Equity and Excellence Liberating the NHS Reform of

Equity and Excellence; Liberating the NHS: Reform of the Public Health System Dr Giri Rajaratnam Deputy Regional Director of Public Health, East Midlands and The East Cluster SHA

Health inequalities across Nottingham

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

Model of Health and Wellbeing Variations in health, ill health and wellbeing Ill health and need for care Heart disease, mental health, respiratory disease, cancers, musculo-skeletal, dementia, frailty etc Lifestyles & Behaviour Smoking Nutrition Physical Activity Sexual practices Substance Misuse Wider Determinants of health & the Environment Housing 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 -2002 250, 000 Deaths potentially averted by medical advances Deaths potentially averted by eliminating education-associated excess mortality Deaths Potentially Averted 200, 000 150, 000 100, 000 50, 000 0 - 50, 000 1996 1997 1998 1999 Year Source: Woolf et all. American Journal of Public Health 2007; 97(4): 679 - 683 2000 2001 2002

The Need For Reform 1. 2. 3. 4. 5. Demography and communities Empowering Patients & Public Health Outcome Focus Productivity increases equivalent to £ 20 b International comparisons (particularly cancer) of performance 6. Competition as a stimulant for innovation, improvement and productivity 7. A better balance between private, public and 3 rd sector provision of services

The Health and Care landscape in 2013 S of S and DH Local Government NHS CB PH (England) Health & Well-being Board JSNA to H&WB strategy to Commissioning Plans PH in LA Health. Watch Communities O&SC CCG

NHS Commissioning Board and Clinical Commissioning Groups Functions 1. Understanding health care needs and commissioning services for registered populations 2. Ensuring NHS response to major incidents. 3. Commissioning selected public health interventions (Immunisations and screening) 4. To co-operate with local authorities and participate in the local Health and Wellbeing Group

The New Public Health System THE NEW DUTY (Local Government) “To take such steps as it considers appropriate for improving the health of the people in its area” Includes: 1. Commissioning services 2. Focus on the most disadvantaged 3. Supporting, engaging and developing local communities 4. Ensuring all local government responsibilities are delivered in a way that they promote health & wellbeing.

Local Government Delivering the new Duty 1. Ring fenced financial allocation 2. Specialist Public Health Workforce including Director of Public Health 3. Legislation to support access to data 4. Creation of the Health and Wellbeing Board 5. National Institute for Health and Clinical Excellence and Social Care Institute for Excellence 6. Three overlapping Outcome Frameworks (public health, NHS and Social care)

Health & Wellbeing Board 1. Leadership group for all aspects of health and wellbeing in a locality 2. Involvement of key local leaders 3. Duty to promote integration; planning, commissioning and provision 4. Key outputs: Joint Strategic Needs Assessment and Health Wellbeing Strategy 5. Review Outcomes for local communities

Public Health England Purpose 1. Deliver, support and enable improvements in health and wellbeing 2. Lead on the design, delivery and maintenance of systems to protect the populations against existing and future threats to public health 3. Support local public health teams to deliver their functions 4. Support NHS CB to commission services such as screening and immunisation 5. Producing benchmarked information on the public health outcome framework indicators

Accountability (1) 1. Health & Wellbeing Boards and Local Authorities: accountable to local communities and Overview & Scrutiny Committee 2. CCGs accountable to NHS CB 3. Public Health England NHS CB accountable to Secretary of State for Health through mandates 4. Health & Wellbeing Boards accountable for leading and co-ordinating for health, social and care systems for delivering appropriate outcomes for local communities.

Accountability (2) 1. Three outcome frameworks. Use of incentives aimed at both CCGs and LAs. 2. NO PERFORMANCE MANAGEMENT 3. Transparency of information: regular publication of benchmarked data related to the indicators listed in the three outcome frameworks.

Taking Advantage 1. Thinking about wellbeing and ill health within your community 2. Understanding how the different factors affect health in your local communities 3. Designing interventions or approaches that best meet local needs and designing indicators to help guide implementation 4. Ownership of local communities and leaders

In Conclusion Opportunities for: 1. Enabling the telling of the local story (Outcomes Frameworks) 2. Ensuring “joined up” planning, commissioning and providing 3. Supporting communities and individuals 4. Shaping the place: physically and psychologically

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