Healthy Lives, Healthy People Government’s vision for an improved public health system

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Healthy Lives, Healthy PeopleGovernment’s vision for an improved

public health system

Public Health Policy & Strategy UnitJuly 12

We face significant challenges to public health …

•England has one of the highest rates of obesity in the developed world.

•Two thirds of adults are overweight or obese, a leading cause of type 2 diabetes and heart disease

•In 2008-10, the gap between areas with the highest and lowest life expectancy was around 12 years

•Smoking claims over 80,000 lives a year.

•1.6 million people are dependent on alcohol.

•Over half a million new sexually transmitted infections were diagnosed in 2010

•Major health threats persist, ranging from risk of new pandemics to the potential impact of terrorist incidents.

• Drug related crime costs £13.9bn per year• Smoking costs the NHS £2.7bn a year• Obesity costs the NHS £4.2bn a year• Dementia costs the UK £17bn a year• Sexual health treatment costs NHS £1.2bn a year

The challenge: what we are facing and the rationale for change

… with significant costs to health and to the economy

The response

• Health & Social Care Act 2012 makes provision for wholesale system change across health and social care– NHS reform– Refocusing on public health and prevention– Localism– Focusing on outcomes not targets

Vision / OutcomesHow do we

see the future?

Mission What does

the PH system have

to do?

• Focused on outcomes: improve and protect health and wellbeing for all the people of England and reduce health inequalities

• We will have succeeded if, as a nation, we are living longer, and in better health; and if the gap in health between rich and poor is reducing.

• Improving outcomes for all at all stages of the life-course

We will improve and protect health and wellbeing – through:

• Empowering local leadership and encourage wide responsibility across society to improve health and wellbeing, and tackle the wider factors that influence it

• Strengthening self-esteem, confidence and personal responsibility

• Positively promoting healthier behaviours and lifestyles

• Adapting environments to make healthy choices easier

• Protecting the public from health threats – with a strong nationally integrated system that offers expert advice to the NHS, local government and the public

The new Public Health System will build on existing success

The new delivery structure: an integrated whole system approach

The New Public Health System

Government

• DH responsible to parliament, with clear line of sight through system

• Cabinet sub-committee and significant contribution from across departments to improve health outcomes

• CMO to continue to provide independent advice to Government

Public Health England

• New, integrated national body

• Strengthened health protection systems

• Supporting the whole system through expertise, evidence and intelligence

NHS

• Delivering health care and tackling inequalities

• Making every contact count

• Specific public health interventions, such as cancer screening

Local authorities

• New public health functions integrated into their wider role, helping to tackle the wider social and economic determinants of health.

• Leading for improving health and coordinating locally for protecting health

• Promoting population health and wellbeing

Accountable and transparent

Focused on outcomes

• Sets out shared priorities for public health

• Focuses on outcomes not targets

• There is alignment & integration across public health, the NHS and social care

• Takes a life-course approach

• Designed to address the causes of the causes of ill health

• The intention is to incentivise local progress on some indicators

A new Public Health Outcomes Framework that;

At

a gl

ance

- P

ub

lic

Hea

lth

O

utc

om

esF

ram

ewo

rk

Ove

rvie

w o

f ou

tcom

es

and

indi

cato

rs

Ob

ject

ive

Ind

icat

ors H

ealth

care

pub

lic h

ealth

and

pr

even

ting

prem

atur

e m

orta

lity

4

Red

uced

num

bers

of p

eopl

e liv

ing

with

pr

even

tabl

e ill

hea

lth a

nd p

eopl

e dy

ing

prem

atur

ely,

whi

lst r

educ

ing

the

gap

betw

een

com

mun

ities

Inf

ant m

orta

lity

Too

th d

ecay

in c

hild

ren

aged

5 M

orta

lity

from

cau

ses

cons

ider

edpr

even

tabl

e M

orta

lity

from

all

card

iova

scul

ar d

isea

ses

(incl

udin

g he

art d

isea

se a

nd s

trok

e) M

orta

lity

from

can

cer

Mor

talit

y fr

om li

ver

dise

ase

Mor

talit

y fr

om r

espi

rato

ry d

isea

ses

Mor

talit

y fr

om c

omm

unic

able

dis

ease

s

(Pla

ceho

lder

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xces

s un

der

75 m

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in a

dults

with

se

rious

men

tal i

llnes

s (P

lace

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Sui

cide

Em

erge

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read

mis

sion

s w

ithin

30

days

of

disc

harg

e fr

om h

ospi

tal (

plac

ehol

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Pre

vent

able

sig

ht lo

ss H

ealth

-rel

ated

qua

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of li

fe fo

r ol

der

peop

le

(Pla

ceho

lder

) H

ip fr

actu

res

in o

ver

65s

Exc

ess

win

ter

deat

hs D

emen

tia a

nd it

s im

pact

s (P

lace

hold

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Ind

icat

ors

Ob

ject

ive

Hea

lth p

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ctio

n3

The

pop

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s he

alth

is p

rote

cted

from

m

ajor

inci

dent

s an

d ot

her

thre

ats,

whi

lst

redu

cing

hea

lth in

equa

litie

s

Air

pollu

tion

Chl

amyd

ia d

iagn

oses

(15

-24

year

olds

) P

opul

atio

n va

ccin

atio

n co

vera

ge P

eopl

e pr

esen

ting

with

HIV

at a

late

sta

ge o

f in

fect

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Tre

atm

ent c

ompl

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r T

B P

ublic

sec

tor

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tions

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appr

oved

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t pla

ns C

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, agr

eed

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r-ag

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pla

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for

resp

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lic h

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Ob

ject

ive

Ind

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or

s

Hea

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prov

emen

t

2

Peo

ple

are

help

ed to

live

hea

lthy

lifes

tyle

s,

mak

e he

alth

y ch

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s an

d re

duce

hea

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ineq

ualit

ies

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bir

th w

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ast

feed

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okin

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velo

pm

ent a

t 2 –

2.5

ye

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(P

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ess

we

ight

in 4

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nd

10

-11

yea

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lds

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mis

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aus

ed

by

uni

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ntio

nal a

nd

del

iber

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inju

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in u

nde

r 18

s E

mot

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al w

ell-b

ein

g o

f loo

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afte

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lace

hol

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okin

g p

reva

len

ce –

15

year

old

s (P

lace

hold

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Ho

spita

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mis

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ns a

s a

res

ult

of s

elf-

har

m D

iet (

Pla

ceh

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xce

ss w

eig

ht in

adu

lts P

rop

ortio

n o

f ph

ysic

ally

act

ive

and

ina

ctiv

e a

dults

Sm

okin

g p

reva

len

ce –

adu

lts (

ove

r 18

s) S

ucce

ssfu

l com

ple

tion

of d

rug

trea

tme

nt P

eopl

e en

terin

g p

riso

n w

ith s

ubst

ance

dep

end

ence

is

sues

who

are

pre

viou

sly

no

t kno

wn

to c

om

mu

nity

tr

eat

me

nt R

eco

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dia

bete

s A

lco

hol-r

ela

ted

ad

mis

sio

ns t

o h

osp

ital

Ca

nce

r d

iagn

ose

d a

t st

age

1 a

nd 2

(P

lace

hol

der)

Ca

nce

r sc

ree

ning

co

vera

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Acc

ess

to n

on

-ca

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r sc

ree

ning

pro

gra

mm

es T

ake

up

of th

e N

HS

Hea

lth C

heck

pro

gra

mm

e –

by

thos

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le S

elf-

repo

rted

wel

l-bei

ng F

alls

and

fall

inju

ries

in th

e o

ver

65s

Ob

ject

ive

Ind

icat

or

s

Impr

ovin

g th

e w

ider

det

erm

inan

ts

of h

ealth

1

Impr

ovem

ents

aga

inst

wid

er fa

ctor

s w

hich

af

fect

hea

lth a

nd w

ellb

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and

hea

lth

ineq

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ies

Chi

ldre

n in

pov

erty

Sch

ool r

eadi

ness

(P

lace

hold

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Pup

il ab

senc

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irst t

ime

entr

ants

to th

e yo

uth

just

ice

syst

em 1

6-18

yea

r ol

ds n

ot in

edu

catio

n,

empl

oym

ent o

r tr

aini

ng P

eopl

e w

ith m

enta

l illn

ess

and

or d

isab

ility

in

settl

ed a

ccom

mod

atio

n P

eopl

e in

pris

on w

ho h

ave

a m

enta

l illn

ess

or s

igni

fican

t men

tal i

llnes

s (P

lace

hold

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Em

ploy

men

t for

thos

e w

ith a

long

-ter

m

heal

th c

ondi

tion

incl

udin

g th

ose

with

a

lear

ning

diff

icul

ty /

disa

bilit

y or

men

tal i

llnes

s S

ickn

ess

abse

nce

rate

Kill

ed a

nd s

erio

usly

inju

red

casu

altie

s on

E

ngla

nd’s

roa

ds D

omes

tic a

buse

(P

lace

hold

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Vio

lent

crim

e (in

clud

ing

sexu

al v

iole

nce)

(P

lace

hold

er)

Re-

offe

ndin

g T

he p

erce

ntag

e of

the

popu

latio

n af

fect

ed b

y no

ise

(Pla

ceho

lder

) S

tatu

tory

hom

eles

snes

s U

tilis

atio

n of

gre

en s

pace

for

exer

cise

/ he

alth

rea

sons

Fue

l pov

erty

Soc

ial c

onne

cted

ness

(P

lace

hold

er)

Old

er p

eopl

e’s

perc

eptio

n of

com

mun

ity

safe

ty (

Pla

ceho

lder

)

VIS

ION

To

imp

rove

an

d p

rote

ct t

he

nat

ion

’s h

ealt

h a

nd

wel

lbei

ng

an

d im

pro

veth

e h

ealt

h o

f th

e p

oo

rest

fas

test

Out

com

e 1)

Inc

reas

ed h

ealth

y lif

e ex

pect

ancy

, i.e

. tak

ing

acco

unt o

f the

hea

lth q

ualit

y as

w

ell a

s th

e le

ngth

of l

ifeO

utco

me

2) R

educ

ed d

iffer

ence

s in

life

exp

ecta

ncy

and

heal

thy

life

expe

ctan

cy b

etw

een

com

mun

ities

(th

roug

h gr

eate

r im

prov

emen

ts in

mor

e di

sadv

anta

ged

com

mun

ities

)

Ou

tco

me

mea

sure

s

With a ring-fenced resource

• A ring-fenced budget for public health at national and local levels

• Estimated baseline spend for public health = £5.2 billion

• Of this we estimate approximately:

– £2.2 billion will go to local authorities

– £2.2 billion will go to the NHS CB

– £800 million will go to PHE

• Incentives for improvements

– To reward local areas that make progress against key outcomes

– That do not create additional burden or perverse incentives

– Policy to be developed in partnership with local government

• Actual grants announced for 2013/14 in late 2012

The role of the NHS CB

• The NHS CB will be responsible for delivering key public health services. These are:– Immunisation services– Cancer screening services– Non-cancer screening services– Children’s public health services for 0-5 year olds (until

2015)– Child Health Information Systems (CHIS) – Public health services for those in custody settings– Sexual Assault Referral Centres

• The details of this will be set out in an agreement between DH and the NHS CB

Local Authorities

CCGs/NHS CB

PHE (Local)

PHE’s support to the local PH delivery system

• Supporting the development of evidence based improvement initiatives through:

• Provision of Data, Analysis, Intelligence, Evidence and Expertise • Identification, cataloguing and coordination of best practice

• Professional support for the PH workforce (incl appointments and professional accountability)

• Nationwide PH improvement campaigns including behavioural science and insight

• National delivery of health protection including expertise and co-ordination for incidents

• Publication of local PH outcomes

With national expertise – The role of Public Health England

DH and OGDs

International partners

PHE support to national bodies

• Advising Government on the delivery of its policy and strategy for public health, including content of mandate and 7A

• Publishing performance against the PH Outcomes Framework• Supporting DAs on UK wide issues (including chemical hazards and

radiological protection)• Supporting Science and Research to develop and improve the PH

evidence base• Development of the intelligence and analysis to support advances in PH

delivery• Learning from and contributing to international experience and research.• Contributing expert resource to public health emergencies elsewhere in

the world

Devolved Administrations

Science and Research

Local Authorities

CCGs/NHS CB

PHE (Local)

Health & Wellbeing

Board

An effective local delivery system in improving and protecting health and wellbeing

PHE will provide the local health protection service, linking to resilient national service that links to scarce expertise, nationwide intelligence and national leadership for serious incidents

Coordinates local strategy through:

• JSNAs• Joint health and wellbeing

strategy• Review of commissioning

plans• Receives and reviews PHE’s

programme for its locality

LOCAL ROLE RATIONALE

NHS will continue to commission PH services where:• within GPC contract• integral part of pathway• 0-5 services and Health Visitors

CCGs and NHS CB will • Commission healthcare• Commission specific PH services (eg

QoF, Immunisations, Military and Prison health)

PHE local units will be part of local delivery system:

• Providing health protection service and expert advice

• Specialist EPRR function

LAs will take the lead role in PH, commissioning majority of services and assuring and

coordinating through DPH and HWBB

Local Authorities will: • Have a duty to improve health• Bring together holistic approach to

health and wellbeing across full range of their responsibilities

• Receive ring-fenced PH budget• Lead commissioning of public health

services (health improvement, drugs, sexual health)

DPH has specific functions to:• Bring together the local PH system• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB




Local Authorities

CCGs/NHS CB

PHE (Local)

Health & Wellbeing

Board








Local Authorities will: • Have a duty to improve health• Bring together holistic approach to health

and wellbeing across full range of their responsibilities



DPH has specific functions to bring together the local PH system:

• Deliver LA functions• Assure health protection plans• Assure vac and imms and screening• Provide “core offer” to NHS• Produce DPH report• Advise HWBB





LAs will take the lead role in PH, commissioning majority of services and assuring and coordinating through DPH and HWBB

Local Authorities

CCGs/NHS CB

PHE (Local)

Health & Wellbeing

Board






















Local Authorities

CCGs/NHS CB

PHE (Local)

Health & Wellbeing

Board






















We have completed the broad policy design for the new system

1Policy Updates issued in December set out the broad design of the new PH system and roles and responsibilities for the Bodies

Updates issued as a short, CE focused narrative, with linked factsheets for details. Well received for both content and ease of communication. Covered role and function of PHE and local authorities, established commissioning responsibilities

3Baseline public health estimates for public health system published

Key issue for LAs. Publication critical first step. But significant concern over variation and future allocation policy

Next step is to engage on ACRA formula and implications

Update on Public Health Funding published on 14 June

4 The overarching HR framework for the transition programme is in placeHR Concordat and LGA Guidance

Awaiting future policy on pensions

Building a People transition Policy for PHE

Direction for PHE terms and conditions established – negotiations due to conclude in June

PH Outcomes Framework published in January setting out key outcomes for the public health system

2

Implementation activity is underway

1PCTs required to complete plans for the transfer of PH to LAs by 31 March 2012 as part of the NHS planning round

Initial plans received from PCTs. Robust processes in place with Cluster SHAs to assure progress.

Final plans required by 31 March to cover the transfer of responsibilities and staff to Local Authorities

Almost every local area has set up their shadow Health and Wellbeing Board, of which public health is part.

2Appointment of PHE CE completed

PHE Transition Team progressing design and transition process for PHE.

Next steps

• Enabling legislation on;– Arrangements for charging arrangements for LAs– London Health & Wellbeing Board– Mandatory functions for LAs– The role of the DPH in emergency planning and

health protection

• Final advice from ACRA on LA financial allocations and formula for the reward element of the health premium

19

Public health system updates

The new public health system factsheets are available at

http://healthandcare.dh.gov.uk/publichealth

Sign-up to our regular Transforming Public Health bulletin

http://phbulletin.dh.gov.uk/

Contact the DH Public Health England transition team

[email protected]

Contact the DH Public Health Policy and Strategy Unit

[email protected]

Documents

Healthy Lives, Healthy People Government’s vision for an improved public health system