Health and WellbeingAccelerating transformation and impact

Professor Kevin A. Fenton MD PhD FFPHNational Director, Health and Wellbeing

National Leading Health and Wellbeing Programme 2013/201414 January 2014

Content

Transformation: The new public health system

Public Health England: Mission; role; priorities

Accelerating progress: Scale of the ambition

Challenges and Opportunities

Leadership: In public health; across the system

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TransformationThe new public health system

Health System Transformation • Health & Social Care Act 2012: wholesale

system change across health and social care• National Health Service reform• Refocusing on public health and prevention• Localism• Focusing on outcomes not targets

• Changes implemented from 1 April 2013

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GovernmentDH responsible to parliamentCross-government senior officials

group to improve health outcomes

CMO to provide independent advice to government

Public Health EnglandNew, integrated national expert bodyStrengthened health protection

systemsSupporting whole system with

expertise, evidence and intelligence

NHS EnglandDelivering health care, tackling

inequalitiesMaking every contact count Specific public health interventions,

such as cancer screening

Local authoritiesNew public health functions, helping to

tackle wider determinants of healthLead on improving health and

coordinate protecting healthPromote population health and

wellbeing (DPHs)

The new PH system provides an opportunity for renewed action and improved outcomes

Local leadership in public health• Health and wellbeing boards: central to local

government’s role as public health leaders.• No one size fits all. Boards differ depending on

• Local priorities• Local partners, stakeholders, agendas• Local assets, including VCs and businesses

• Democratic legitimacy • Elected council members• Healthwatch represent views of local people 6

Health and wellbeing boards• Nearly all have produced joint strategic needs

assessments (JSNA) and joint health and wellbeing strategies (JHWS)

• Public health and health inequalities: top priority

• Keen to play bigger role in commissioning services

Source: The King’s Fund. Health and wellbeing boards. One year on. 31 October 2013

Public Health EnglandMission; Role; Priorities

System Leadership: Work transparently, provide government, local government, the NHS, MPs, industry, public health professionals and the public with evidence-based professional, scientific and delivery expertise and advice

Protection: Ensure there are effective national and local arrangements for preparing, planning and responding to health protection concerns and emergencies, including the future impact of climate change

Local Support: Support local authorities and clinical commissioning groups by providing evidence and knowledge on local health needs, alongside practical and professional advice on what to do to improve health

Public Health England

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Help people to live longer and healthier lives

Reduce the burden of disease and disability

Protect the country from infectious diseases and environmental hazards

Support families to give children and young people the best start in life

Improve health in the workplace

PHE’s outcomes focused priorities for FY13/14

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Support people to live healthier lives via NHS Health Checks Promote tobacco control and reduce smoking

Promote healthy weight and tackle childhood obesityImprove recovery rates from drug dependencyImprove sexual health and reduce the burden of STIs

Develop a national programme on mental healthLead gold standards for vaccination and screening programmesMake the case for promoting wellbeing, prevention and early intervention as the best approach to improving health

Partner NHS England to maximise improvements in public health

PHE’s Health and Wellbeing priorities

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Accelerating progressScale of the ambition

Accelerating impact on NCDs• There is a rising tide of Non-Communicable

Disease (NCD) in England.• Many NCDs: associated with inequalities in

health

• UK’s underperformance on premature mortality • Focus on major drivers of disease, disability,

disadvantage and death

Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 997-1020

We need new approaches, new vision• Focus on the risk factors, upstream causes• Maximise impact by working with range of

stakeholders• Shift national focus to prevention and wellbeing:

campaigns and engagement

• Translate evidence into best practice

15 http://www.healthmetricsandevaluation.org; The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4

The burden of disease: risk factors

Focus on the risk factors• NHS Health Check implementation:

- World-leading risk awareness, risk assessment, risk and disease management programme

- Aimed at 15m people (aged 40-74)

- Top ten risk factors for premature death/disability

- Prevent 1,600 heart attacks and strokes, detect 20,000 cases of diabetes or kidney disease earlier, avoid 3,250 premature deaths over 5 years

Focus on the risk factors• High blood pressureAbout 30% of adults in England have high blood pressure1, of whom over 4 million are undiagnosed2.

Of those in treatment, almost 40% have not reduced their blood pressure enough to be deemed ‘controlled’3.

High blood pressure is the second biggest risk factor of disease leading to premature mortality in this country5.

It is a major risk factor for stroke, heart attack, heart failure, chronic kidney disease and cognitive decline 1. Health Survey for England 2011, defined as 140/90mmHg or above, adults as 16+ / 2. Health Survey for England 2011 (34% undetected in women, 39% undetected in men) and ONS mid-2012

England population estimates. Note, the DH CVD outcomes strategy estimated 6.8m (47%) undiagnosed / 3. Health Survey for England 2011 (63% of all men and 61% of women receiving drug treatment now with blood pressure below 140/90mmHg) / 4. Joffres et al. (2013) ‘Hypertension prevalence, awareness…’, BMJ / 5. Global burden of disease: UK study 2013

Maximising impact: working together• PHE engagement with voluntary and

commercial sector: potential for wider impact of NHS Health Check

• PHE support for Health and Wellbeing Boards (15 Centres, local information and intelligence): evidence to inform local health strategy

• PHE work with NICE: translate evidence into practice, improve quality and standards

National focus on prevention Campaigns to shift the debate to health promotion

Be clear on cancerNational bowel campaign: 40% rise in two-week referralsRegional lung campaign:14% rise in diagnoses

Smokefree Homes & Cars37% who saw ads reduced their second-hand smoke85,000 smokefree kits distributed

Smart Restart150,000 families (300,000 children) signed upApp downloaded more than 100,000 times

Stoptober700,000 engaged in 2013200,000 registered for support products

Evidence and best practice• Data that are relevant to local public health

leaders (Longer Lives, Health Profiles, Excess Winter Deaths Index)

• Data that highlight new developments (NCMP: prevalence of obesity reduced for Year 6 children)

• Evaluation of interventions (NHS Health Check)

20 Source: National Child Measurement Programme – England, 2012-13 school Year (NS). Health & Social Care Information Centre. December 11 2013. Accessed at: http://www.hscic.gov.uk/catalogue/PUB13115

Challenges/Opportunities

Challenges: change and complexity• Changes to public health landscape: require

new structures, new relationships

• How will this impact on commissioning and pathways of care (eg: in STIs)

• Economic hardships: how do we assess their impact on public health?

• Our mission to improve health and address inequalities: extremely complex problems

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Opportunities: local agenda, integration• We have an unparalleled opportunity to drive

system transformation

• The new national focus on health and wellbeing follows and complements local government leadership

• A focus on health in all policies: integrating health considerations into broad range of policy areas (employment, education, social policy)

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LeadershipIn public health; across the system

Leadership in public health• We need to change the narrative: from

healthcare to health and resilience

• We need to set out the case for evidence-based interventions to improve health and wellbeing at all levels

Health and Wellbeing Framework

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Leadership in public health• Monitor impact and effectiveness of

interventions

• Highlight areas of concern where there is potential impact on public health

• Set the bar high: a number of other countries have better record on premature mortality than UK

Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 997-1020

Leadership across the systemLeverage opportunities for cross-government health agenda

Housing

Work

Crime and violence

Early intervention

• Good housing drives health• 20,000 excess deaths each

winter

• Work a key health determinant• Poor health keeps people out

of work

• Foundations for every aspect of development laid in childhood

• Alcohol a factor in 44% of violent crime

Physical activity

Healthy Food

Smoking

Healthy community

• Reduces risk of illness by up to 50%

• 2/3 of adults obese or overweight

• 1/3 children in Y6 obese or overweight

• Cost of obesity to NHS £5bn a year

• Isolation significant driver of poor health

• Poor environments lead to social isolation

• Leading cause of premature mortality

• Estimate cost to economy £13bn

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Concluding thoughts

Summary• Greater investment in strengthening health

improvement programmes could be part of solution on NCDs

• We need to focus on integrated, upstream approaches

• Even in environment of localism, areas with limited resources can focus on cost effective population approaches

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Thank youNational Leading Health and Wellbeing Programme 2013/201414 January 2014

Professor Kevin A. FentonNational Director, Health and Wellbeing

Email: Kevin.Fenton@phe.gov.ukTwitter: @ProfKevinFenton