Public Health Reform

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Public Health Reform the Voluntary Community
Faith sector

• Dominic Harrison
• _at_BWDDPH

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Impact of the NHS on Life Expectancy and Infant
Mortality 1900-2021?
Source House of Commons Research Paper, 1999.
99/111 A Century of Change Trends in UK
Statistics since 1900.
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NHS Reform Context

• From 1/4/13 NHS will become a system not an
  organisation.
• Current Government policy is for NHS to be a
  commissioned brand of health services provided
  to specific standards delivered by plurality of
  providers who will be allowed into the market
  by accreditation.
• Specialist Public Health Services, Statutory
  (DPH) functions and NHS prevention spend
  programmes transfer to Local Government from
  1/4/13.
• Local Government will lead the Public Health
  transition from October 12 March 13.
• The new public health system in England will be
  50 local government and 50 Public Health
  England.
• Local Government Specialist PH Services must
  allocate 40 of its capacity to providing NHS
  advice (principally to CCG detailed in MOU)

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Responsibility
Institution
Spatial Level
NHS(CCG, Local Government Health , Wellbeing
SC System) (for policy, performance,
commissioning, scrutiny ,accountability,
governance, engagement)
Secretary of State
Is in charge of all
National
Department of Health
Sets policy for all
Public Health England (EA)
National Commissioning Board/PHE
1 NCB
Health Care Strategy System Management
Performance manages all Spends about 20 of
Local NHS Budget
SHA Cluster (4 NCB)
North
PCT Cluster (50 NCB)
Lancashire
Health and Wellbeing Board
Local
Holds all to account for health
improvement/outcome delivery
Local Authority
Social Care Commissioning (50m) Public Health
Commissioning (15m from 2015)
ICCG ?
Clinical Commissioning Group
Commissions Local NHS services Spends 75 of
Local Budget
Local Authority Public Health Service
Advises all on prevention outcome delivery
spends about 5 (current) local NHS Budget
Clinical Senate
Advises CCG
Childrens and Health Scrutiny Committee/Healthwatc
h/HWB
New local web of Scrutiny
Health-Watch
Represents community to all /CQC
Commissioning Support Unit
Regional/Lancashire Cumbria
Supports the CCG to commission
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Christie Report 2011
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Delivering Public Sector Outcomes
Alcohol, obesity, healthy eating, physical
activity, tobacco control, road traffic
collisions, etc
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NHS Public Health/Prevention Spend Transfer to LAs

• tobacco control
• alcohol and drug misuse services
• obesity and community nutrition initiatives
• increasing levels of physical activity in the
  local population
• assessment and lifestyle interventions as part of
  the NHS Health Check Programme
• public mental health services
• dental public health services
• accidental injury prevention
• population level interventions to reduce and
  prevent birth defects
• behavioural and lifestyle campaigns to prevent
  cancer and long term conditions
• local initiatives on workplace health
• supporting, reviewing and challenging delivery of
  key public health funded and NHS delivered
  services such as immunisation programmes
• comprehensive sexual health services (this
  includes testing and treatment for sexually
  transmitted infections, contraception outside of
  the GP contract, termination of pregnancy, and
  sexual health promotion and prevention
• local initiatives to reduce excess deaths as a
  result of seasonal mortality
• role in dealing with health protection incidents
  and emergencies (Annex B)
• promotion of community safety, violence
  prevention and response and
• local initiatives to tackle social exclusion.

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1This is 11/12 budget inflation uplifted from
10/11 data. Actual 13/14 will depend on ARCA
formula 2 Commissioning budget (5 current PCT
commissioning spend) 230K SPHS 900K
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Health Outcomes Frameworks Public Health, NHS
and Adult Social Care
Public Health
Adult Social Care and Public Health Maintaining
good health and wellbeing. Preventing avoidable
ill health or injury, including through
reablement or intermediate care services and
early intervention.
NHS and Public Health Preventing ill health and
lifestyle diseases and tackling
their determinants. Awareness and early detection
of major conditions
Adult Social Care and NHS Supported discharge
from NHS to social care. Impact of reablement
or intermediate care services on reducing repeat
emergency admissions. Supporting carers and
involving in care planning.
Adult Social Care
NHS
ASC, NHS and Public Health The focus of Joint
Strategic Needs Assessment shared local health
and wellbeing issues for joint approaches.
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Place
People
Services
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(No Transcript)
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What outcomes are the PH Function delivering on
Post 2013

1. Strategic Priorities (whole system) Health
   Improvement (CCG,BWD BC, Third Sector, Community)
   e.g. COPC /CCG Care Strategy
2. DPH Statutory duties (NHS, BwD BC, PHE) e.g. HWB
   Board
3. BWD Borough Council Corporate Plan Health Targets
4. 10.5m PH Prevention Service delivery targets
   (contributing to NHS outcome targets) e.g.
   sexual health
5. Integrated Commissioning Network Service Priority
   targets e.g. wellbeing /LTC Service
6. Public Health Outcomes Framework Targets e.g. TB
   control (integrated PH/Childrens/Social Care
   Outcome Priorities)
7. Health and Wellbeing Board Priority Targets e.g.
   child death rate
8. CCG MOU outcome delivery (service targets
   /analysis etc)
9. Shared BC Directorate (HIAP) targets e.g.20mph,
   Housing, domestic violence etc
10. Shared PCC targets e.g. Violence prevention

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CCG / PH / Local Government Commissioning
NHS
Local Government / Others e.g.PCC?
Shared services
Local Government
CCG
PH
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Integrated Commissioning Network- Joint decision
making and accountability
Corporate Strategy
Single Integrated Plan
Health and wellbeing strategy
Ratification
Council Executive Board
CCG Board
Health and Wellbeing Board
Decision making at agreed delegated level
Officers Sally McIvor Debbie Nixon Dominic
Harrison
Members Chris Clayton Harry Catherall Joe Slater
Cllr Khan
Executive Joint Commissioning Group (Exec JCG)
Recommendation
Officers Sally McIvor Debbie Nixon Dominic
Harrison Linda Clegg
Joint Commissioning and Recommendation Group
(JCRG)
Joint business cases
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1.ACRAs interim recommendations would see
councils in the poorest areas receiving less
money than is currently spent by the NHS on these
services. 2. This reduction in spending on
public health services in poor areas would
compound the effect of other budget cuts that
have disproportionately affected these same
areas- further exacerbating health inequalities.
3.The health premium component of the public
health allocation to local authorities could
further shift resources away from deprived areas
than is implied by the proposed formula. 4. The
use of SMRlt75 in the ACRA formula does not
sufficiently reflect the differences in the level
of poverty between areas that are the main causes
of health inequalities.
Public Health Funding Formula Risk Unfair,
Unjust avoidable aspects of ACRA Recommendations
Figure 1. Change in funding per head of
population that would result from moving from
2010-11 baseline funding to proposed target
allocation. Assumes total budget for public
health services taken on by Local Authorities is
2.2 as estimated by the Department of Health.