The document outlines plans for a new public health system in England, including: 1) Establishing Public Health England to lead nationally on public health and support local authorities. 2) Returning public health leadership to local governments and giving them dedicated funding and responsibilities. 3) Defining the new role of the Director of Public Health to advise local authorities and lead on health strategies. 4) Explaining how public health advice will be accessed by the NHS and clinical commissioning groups.

1. Healthy Lives Healthy People
Lives,
Our strategy for p
gy public health in England
g

2. Secretary of State’s vision
State s
Our mission is to protect the public; and to improve the healthy life expectancy of the
population, improving the health of the poorest, fastest.
Our l
O 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 health
Our i i l
O 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

3. 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

4. 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)

5. 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

6. 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

7. 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 management
All 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
programmes
Obesity 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

8. 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

9. How will GP Commissioning Consortia access public health
advice?
• 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?

10. How will GP Commissioning Consortia access public health
advice – 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

11. 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?