The white paper published in November 2011 set out a powerful case for change. This includes the case set out my Michael Marmot in his report into health inequalities, Fair Society, Healthy Lives This case for change remains, as we set out important progress to setting-up the new public health system.
This slide serves as a quick recap of what the reforms aim to achieve. The following notes provide more detail under each heading 1: Local leadership: Giving this role to local government opens new opportunities for: A clear focus on people, places, empowerment develop holistic solutions, embracing the full range of local services e.g., housing, planning, social care. supported by a ring-fenced budget and with DsPH to lead this work, as the local authority’s principal health adviser 2: A new integrated public health service, Public Health England drive delivery of improved outcomes in health and well-being protect the population from threats to health. integrate the diverse range of public health expertise current distributed across the system. Highest ambition for an internationally-renowned system, including expert intelligence and evidence develop new approaches e.g. behavioural sciences; provide expert and resilient health protection service. 3: Stronger focus on the outcomes we want to achieve A public health outcomes framework, setting out opportunities to improve and protect health and to reduce inequalities require collective efforts of all parts of the public health system, 4: Public health as clearer priority a core part of business across Government with the resources to ensure the focus is maintained integrated as a coherent system 5: Commitment to reduce health inequalities priority for all parts of the public health system drawing on the Marmot review to address the wider determinants complement the role of the NHS to reduce inequalities in access to and outcome from health services.
Note: animated slide DN 13 July : the summary of consultation responses to follow shortly - to be published on DH website.
Broadly, people told us that the Government’s vision for public health is the right one. There is real enthusiasm from local authorities and directors of public health for this new leadership role. Many responses to the consultation set out examples of the public health challenges we face - underlining the need for reform. This included in tackling inequalities
Within support for that broad vision, respondents identified a number of concerns.
NOTE: animated slide This is not a comprehensive list but identifies some of the main areas where we have revised our approach or confirmed proposals in the white paper.
DN 13 July : PHETT will provide more detail of the precise engagement process once finalised. The key message is a commitment to working with stakeholders in these five areas and to step up engagement.
This supplements the previous slide as a table of the top-level next steps across the system.
DN: contacts details of the speaker could be added here
Phe Reforms Dh Update Sept 11 2
Healthy Lives, Healthy People Update and Way Forward Dan Berry and Rumku Basu-Owen 13 September 2011
A powerful case for change <ul><li>The white paper Healthy Lives, Healthy People set out a powerful case for reforming the public health system: </li></ul><ul><ul><li>two out of three adults are overweight or obese </li></ul></ul><ul><ul><li>rates of tuberculosis are rising </li></ul></ul><ul><ul><li>inequalities in health remain: people in the poorest areas live on average 7 years fewer than those in the richest </li></ul></ul><ul><ul><li>Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents. </li></ul></ul><ul><li>We need a new approach to meet these and other public health challenges of the twenty-first century. </li></ul>
Leadership role for local authorities – so services are shaped by local needs Stronger focus health outcomes supported by the public health Outcomes Framework Public health as a clear priority across government – supported by resource Supported by a new integrated public health service, Public Health England The commitment to reduce health inequalities as a priority across the system 1 5 4 3 2 The new approach to public health
Consultation process and response <ul><li>Healthy Lives, Healthy People published November 2010 alongside consultations on outcomes framework and funding and commissioning </li></ul><ul><li>Sought views on Dr Scally’s professional regulation review </li></ul><ul><li>Over 2,100 written responses and 60 consultation events – with the public health profession, local authorities and voluntary sector </li></ul><ul><li>NHS Future Forum report in June 2011 </li></ul><ul><li>Healthy Lives, Healthy People : Update and Way Forward, published 14 July 2011: </li></ul><ul><ul><li>Updates on our progress so far </li></ul></ul><ul><ul><li>Provides information to inform continued local preparations </li></ul></ul><ul><ul><li>Sets out where further development is required </li></ul></ul><ul><li>This is subject to the Health and Social Care Bill </li></ul>
What respondents liked <ul><li>Enthusiasm for the new leadership role for local government </li></ul><ul><li>Strengthening central government’s focus on public health </li></ul><ul><li>The local system supported by a new integrated public health service – Public Health England </li></ul><ul><li>Commitment to the ‘Marmot agenda’ for addressing health inequalities </li></ul><ul><li>Proposals for a public health Outcomes Framework </li></ul><ul><li>Proposed commissioning routes for public health… though with concerns about some of the detail. </li></ul>
Criticisms, concerns and suggestions <ul><li>Independent advice: preserving the ability to provide independent advice to local and national government </li></ul><ul><li>More clarity on the role of the director of public health across the ‘three domains’. </li></ul><ul><li>Fear of fragmenting commissioning responsibilities </li></ul><ul><li>Questions about roles in incidents and emergencies </li></ul><ul><li>Questions about the size and scope of the ring-fenced budget </li></ul><ul><li>Clarity about specialist roles across the new system, the workforce transition, the importance of training and professional regulation. </li></ul>
Directors of Public Health : reaffirmed role in advising the LA, on health and wellbeing board, working with PHE and in population healthcare Given the importance of the Director of Public Health role , we would expect it to have Chief Officer status . Mandated functions kept to a minimum : including sexual health services and core offer of public health advice. More work to come Public Health England to operate across the three domains of public health. As an executive agency, able to provide expert and evidence-based advice Clear line of sight . Secretary of State is accountable to Parliament, leads the public health cabinet sub-committee and sets direction for PHE Commissioning responsibilities across PHE, local authorities and NHS Commissioning Board to empower communities and avoid fragmentation Workforce strategy to ensure a professional public health workforce and rewarding careers Gather further evidence from stakeholders on the most appropriate system for regulating public health professionals
Further developments <ul><li>A number of issues require further development </li></ul><ul><li>We will step up work with stakeholders to develop credible policy and implementation plans over the coming months </li></ul><ul><li>We will produce in the autumn a series of Public Health System Reform Updates : </li></ul><ul><ul><li>The public health Outcomes Framework </li></ul></ul><ul><ul><li>Operating model for PHE </li></ul></ul><ul><ul><li>Public health in local government and the DPH role </li></ul></ul><ul><ul><li>Public health funding </li></ul></ul><ul><ul><li>Workforce strategy </li></ul></ul>
Commitment to co-design <ul><li>We are committed to working with stakeholders during the autumn to co-design these five system reform updates </li></ul><ul><li>To support this, the CMO has established a Public Health Engagement Group , chaired by Chris Bull, chief executive of Herefordshire Council </li></ul><ul><li>The Public Health Engagement Group will: </li></ul><ul><ul><li>Provide advice and challenge on the five system reform updates, working alongside DH policy leads </li></ul></ul><ul><ul><li>Support wider engagement with stakeholders </li></ul></ul><ul><li>The Public Health Engagement Group will operate in the autumn alongside a range of existing engagement events </li></ul>
Key issue next steps Public health funding Further work to finalise the funding arrangements. Public health commissioning Continue work to finalise commissioning routes and to minimise risk of fragmentation. Outcomes Framework Further work to finalise the Outcomes Framework Public Health England Approval process for an Executive Agency. Alongside development of operating model. Local authority and PHE relationships. Working with stakeholders on relationship between PHE and local – including DPH role Commissioning advice Strong commitment to this ‘third pillar’. Further work with stakeholders on the detail. Workforce Workforce Strategy due in Autumn. A working group is ongoing, alongside other HR engagement. Emergency preparedness Further work with key stakeholders based on principles set out in July 2011
Contact details and further information <ul><li>Update and Way Forward available at: </li></ul><ul><li>www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128120 </li></ul><ul><li>Contact the DH Public Health England transition team </li></ul><ul><li>[email_address] </li></ul><ul><li>Contact the DH Public Health Development Unit </li></ul><ul><li>[email_address] </li></ul><ul><li>Information about the overall modernisation process (and where publications and letters are stored): </li></ul><ul><li>http://healthandcare.dh.gov.uk/ </li></ul>