the effects of national legislation on the public health role of local government in england oslo,...
TRANSCRIPT
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The Effects of National Legislation on the Public Health Role of Local Government in England
Oslo, December 2015
Professor John Kenneth Davies Centre for Health ResearchSchool of Health Sciences
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Presentation Overview
• Historical perspective
• Health & Social Care Act 2012
• Funding
• Management & operation
• UK context
• Early implementation
• Conclusions
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Historical Perspective
• Health in Towns Commission 1843 & Association 1844
• Public Health Act 1848
• Local Boards of Health 1848-1894
• Urban Districts 1894
• Expanded role 1900-1948
• NHS & Local Authorities 1948-1974
• NHS & Local Authorities1974-2012
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Health and Social Care Act 2012
• Local authorities given responsibility for public health/improving local health (since 1974)
• Director of Public Health
• Health & Wellbeing Boards
• Public Health England – executive agency of DOH
• Public Health Outcomes Framework
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Role of Local Authorities (L/As)
• Localism Act 2011
• Public Services (Social Value) Act 2012
• NHS Bodies & Local Authority (Partnership Arrangements, Care Trusts, Public Health & Local Health Watch) Regulations 2012
• Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013
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Funding
• £6 billion spent annually on public health services
• 2015-2016 DOH ring-fenced grant of £2.79 billion to local authorities for public health
• Local authorities contribute additional £54m to public health in 2013-14 (housing, leisure, adult care, etc)
• 6.2% cut in money received by local authorities for public health in 2015-16
• Health Premium Incentive Scheme
• Current consultation to cut ring-fenced grant by £200m
• Will ring-fencing be removed in future?
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Management & Operation
• 3 domains of public health
• Health improvement
• Health protection
• Health care/public health services
• Variety of organisational structures
• Dedicated team as part of corporate function
• Dispersed across a range of functions
• Key role of Director of Public Health
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Situation in Wales, Scotland & N Ireland
• Size/Scale UK
• 64m (England 54m, Scotland 5m, Wales 3m, NI 2m)
• Divergence of approaches in structure & management
• Scottish Public Health Network
• Public Health Wales
• Public Health Agency of Northern Ireland
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9 Key Areas to improve Public Health & reduce Health Inequalities
• Best start in life
• Healthy schools & pupils
• Helping people find jobs and remain in work
• Active and safe travel
• Warmer and safer homes
• Access to green and open spaces & leisure services
• Strong communities, wellbeing and resilience
• Public protection and regulatory services
• Health and spatial planning
King’s Fund 2013
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Marmot Indicators for Local Authorities
• Give every child the best start in life
• Enable all children, young people and adults to maximise their capabilities, and have control over their lives
• Create fair employment, and good work for all
• Ensure healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill health prevention
• instituteofhealthequity.org
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Initial Impact of Changes in England 1
• Changes welcomed
• Taking whole council approach
• Access to local politicians
• County councils PH links to district councils
• Good links to Clinical Commissioning Groups (CCGs)
• Building neighbourhood and asset based approaches
• Many moving to wider social determinants of health
• Using research and evidence
• Some building on regional developments
- Local Government Association (2014) Public Health Transformation: 9 Months On.
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Initial Impact of Changes in England 2
• PHE have built good working relations with LAs
• Increased transparency of PH spending
• PH funding increased by 5.5% in 2013-14
• Spending in some LA areas not fully aligned with areas of concern
• Department of Health not decided how long ring-fencing should remain and impact of removing it?
- National Audit Office (2014) Public Health England’s Grant to Local Authorities.
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Main Challenges
• Government Austerity Policy
• Impact on poor communities
• Limitations on data availability – PH Outcomes Framework
• Too early to assess whether PH outcomes are improving
• PHE not yet documented coordinated plan
• Capacity of LA PH functions?
• Ability of PHE to influence in absence of ring-fenced funding
• Are PHE giving value for money?
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Future Needs
• Review how best PHE can provide support to PH staff in Local Authorities
• Improved tools and information available to Local Authorities
• Consider how to adapt working relations if ring-fencing removed
• Produce more cross-Whitehall studies
• Department of Health with PHE should codify their respective roles in policy making and speaking to the evidence
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Conclusions
• Leadership
• Funding
• Public health service delivery
• Partnership working
• Data limitations
• Changing focus – public health vision