttp://phbulletin.dh.gov.uk/

Contact the DH Public Health England transition teamPublicHealthEngagement@dh.gsi.gov.uk

Contact the DH Public Health Development UnitPublicHealthDevelopmentUnit@dh.gsi.gov.uk