Equity and Excellence; Liberating the NHS: Reform of the Public Health SystemDr Giri RajaratnamDeputy Regional Director of Public Health, East MidlandsMidlands and The East Cluster SHA

Health inequalities across Nottingham

Why more of our kids end up arrested, homeless or in hospital over drugs

Male Life Expectancy at Birth: Trends in the Worst and Four Best LA Quintiles in East Midlands, 1995-2009

Model of Health

Health and WellbeingVariations in health, ill health and wellbeing

Ill health and need for careHeart disease, mental health, respiratory disease, cancers, musculo-skeletal, dementia, frailty etc

Lifestyles & BehaviourSmoking Nutrition Physical Activity Sexual practices Substance Misuse

Wider Determinants of health & the EnvironmentHousing Education Employment Safety Culture Poverty

Deaths potentially averted per year in the United States by medical advances and by eliminating education-associated excess mortality: 1996-2002Source: Woolf et all. American Journal of Public Health 2007; 97(4): 679 - 683

The Need For ReformDemography and communitiesEmpowering Patients & Public HealthOutcome FocusProductivity increases equivalent to 20bInternational comparisons (particularly cancer) of performanceCompetition as a stimulant for innovation, improvement and productivityA better balance between private, public and 3rd sector provision of services

The Health and Care landscape in 2013S of S and DHPH (England)NHS CBPH in LACCGHealth & Well-being BoardLocal GovernmentHealthWatchCommunitiesO&SCJSNA to H&WB strategy to Commissioning Plans

NHS Commissioning Board and Clinical Commissioning GroupsFunctionsUnderstanding health care needs and commissioning services for registered populationsEnsuring NHS response to major incidents.Commissioning selected public health interventions (Immunisations and screening)To co-operate with local authorities and participate in the local Health and Wellbeing GroupTo involve patients and the public

The New Public Health SystemTHE NEW DUTY (Local Government)To take such steps as it considers appropriate for improving the health of the people in its area

Includes:Commissioning servicesFocus on the most disadvantagedSupporting, engaging and developing local communitiesEnsuring all local government responsibilities are delivered in a way that they promote health & wellbeing.

Local GovernmentDelivering the new Duty Ring fenced financial allocationSpecialist Public Health Workforce including Director of Public HealthLegislation to support access to dataCreation of the Health and Wellbeing Board National Institute for Health and Clinical Excellence and Social Care Institute for ExcellenceThree overlapping Outcome Frameworks (public health, NHS and Social care)

Health & Wellbeing BoardLeadership group for all aspects of health and wellbeing in a localityInvolvement of key local leadersDuty to promote integration; planning, commissioning and provision Key outputs: Joint Strategic Needs Assessment and Health Wellbeing StrategyReview Outcomes for local communities

Public Health EnglandPurposeDeliver, support and enable improvements in health and wellbeingLead on the design, delivery and maintenance of systems to protect the populations against existing and future threats to public healthSupport local public health teams to deliver their functionsSupport NHS CB to commission services such as screening and immunisationProducing benchmarked information on the public health outcome framework indicators

Accountability (1)Health & Wellbeing Boards and Local Authorities: accountable to local communities and Overview & Scrutiny CommitteeCCGs accountable to NHS CBPublic Health England and NHS CB accountable to Secretary of State for Health through mandatesHealth & Wellbeing Boards accountable for leading and co-ordinating for health, social and care systems for delivering appropriate outcomes for local communities.

Accountability (2)Three outcome frameworks. Use of incentives aimed at both CCGs and LAs.NO PERFORMANCE MANAGEMENTTransparency of information: regular publication of benchmarked data related to the indicators listed in the three outcome frameworks.

Taking AdvantageThinking about wellbeing and ill health within your communityUnderstanding how the different factors affect health in your local communitiesDesigning interventions or approaches that best meet local needs and designing indicators to help guide implementationOwnership of local communities and leaders

In ConclusionOpportunities for:Enabling the telling of the local story (Outcomes Frameworks)Ensuring joined up planning, commissioning and providing Supporting communities and individualsShaping the place: physically and psychologically

Timeline for ChangeMar 2012Local transition plans completedApr 2012Local areas agree arrangements for any in year delegation of functions and secondments/assignment of transferring staff in line with guidanceBy Oct 2012Local area test arrangements for delivery of specific public health services in particular screening and immunisation, and Emergency ResponseOct 2012Agree arrangements on public health information requirements and information governance Jan 2102Ensure final legacy and handover documents completedApr 2013Local authorities formally take on new responsibilities

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