Healthier Horizons

The New PH System, National and Local.Maintaining a Focus on Children and Young People

Dr Ann HoskinsInterim Regional Director of Public Health /

Director of Children, Young People and Maternity Services

2

There Remains a Powerful Case for Change

All Cause mortality in Children in European Countries

Health Inequalities

3

Consequences of inaction

• More than half of 15 – 16 year olds had consumed more than five alcoholic drinks in the previous month

• Half of life time mental illness starts by the age of 14

• More than 8 out of 10 adults who have ever smoked regularly start before 19

• 8 out of 10 obese teenagers go on to be obese adults.

Strategic shift from healthier habit

6

Healthy Lives, Healthy People: Our Strategy for Public Health in England

The Government aims to:• empower local leadership to strengthen health and

wellbeing• support self esteem, increased confidence and

personal responsibility• promote healthier behaviour and lifestyles• change the environment to support healthier choices• protect the public from threats to health.

December 2011: finalising key elements of the design of the new public health system

Following extensive consultation, further details published in July 2011’s Update and Way Forward

Leadership role for local authorities – so services are shaped by local needs

Stronger focus health outcomes supported by the public health Outcomes Framework

Public health as a clear priority across government

Supported by a new integrated public health service, Public Health England

The commitment to reduce health inequalities as a priority across the system

1

5

4

3

2

The New Approach to Public Health

8

Local Government Leadership

• Population focus, as the democratically accountable stewards of local health and wellbeing

• Role as the shapers of place• Ability to address many of the wider social

determinants of health, and• Experience of, and ability to tackle, inequalities in

health.

Local government should lead for public health because of its:

Factsheet: local government leading for public health

9

Local Government’s New Functions

New duty to improve the health of the population:

• Commissioning services from a range of providers

• Working with clinical commissioning groups to integrate care pathways

• Using health and wellbeing board to integrate commissioning approaches

• Providing population healthcare advice to the NHS

• Duty to ensure plans in place to protect health.

Local political leadership critical to making this work.

Factsheet: local government’s new public health functions

10

Local Authority Commissioning Responsibilities (1)

• Tobacco control & smoking cessation

•Alcohol and drug misuse

•Services for children 5-19

•National Child Measurement Programme*

•Obesity and weight management

•Local nutrition services

•Increasing physical activity

• NHS Health Checks*

•Public mental health services

•Dental public health services

•Injury prevention•Birth defect prevention

•Behavioural and lifestyle campaigns to prevent LTCs

•Local initiatives on workplace health

• Support and challenge of NHS services (imms and screening)

•Public health advice to NHS*

•Sexual health services*

•Seasonal mortality initiatives

•Local role in health protection incidents*

•Community safety •Social exclusion

* Indicates mandated services

11

Local Leadership For Health Protection

Secretary of State responsible for health protection via PHE

Local authority under a duty to ensure plans are in place to protect the local population

Ensuring plans in place for:

•outbreaks and emergencies; and preventing them occurring

•immunisation and screening

•infection control

• DPH leadership, rather than managerial role to highlight, advise, challenge and advocate.

•Supported by PHE expertise and infrastructure•NHS commissioners duty to cooperate•Lead DPH to co-ordinate local authority public health input to LRF emergency planning and response

•DPH challenge and advice to NHS on local screening and immunisation plans

•Professional relationship between DsPH and the Chief Medical Officer

Local authority role How the role will work

Factsheet: commissioning responsibilities

12

Population Health Advice to the NHS

• To support healthcare commissioners, including via the JSNA, with strategic population data from many sources

• Applying skills to interpret data

• Advice at all stages of the commissioning cycle alongside:

• advice from new commissioning support organisations, which will focus on processes and clinical systems

• PHE role through information and intelligence service to LAs e.g. by providing baseline data

• Further work on role for supporting the NHS Commissioning Board and how this advice will meet the needs of CCGs

Local authorities will provide population healthcare advice to the NHS

Factsheet: public health advice to NHS commissioners

13

• PHE’s national office will act as the service centre for the organisation and provide leadership, strategic direction and support the overall public health system.

• PHE will build the current system’s centres of professional, scientific and analytical expertise with national centres of expertise and excellence.

• PHE will distribute a small number of national office functions across four regions that are coterminous with the NHS Commissioning Board’s sectors and DCLG resilience hubs.

• Each hub will:• Ensure PHE’s emergency preparedness, resilience and

response plans are in place• Quality assure services delivered by centres• Ensure high-quality advice to the NHS commissioning board• Support transparency and accountability across the system• Offer professional support to directors of public health.

PHE’s National Office

Senior Leadership Team

Distributed Evidence and Intelligence Teams

Chief Operating Officer

PHE centre • Develop and maintain key relationships with local government and

provide professional support to enable LAs and other partners maximise health improvement of local population

• Provide health protection services• Provide local NHS with public health advice, including supporting DPH in

their relationship with NHS• Employment and professional development of immunisation and

screening teams• Development of specialist wider PH workforce to support LAs and

manage relationship with local health and education boards (LETBs)• Provide specialist PH support specialised commissioning and dental

commissioning• Oversee drug and alcohol services

18

19

Public Health System Updates

The new public health system factsheets are available athttp://healthandcare.dh.gov.uk/publichealth

Sign-up to our regular Transforming Public Health bulletinhttp://phbulletin.dh.gov.uk/

Contact the DH Public Health England transition teamPublicHealthEngagement@dh.gsi.gov.uk

Contact the DH Public Health Development UnitPublicHealthDevelopmentUnit@dh.gsi.gov.uk

20

Public Health England(National and Regional)

•Delivers national health promotion and prevention campaigns•Infectious diseases national overview •Child and Maternal Health Observatory (CHIMAT)•Inform regional strategic commissioning with NHSCB

Commissioning responsibilities for children, young people and maternal health services in 2013, as of 17 July 2012

National Health Service Commissioning Board•Neonatal care and Screening (ante/post natal)•Immunisation and vaccination (incl. school-based programmes)•Healthy Child Programme 0-5 years including Health Visiting and Family Nurse Partnership (transfers to Local Authorities in 2015)•Child health information service•Primary care including GP contraception •HIV/infectious diseases treatment •Health care in secure settings - Youth Offending Institutes, secure children’s homes and training centres•Community healthcare for military families•Sexual assault and referral centres•Specialised commissioning

Clinical Commissioning Groups•Maternity services•Elective hospital treatment/rehabilitative care •Emergency and urgent care•Community health services i.e. speech and language•Mental health including CAMHS, learning disabilities services•Secondary health care accessed by those in secure settings•Continuing healthcare•Wheelchair services

Local Authority (Public Health)•Healthy Child Programme 5-19 years (incl. school nurses)•National child measurement programme•Tackling obesity/increasing physical activity•Sexual health services inc teenage pregnancy•Substance misuse services (incl. alcohol)•Public mental health services•Community safety/violence prevention /accident prevention

Department of Health

NHSCB Local Area Teams (LATs)• Core functions include CCG development and assurance, quality and safety, partnerships, system oversight• Commissioning GP services, dental, pharmacy, prison health. Some LATs host specialised commissioning teams

Public Health Centres•Support partnerships locally to improve public health outcomes•Health protection services•Employ and develop immunisation and screening teams in LATs•Specialist support to dental and specialised commissioning•Oversee delivery of drug and alcohol services

Joint Working

Joint Working

Joint Working

Health and Wellbeing Boards

22

Health And Wellbeing Boards and Children, Young People and Families

Vision“That Health and Wellbeing Boards make an effective contribution to improving health and wellbeing outcomes for children and young people”

Key Success Factors

• Governance of HAWB should link into CYP partnership

• Holistic Commissioning i.e. commissioning of NHS services for CYP must sit alongside commissioning of all services for CYP

• HAWB should prioritise proven interventions

• Commissioning of services should be informed by engagement of CYP, parents and families

• HAWBs should focus on early intervention, within an overall “life course” approach

Key Strategic Questions & Challenges for HAWBs • Are there effective links between HAWB, Children’s Trust, Safeguarding

Board & CCGs?

• Does HAWB have an agreed process to ensure Children’s issues receive sufficient focus?

• Has the HAWB contributed to defining the early help offer (as recommended by Professor Monro)?

• Is HAWB really listening to views of CYP, parents and families?

• Does JHWS prioritise health needs of children and describe success?

• Have views of frontline staff & clinicians been factored into HAWBs planning?

• Has HAWB got a clear plan to maximise use of public assets to improve health outcomes for CYP?

• Is the HAWB satisfied that the common assessment framework is sufficiently embedded in the local partnership?

Questions?

25