Health and Wellbeing

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Transcript Health and Wellbeing

Health and Wellbeing

Accelerating transformation and impact

Professor Kevin A. Fenton MD PhD FFPH National Director, Health and Wellbeing

National Leading Health and Wellbeing Programme 2013/2014 14 January 2014



1 2 3


The new public health system

Public Health England:

Mission; role; priorities

Accelerating progress:

Scale of the ambition 4 5

Challenges and Opportunities Leadership:

In public health; across the system


The new public health system


Health System Transformation

• Health & Social Care Act 2012: wholesale system change across health and social care • National Health Service reform • Refocusing on public health and prevention • Localism • Focusing on outcomes not targets • Changes implemented from 1 April 2013

The new PH system provides an opportunity for renewed action and improved outcomes


DH responsible to parliament Cross-government senior officials group to improve health outcomes CMO to provide independent advice to government

Public Health England

New, integrated national expert body Strengthened health protection systems Supporting whole system with expertise, evidence and intelligence

Local authorities

New public health functions, helping to tackle wider determinants of health Lead on improving health and coordinate protecting health Promote population health and wellbeing (DPHs)

NHS England

Delivering health care, tackling inequalities Making every contact count Specific public health interventions, such as cancer screening


Local leadership in public health

• Health and wellbeing boards: central to local government’s role as public health leaders .

• No one size fits all. Boards differ depending on • • Local priorities Local partners, stakeholders, agendas • Local assets, including VCs and businesses • Democratic legitimacy • • Elected council members Healthwatch represent views of local people

Health and wellbeing boards

• Nearly all have produced joint strategic needs assessments (JSNA) and joint health and wellbeing strategies (JHWS) • Public health and health inequalities: top priority • Keen to play bigger role in commissioning services Source: The King’s Fund. Health and wellbeing boards. One year on. 31 October 2013

Public Health England

Mission; Role; Priorities


Public Health England

System Leadership:

Work transparently, provide government, local government, the NHS, MPs, industry, public health professionals and the public with evidence-based professional, scientific and delivery expertise and advice


Ensure there are effective national and local arrangements for preparing, planning and responding to health protection concerns and emergencies, including the future impact of climate change

Local Support:

Support local authorities and clinical commissioning groups by providing evidence and knowledge on local health needs, alongside practical and professional advice on what to do to improve health


PHE’s outcomes focused priorities for FY13/14

1 2 Help people to

live longer and healthier lives

Reduce the

burden of disease and disability

3 Protect the country from

infectious diseases and environmental hazards

4 Support

families to give children and young people

the best start in life 5 Improve

health in the workplace

PHE’s Health and Wellbeing priorities

1 2 Support people to live healthier lives via

NHS Health Checks


tobacco control

and reduce smoking 3 4 5 6 Promote healthy weight and tackle childhood


Improve recovery rates from

drug dependency


sexual health

and reduce the burden of STIs Develop a national programme on

mental health

Lead gold standards for vaccination and

screening programmes

7 8 Make the case for promoting


, prevention and early intervention as the best approach to improving health 9 Partner

NHS England

to maximise improvements in public health

Accelerating progress

Scale of the ambition

Accelerating impact on NCDs

• There is a rising tide of Non-Communicable Disease (NCD) in England.

• Many NCDs: associated with inequalities in health • UK’s underperformance on premature mortality • Focus on major drivers of disease, disability, disadvantage and death Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 997 1020

We need new approaches, new vision

• Focus on the risk factors, upstream causes • Maximise impact by working with range of stakeholders • Shift national focus to prevention and wellbeing: campaigns and engagement • Translate evidence into best practice

The burden of disease: risk factors

15; The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4

Focus on the risk factors

• NHS Health Check implementation: - World-leading risk awareness, risk assessment, risk and disease management programme - Aimed at 15m people (aged 40-74) - Top ten risk factors for premature death/disability - Prevent 1,600 heart attacks and strokes, detect 20,000 cases of diabetes or kidney disease earlier, avoid 3,250 premature deaths over 5 years

Focus on the risk factors

• High blood pressure About 30% of adults in England have high blood pressure 1 , of whom over 4 million are undiagnosed 2 . Of those in treatment, almost 40% have not reduced their blood pressure enough to be deemed ‘controlled’ 3 . High blood pressure is the second biggest risk factor of disease leading to premature mortality in this country 5 .

It is a major risk factor for stroke, heart attack, heart failure, chronic kidney disease and cognitive decline 1. Health Survey for England 2011, defined as 140/90mmHg or above, adults as 16+ / 2. Health Survey for England 2011 (34% undetected in women, 39% undetected in men) and ONS mid-2012 England population estimates. Note, the DH CVD outcomes strategy estimated 6.8m (47%) undiagnosed / 3. Health Survey for England 2011 (63% of all men and 61% of women receiving drug treatment now with blood pressure below 140/90mmHg) / 4. Joffres et al. (2013) ‘Hypertension prevalence, awareness…’, BMJ / 5. Global burden of disease: UK study 2013

Maximising impact: working together

• PHE engagement with voluntary and commercial sector: potential for wider impact of NHS Health Check • PHE support for Health and Wellbeing Boards (15 Centres, local information and intelligence): evidence to inform local health strategy • PHE work with NICE: translate evidence into practice, improve quality and standards

National focus on prevention

Campaigns to shift the debate to health promotion

Be clear on cancer National bowel campaign: 40%

rise in two-week referrals

Regional lung campaign:14%

rise in diagnoses

Smokefree Homes & Cars 37%

who saw ads reduced their second-hand smoke


smokefree kits distributed

Smart Restart 150,000 families (300,000 children)

signed up App downloaded more than



Stoptober 700,000

engaged in 2013


registered for support products

Evidence and best practice

• Data that are relevant to local public health leaders (Longer Lives, Health Profiles, Excess Winter Deaths Index) • Data that highlight new developments (NCMP: prevalence of obesity reduced for Year 6 children) • Evaluation of interventions (NHS Health Check) 20 Source: National Child Measurement Programme – England, 2012-13 school Year (NS). Health & Social Care Information Centre. December 11 2013. Accessed at:



Challenges: change and complexity

• Changes to public health landscape: require new structures, new relationships • How will this impact on commissioning and pathways of care (eg: in STIs) • Economic hardships: how do we assess their impact on public health? • Our mission to improve health and address inequalities: extremely complex problems


Opportunities: local agenda, integration

• We have an unparalleled opportunity to drive system transformation • The new national focus on health and wellbeing follows and complements local government leadership • A focus on health in all policies: integrating health considerations into broad range of policy areas (employment, education, social policy)


In public health; across the system


Leadership in public health

• We need to change the narrative: from healthcare to health and resilience • We need to set out the case for evidence-based interventions to improve health and wellbeing at all levels Health and Wellbeing Framework

Leadership in public health

• Monitor impact and effectiveness of interventions • Highlight areas of concern where there is potential impact on public health • Set the bar high: a number of other countries have better record on premature mortality than UK Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 997-1020


Leadership across the system

Leverage opportunities for cross-government health agenda

Housing • • Good housing drives health 20,000 excess deaths each winter Physical activity • • Reduces risk of illness by up to 50% 2/3 of adults obese or overweight Work • • Work a key health determinant Poor health keeps people out of work Crime and violence • Alcohol a factor in 44% of violent crime Early intervention • Foundations for every aspect of development laid in childhood Healthy Food • • 1/3 children in Y6 obese or overweight Cost of obesity to NHS £5bn a year Smoking • • Leading cause of premature mortality Estimate cost to economy £13bn Healthy community • • Isolation significant driver of poor health Poor environments lead to social isolation

Concluding thoughts



• Greater investment in strengthening health improvement programmes could be part of solution on NCDs • We need to focus on integrated, upstream approaches • Even in environment of localism, areas with limited resources can focus on cost effective population approaches

Thank you

National Leading Health and Wellbeing Programme 2013/2014 14 January 2014

Professor Kevin A. Fenton National Director, Health and Wellbeing Email: [email protected]

Twitter: @ProfKevinFenton