Tim Baxter: Healthy lives healthy people: Healthy lives healthy people
Healthy Lives Healthy People Lives,Our strategy for p gy public health in England g
Secretary of State’s vision State sOur mission is to protect the public; and to improve the healthy life expectancy of the population, improving the health of the poorest, fastest.Our lO values: To seek to prevent harm and reduce the risks of poor health, by early and effective interventions To strengthen responsibility – in individuals, families, communities, business and government – f our health by working t t for h lth b ki together t promote positive actions to th to t iti ti t improve health To do what works, on the basis of evaluation and evidence, focussed on outcomes; recognising the influence of the wider determinants of healthOur i i lO principles: To establish a clear national strategy and world-class public health infrastructure of health protection and for supporting health improvement Locally-led strategies which link across communities and government, seeing health and well-being as i t d ll b i integral to civic and social responsibility lt i i d i l ibilit Partnership, reaching across government, business and the voluntary sector, to create integrated, joined-up strategies Positively supporting the adoption of healthy lifestyles and supporting self-esteem and confidence d fid Actively adapting the environment to make healthier outcomes easier to achieve, reducing potential harm and encouraging healthy choices, especially at key moments in one’s life
Our Health and Wellbeing Today• We are living longer than ever before with dramatic changes in the nature of health over the last 150 years t f h lth th l t – infectious diseases now account for only 2% of deaths – 4 in every 5 deaths occur after the age of 65 – clean air, water, and environmental protection , , p• BUT: success brings new challenges – circulatory diseases account for 34% of deaths – cancers 27% and respiratory diseases 14% – rising prevalence of mental ill-health – persistence of long-term conditions• Lifestyles and behaviours influence our outcomes and inequalities – 21% of the adult population still smoke – 61% of adults are overweight or obese – Fewer than 40% of adults meet physical activity guidelines – 2.4 million adults regularly drink more than recommended
Healthy lives healthy people lives,• Healthy lives, healthy people sets out a framework for tackling some of the most intractable social issues• The White P Th Whit Paper: – starts from the evidence base (Chapter 1) – Articulates a radical new approach to public health including the concept health, of a “ladder of interventions” (Chapter 2) – Takes a life course approach, rather than focusing on specific policy areas such as smoking or obesity (Chapter 3) – S t out a new organisation f public h lth i l di a critical role f Sets t i ti for bli health, including iti l l for local government and a new clarity to central government’s role (Chapter 4)
A new public health system• Public Health England – a national public health service• A return of public h lth l d hi t L t f bli health leadership to Local G l Government t• Professional leadership nationally and locally• Dedicated resources for public health at national and local levels• Focus on outcomes and evidence based practice supported by a strong information & intelligence system• Maintaining a strong relationship with the NHS, social care and civil society S• Set out in the Health and Social Care Bill
The Director of Public Health a proposed role Health,• Will be jointly appointed by the relevant local authority and Public Health England and employed by the local authority with accountability to locally elected members and through them to the public• Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population• Will play a key role in the proposed new functions of local authorities in promoting integrated working• Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children’s Services) Children s• Will continue to be an advocate for the public’s health within the community• Will produce a au o a e a ua report o the health o their local popu a o p oduce an authoritative annual epo on e ea of e oca population
Public health funding and commissioning- examples p Proposed activity to be Proposed Examples of proposed funded from the new commissioning route/s associated activity to be public health budget for activity (including funded by the NHS (provided across all any direct provision) budget (including from sectors) all providers)Infectious disease Current functions of the PHE with supported role Treatment of infectious Health Protection Activity by local authorities disease; co-operation with in this area, and public PHE on outbreak control health oversight of and related activity prevention and control, including co-ordination of outbreak managementAll screening PHE will design, and design NHS Commissioning - provide the quality Board (cervical screening assurance and monitoring is included in GP contract) for all screening programmesObesity programmes Local programmes to Local authority NHS treatment of prevent and address overweight and obese obesity, e.g. delivering the patients, e.g. provision of National Child brief advice during a Measurement Programme easu e e t og a e p a y care consultation, primary ca e co su tat o , and commissioning of dietary advice in a weight management healthcare setting, or services bariatric surgery
How will the NHS access public health advice?• Public health remains critical to the NHS: – many public health-funded services will continue to be delivered through the NHS, largely commissioned via the NHS Commissioning Board – There are huge opportunities to make routine clinical interventions into public health interventions – commissioning will continue to require a population focus to maximise its effectiveness and ensure the system as a whole reduces health inequalities, improving the health of the p q , p g poorest, fastest. ,• DH will use the annual mandate with the Commissioning Board to deliver Secretary of State’s priorities through the NHS. This will need to reflect a range of public health priorities, in particular: – The public health services to be commissioned via the Board p – NHS contributions to public health outcomes – PHE’s “offer” to the NHS – Arrangements for NHS response to the spectrum of outbreaks, ranging from relatively minor outbreaks to the full panoply of emergency planning, resilience and response
How will GP Commissioning Consortia access public healthadvice?• GP commissioning consortia will need to play their full part in the Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy• Consortia will need public health advice on a range of issues, including advice on: – Profiling the local practice and resident population and identifying those at greatest risk – Technical input into some areas of commissioning – Prioritisation and areas for disinvestment – Using evidence on cost and clinical effectiveness to challenge secondary care clinicians – Advising on the evidence-base for patient pathways• Consortia may also need advice on identifying and addressing inequalities, and on understanding local authorities• Where will they get this advice?
How will GP Commissioning Consortia access public healthadvice – some models• Local authorities will provide a core service to the health and wellbeing board to support the JSNA/joint strategy process, but no more. Consortia would have to purchase anything over and above that core offer, or employ their own expertise• Local authorities are funded to provide a comprehensive public health service on demand, free of charge – a PCT type service• There is a defined offer from local authorities, which includes some but not all of the third ill th thi d pillar services i• The Government’s response to the consultations on the White Paper will be Government s published in the Summer and will contain more detail
Some questions• What public health expertise do you want access to in the future as commissioners? As providers?• Would you expect to be able to receive that advice a matter of course from the local Director of Public Health and his/her team or would you prefer to buy in team, public health advice from the market?• what relationship, if any, do you have now with the local Director of Public Health? How would you expect that to change?