Transcript Document

Healthy Lives, Healthy People
The Public Health White Paper
Karen Wright, Older Adults Lead, Public
Health
www.worcestershire.gov.uk
[Slideshow Title - edit in Headers & Footers]
www.worcestershire.gov.uk
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Summary
• Public health is a priority for this government
• The challenges remain the same - but the delivery system will
be different
• “…we cannot sit back while so many people are suffering
lifestyle-driven ill health and health inequalities…”
• Over prescriptive central planning and lack of a dedicated
budget has stifled progress
• Local government will take the lead for improving the health of
their populations - and there will be responsibility across society
with everyone, including citizens, playing a part
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Policy context
• Coalition values: Freedom, Fairness & Responsibility
• Drive towards localism and ‘Big Society’
• Benefits of good health on economy
• Importance of prevention in ensuring sustainability of NHS
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NHS and social care reforms
• ‘Equity and Excellence: Liberating the NHS’
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Independent NHS Commissioning Board
GP Commissioning Consortia – NB: 3 in Worcestershire
SHAs and PCTs to be abolished
Healthcare providers to be independent
Transfer of responsibility for public health
Health and Well-being Boards
• ‘A Vision for Adult Social Care: Capable Communities and
Active Citizens’
• Personalised prevention services, tailored to local communities
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Background
• High burden of lifestyle related disease:
• Smoking claims 80,000 lives - costs NHS £2.7bn annually
• Among highest levels obesity in the world – costs NHS £4.2bn annually
• 1.6mn people are dependent on alcohol
• Mental health is a vital component of well-being:
• Mental ill-health contributes ¼ total burden of ill health
• Persistent inequalities in health outcomes:
• Life expectancy 7 years less in poorest than richest areas.
• Range of social, economic, environmental and behavioural
influences on health and on choices
• Ongoing significant threats to health - CBRN
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Approach
• Responsive – owned by communities and shaped by their
needs
• Resourced – with ring-fenced funding and incentives to
improve
• Rigorous – professionally-led and focused on evidence;
efficient and effective
• Resilient – strengthening protection against current and future
threats to health
• Least intrusive measures possible
• Coherent approach to different stages of life instead of
tackling risk factors in isolation - with cross government
committee to co-ordinate policy
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Ladder of interventions
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Coherent life course approach (1)
• Giving every child the best start in life:
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Eradicate child poverty by 2020
Free nursery care for pre-school children
Increase number of Health Visitors
Extend Family Nurse Partnerships
Refocus SureStart Children’s Centres
Big role for schools – including Healthy Schools, PHSE, PE & Bikeability
New service vision for school nurses
Promote mental health and early treatment - including talking therapies
Strengthen self esteem and reduce susceptibility to harmful influences
• Making it pay to work:
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Apprenticeships, careers advice and National Citizen Service
Comprehensive welfare reforms
New jobs through local growth
Employers as champions of better health
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Coherent life course approach (2)
• Designing communities for active ageing and sustainability:
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Improve community sports facilities and access to green spaces
Active travel
Walking for Health and Let’s Get Moving
Health Checks
Lifetime Homes and Warm Front
Winter fuel allowance and free bus travel
• Collaboration with business and the voluntary sector through
the Public Health Responsibility Deal:
• Better information for consumers and socially responsible retailing
• Agreements on reduction of salt and trans-fat in food
• Maintain smoke free legislation – and consider extension to plain
packaging and ban on point of sale display
• Reform Licensing Act including ban on alcohol sales below cost
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System - national
• Public Health England:
• Part of DH and accountable to SoS - ring fenced budget around £4bn
• Achieve measurable improvements in health outcomes and protect
against health threats
• National and sub-national infrastructure for health protection, emergency
preparedness, resilience and response - working closely with NHS
• Commissioning of health improvement interventions - via NHSCB or
devolved budgets to local authorities
• Helping citizens take care of their own health
• Intelligence function - PH observatories and cancer registries
• Developing the evidence base – including NIHR school for PH research
• Upholding excellence in PH practice and develop PH workforce
• NHS role:
• Embedded in the mandate SoS sets for NHSCB and thence to GPCC
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The NHS White Paper
Commissioning arrangements
e.g. (?) drug & alcohol,
smoking & obesity, sexual
health, school nursing
e.g. (?) screening,
immunisations, QOF,
health visiting
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System - local
• Local government
• GPCC and GP practices – and wider NHS
• DPH
• Health and Wellbeing Board
• Voluntary sector and local business
• Mobilising and supporting communities
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Local government
• Health and Social Care Bill will give unitary and upper tier local
authorities a duty to improve the health of their population
• Ring-fenced budget
• Ability to bring to bear wider social, economic and
environmental influences on health
• Facilitate and empower voluntary sector, businesses and
individuals to play their part
• Personalise interventions to ensure they are relevant to
communities
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GPCC and GP practices
• Public health outcomes to feature in GPCC performance
framework
• Expected to maximise opportunities for preventive health within
commissioning portfolio
• Quality of primary care contribution to public health will be
measured and published
• Advice and support from local DPH
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DPH
• Requirement for all unitary and upper-tier local authorities
• Jointly appointed by local authority and PHE
• Professionally regulated and accountable to CMO
• Responsibilities:
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“Strategic leader for public health in local communities”
Principal adviser on all health matters to their local authority
Jointly lead development of the JSNA and JHWS
Advocate for the public’s health
Independent annual report
Ensure local preparedness, resilience and response in the face of
threats to health
Support GPCC to secure better health outcomes, better quality of care
and better value for money
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Health and Well-being Board
• Statutory from 2013/14
• Core membership from local authorities and GPCC - additional
membership from others who influence health and well-being
• Principle overarching forum for partnerships to improve health
and well-being
• Integrate commissioning across NHS, public health, social care,
related children’s and other services
• JSNA as a statement of population needs
• JHWS as a summary of how these are to be addressed.
• Ensure that commissioning is consistent with the JSNA/JHWS
• Support joint commissioning and pooled budgets
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Outcomes
• New framework - overlap with NHS and social care outcomes
• Transparency and accountability across public health system
• For local authorities subset linked to a ‘health premium’
• Five domains:
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Health protection and resilience
Tackling wider determinants of ill health
Health improvement
Prevention of ill-health
Healthy life expectancy and preventable mortality
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Transition and timetable
• Legislative basis will be Health and Social Care Bill - Jan 2011
• Consultation until March 2011 – including additional papers on
outcomes and commissioning/funding arrangements
• Accountability in rests with SHAs and PCTs until transferred
• PHE established ‘shadow’ 2011/12 – statutory from 2012/13
• Budgets ‘shadow’ 2012/13 – then ‘real’ from 2013/14
• RDsPH will lead transition at regional and local level
• Detailed work on functions/structures and transition ‘roadmap’
• ‘Assignment’ of staff under HR framework
• PH workforce strategy Autumn 2011
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Opportunities for Worcestershire
• Build on a solid foundation:
• Political ownership at both tiers of local government
• History of partnership working
• In the vanguard of devolved decision making and personalised health
improvement services: HIF, CLFH, development of voluntary sector,
commissioning with tariffs
• Strong local professional team
• Strengthen political leadership:
• Raises profile and priority for Members
• Basis for further engagement with communities
• Re-energise partnerships:
• Central role for Health and Well-being Board
• Integrated Health and Well-being strategy
• Re-define respective roles and responsibilities
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Next steps for Worcestershire
• Conversation and consultation with partners
• Clarity re: scope and budgets
• National and regional transition process
• Establishment of Health and Well-being Board
• PH Excellence and Efficiency programme:
• Prioritisation of resources
• New working arrangements and structures
• Transfer of PH staff
• Strategy development and roll-out
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Healthy Lives, Healthy People
The Public Health White Paper
Karen Wright, Older Adults Lead, Public
Health
www.worcestershire.gov.uk