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Healthy Lives, Healthy People
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the new public health system
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Morrin
Public Health England Transition Team
The new public health system
1. The case for change
2. Local government leading for public health
3. The role of Public Health England
4. The public health workforce
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The case for change
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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
• 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)
CHD
Higher than
expected
need
(Lung) Cancer
Cancers
Diabetes
Neurotic
disorders
Psychotic
disorders
Asthma
Expected level
of need given
population size
Epilepsy
Stroke
Lower than
expected need
COPD
Renal
I Professional
& technical
II - Managerial
IIIN - skilled
(non-manual)
IIIM - skilled
(manual)
Socio-economic class
IV - partly
skilled
V - unskilled
Drug
dependence
Alcohol
dependence
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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.
Following extensive consultation, further details
published in July 2011’s Update and Way Forward
December 2011: finalising key elements of
the design of the new public health system
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The new public health system
leadership role for local authorities
new roles and
responsibilities
supported by a new integrated public health
service, Public Health England
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
clear priorities
public health as a clear priority for Government,
backed by ring fenced resources
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Local government leading for
public health
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Local government leadership
Local government should lead for public health
because of its:
• population focus, as the democratically accountable
stewards of local health and wellbeing
• role as the shaper of place
• ability to address many of the wider social
determinants of health, and
• experience of, and ability to tackle, inequalities in
health.
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 will be under a duty to ensure plans are in place to
protect the local population
Local authority role
Ensuring plans in
place for:
•outbreaks and
emergencies; and
preventing them
occurring
•immunisation and
screening
•infection control
Factsheet: commissioning
responsibilities
How the role will work
• 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 co-ordinate local authority public
health input to LRF 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
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Population health advice to the NHS
Local authorities will provide population healthcare
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
Factsheet: public health advice
to NHS commissioners
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The role of Public Health
England
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PHE’s mission and role
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:
•
•
•
•
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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PHE will work in partnership
with
Local government
PHE will support local
authorities by providing
services, expertise,
information and advice to
ensure action is taken on best
available evidence
NHS Commissioning Board
PHE will provide advice and
service to support
commissioning, support
delivery of service, and ensure
prevention and health
promotion are systematically
addressed
Devolved administrations
PHE will coordinate
nationwide action to tackle
threats to health and enable
effective UK-wide emergency,
resilience and response
arrangements
Expert partners worldwide
PHE will work with partners to
identify, understand and
develop approaches to tackle
health threats, foster
innovation and draw on
behavioural sciences
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PHE will have three functions
delivering
services
• 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
leading for
public
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
workforce
• Public Health England will support the development of the specialist
and wider 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 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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PHE’s status and accountability
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.
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
work.
• We will continue to engage and listen on the details of PHE’s design.
Factsheet: PHE’s status
and accountability
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The public health
workforce
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Public health workforce
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.
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•
•
•
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 are 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.
Factsheet: establishing PHE
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Timeline – policy and system design
End 2010:
July 2011:
Dec 2011:
Jan 2012:
White paper: Healthy Lives, Healthy People
White paper response, confirming new public health
system structure
Complete major elements of the design of the new
system
Public Health Outcomes Framework
finance information
workforce strategy for consultation
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Timeline – Public Health England
Jan 2012:
Building a PHE People Transition Policy published
Apr 2012:
Chief executive designate for PHE appointed
May 2012:
PHE structure agreed
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:
Apr 2013:
Review and agree PHE People Transition Policy for
phase two
PHE established
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Conclusion
• The Government has set out radical plans to reform the public
health system
• At the heart of the new system will be the local leadership
role for local authorities, supported by an integrated
professional public health body, Public Health England
• The NHS will continue to play a vital role in promoting health
• We have set out the core elements of the new system in a
series of policy documents, but
• The success or otherwise of the new system will be down to
effective, local relationships.
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