healthy lives, healthy people: our strategy for public health in england the white paper in a...

Healthy Lives, Healthy People: Our Strategy for Public Health in

EnglandThe White Paper in a nutshell

Key Underlying Themes

• Need to focus the nation’s resources on the root causes of ill health

• Responsibility needs to be shared right across society

• Local government best placed to influence many of the wider factors affecting health and wellbeing


• Greater emphasis on personal responsibility and efforts to influence personal choice

• Reluctance to legislate or regulate to eliminate personal choice unless all other interventions fail


• Local government and local communities empowered to improve health

• Resources for public health and prevention will be ring-fenced so it can no longer be ‘raided’ for treatment

Key Policy Proposals

S.o.S

Department of Health

CMO

NHS Commissioning BoardPublic Health

England

• Secretary of State will devolve running of health services to NHS Commissioning Board

• Department of Health will retain responsibility for Public Health

• National Public Health Service will be called ‘Public Health England’

• Chief Medical Officer provides independent advice to SoS, leads professional network for Public Health England, and holds DsPH to account

S.o.S


Health Protection

Screening

Immunisations

Health Improvement

PH Research

Sexual Health

PH Intelligence

Child Health Promotion

15% QOF

Drugs & Alcohol

Smoking

Obesity

Health Checks

Nutrition

Health Visiting

School Nursing

Local HPUs

CMO

Public Health Outcomes Frameworkhealth protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health,

healthy life expectancy and preventable mortality

NHS Commissioning Board

Screening, ImmunisationsPH QOF, Contraception, Dental PH

>= £4bn

Public Health England £

• Possibly up to, or more than, £4bn to be taken from NHS budget and given to PH England

• PH England will directly deliver some functions (mainly national emergency response, Screening, Research & Intelligence, local Health Protection Units)

• PH England will devolve some PH commissioning to NHS Commissioning Board

• All Public Health Commissioning & Provision will be guided by a National PH Outcomes Framework with 5 domains of outcome indicators

S.o.S


Health Protection

Screening

Immunisations

Health Improvement

PH Research

Sexual Health

PH Intelligence


15% QOF

Drugs & Alcohol

Smoking

Obesity

Health Checks

Nutrition

Health Visiting

School Nursing

Local HPUs

CMO





>= £4bn

Public Health England £

• PH England Budget will pay for Drugs & Alcohol services, Health Checks, and approximately 15% of QOF payments to GPs for PH related outcomes

• NHS Commissioning Board will be expected to commission primary care provision of some screening, immunisations, contraception and dental public health

• PH England budget will eventually include health visiting and school nursing services although they will be provided by the NHS and commissioned by NHS Board for the next five years

• Old HPA, LHO, NTA functions will transfer to PH England

S.o.S


Local Councils

Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes)

DPH with team of PH professionals

Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report

CMO





GP Consortium

Service Providers

Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector

>= £4bn

Public Health England

£

£

£

£

£

Includes HV & School Nurses for 5 years

• Ring fenced budget, adjusted for need, under section 31 of LG Act 2003, to be given to local government, with LA Chief Executive as accountable officer

• Health Premium additional funding will reward councils for achievement of agreed PH Outcomes under the PH Outcomes Framework

• DPH to be jointly appointed by PH England and Local Government (can be fired by SoS for health protection failure and by LG for failure across full spectrum of responsibilities)

• DPH to be supported by team of PH Professionals (yet to be defined)

• LG will lead on commissioning of health improvement, sexual health services, production of JSNA and support to GP consortia

S.o.S


Local Councils




CMO





GP Consortium

Service Providers


>= £4bn


£

£

£

£

£


• DPH role to include emergency planning and protection against public health threats, health improvement and tackling health inequalities, acting as principal adviser to elected members and officers, acting as advocate of the public’s health in the community, analysing and interpreting evidence, working closely with GPs, and producing and independent annual report on health of local population

• Detailed workforce strategy for PH Autumn 2011

• Local flexibility for LG to structure itself to discharge PH and DPH responsibilities

• HR Framework for staff transfer to LG early 2011

• PH ring fenced budget allocated in shadow form April 2012

S.o.S


Health Protection

Screening

Immunisations

Health Improvement

PH Research

PH Intelligence


15% QOF

Drugs & Alcohol

Smoking

Obesity

Health Checks

Nutrition

Health Visiting

School Nursing

Local HPUs

Local Councils




CMO





Health & Wellbeing Board

Elected members, DAS, DCS, DPH, GP Consortium,

HealthWatch

GP Consortium

Service Providers


>= £4bn


£

£

£

£

£


• Statutory H&WB Board to include minimum of elected members, DAS, DCS, DPH, GP Consortia, local HealthWatch and where appropriate NHSCB

• Boards may invite voluntary groups, clinicians and providers

• GP Consortia, LA and DPH have equal and explicit obligation to prepare JSNA through Board

• Board to develop joint H&WB strategy based on JSNA, providing overarching framework for more detailed commissioning plans for NHS, Social Care, Public Health and other services

S.o.S


Health Protection

Screening

Immunisations

Health Improvement

PH Research

PH Intelligence


15% QOF

Drugs & Alcohol

Smoking

Obesity

Health Checks

Nutrition

Health Visiting

School Nursing

Local HPUs

Local Councils




CMO




Screening, ImmunisationsPH QOF, Contraception, Dental PHResponsibility

Deal



HealthWatch

GP Consortium

Service Providers


>= £4bn


£

£

£

£

£


• New ‘Responsibility Deal’ with business and other partners

• Voluntary agreements with time limits for responsible action

• five networks on food, alcohol, physical activity, health at work and behaviour change

• to be launched early 2011

S.o.S


Health Protection

Screening

Immunisations

Health Improvement

PH Research

Sexual Health

PH Intelligence


15% QOF

Drugs & Alcohol

Smoking

Obesity

Health Checks

Nutrition

Health Visiting

School Nursing

Local HPUs

Local Councils




CMO




Screening, ImmunisationsPH QOF, Contraception, Dental PHResponsibility

Deal



HealthWatch

GP Consortium

Service Providers


>= £4bn


£

£

£

£

£


Unanswered Questions

• Exactly how big a % of NHS spend will be included in the ring-fenced budget?

• Exactly what will it be ring-fenced for?

• Will the % allocated to prevention be sufficient to achieve the scale of public health improvement required?


• How are the public health functions and responsibilities to be effectively balanced / shared between Public Health England, Local Government and the NHS (and GLA in London)?

• Who should be defined as the public health professional workforce?

• Who will employ them?


• What powers will the Health & Wellbeing Board have to influence delivery of public health outcomes?

• Where does mental health improvement fit?

When are these questions likely to be answered?

• Local Areas encouraged to shape structures required to discharge public health functions now

• Shadow form Public Health England to be established during 2011


• Key documents on health visitors, mental health, tobacco control, Outcomes Framework – Winter 2010/11

• Key documents on Responsibility Deal, obesity, physical activity, social marketing, sexual health & teenage pregnancy, pandemic flu – Spring 2011


• Key documents on health protection, emergency preparedness, public health workforce strategy – Autumn 2011

• Shadow public health ring-fenced budget – Spring 2012

healthy lives, healthy people: our strategy for public health in england the white paper in a...

Documents