Public Health and Public Sector Reform

Adding an apostrophe - making a difference

CIPFA North East Conference20 November 2015

What is Public Sector Reform?

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Getting better results (outcomes) that matter to people

For less (resources)

By tackling the real problems

Regardless of institutions boundaries

Public sector reform is really about:

The Public Health ‘System’

Reform of UK Public Health system152 Local Authorities given the statutory duty to improve health

• Public health teams moved to Local Authorities

• c. £3 billion budget for public health services

• Alignment with responsibility for local economy, social care, housing, leisure

• People and Place

PHE created as the first national public health body

• Remit to protect and improve the public’s health

• Freedom to speak and publish the evidence

• Based on values, focussed on evidence, judged on outcomes

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Place-based approach to public health

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Public health advice

Health and wellbeing boardsHealth and wellbeing boards

Local governmentLocal government CCGsCCGsPHE

centreNHSE

area team

• EPPR• Screening and immunisation• Offender public health programmes• Specialised commissioning• Primary care public health programmes

and population healthcare

NHS providers

Non-statutory

providers*People and communities

*Including voluntary and community sector

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PHE provides expert advice to local government

DsPH have influence across all local government spend

PHE provides expertise in local area teams

Embedding ‘making every contact count’

Influence on wider spending in

commercial and voluntary sectors

Clinical Commissioning

GroupsAnd

NHS England

Leverage from the public health grant

Our health challenges

Our health in England today

• Increased life expectancy, BUT more years in poor health and big inequalities.

• This is despite 65+ years of NHS free to all at point of need and doubling of spend on the NHS.

• Need a fundamentally new approach to creating and sustaining health, mental and physical, at every stage of life across all our communities.

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The challenge we face

Health is more than healthcare

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Our task is to address all of these to improve the public’s health

CFOA conference

The main causes of disease are life-style related

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The Challenge we face

…and the inequalities we face.

… across the country

Male life expectancy

Life expectancy at birth for males and females varies by 11 years between the highest and lowest upper tier LA – this difference is directly correlated

with income

Female life expectancy

Social drivers

• Economic prosperity and a good start to life

• While individuals’ behaviours do matter (for example, studies show around half of the health inequalities between rich and poor are the result of smoking), the reality is that our health is impacted by a range of wider determinants including:

• good employment - symbiotic

• higher educational attainment

• safe, supported, connected communities

• poor housing and homelessness

• living on a low income

• social isolation, exclusion and loneliness

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Devolution and Public Health

Devolution

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PHE is a vocal supporter of devolution and place based approaches

Strong voice with GM, London and hopefully in the NE

RoI/economic modelling to support the case

PH already devolved. Focused on how we work, access to national teams and local relationships

Enable cities and sub regions to integrate and benefit from economies of scale and co-commissioning

Be the honest broker in health and care integration speaking the same language as both local government and the NHS

Put prevention at the heart of devolution settlements to deliver demand reduction across organisational boundaries

Championing the link between health and wealth

Influence government for greater legislative powers

Obesity – a case in point

Obesity and Reducing sugar consumption

We are eating too much sugar, and its bad for our health

25% of adults, 19% of 10 + 11 year olds and 10% of 4+ 5 year olds are obese

SACN recommended halving the guidelines on sugar consumption to 5% of calories

PHE has reviewed the evidence on what action would reduce sugar consumption

No silver bullet. Broad range of measures needed. Must tackle food.

Reformulation and portion size , Restrictions on Marketing and Advertising, and fiscal measures likely to have the most impact

Continue to work with DH on a Childhood Obesity Strategy

McKinsey & Company | 21

Looking at just one of the relevant stakeholders – Government – there is a significant coordination challenge

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Impact on obesity

EU Directorates-General UK Central Government, Ministerial Departments UK Central Government, Non-Ministerial Departments

Department for Education

Department for Environment, Food and Rural Affairs

Department for Culture, Media and Sport

Department for Communities and Local Government

Department for Business, Innovation and Skills

Department for Transport

Cabinet Office

Department for International Development

Department for Work and Pensions

HM Treasury

Department of Energy and Climate Change

Ministry of Defense

Ministry of Justice

Department for health

Foreign & Commonwealth Office

Home Office

Scotland Office

Northern Ireland Office

Wales Office

Health & Consumers

Home Office

Communication

Agriculture & Rural Dev.

Budget

Climate action

Comms. Networks

Competition

Energy

Enlargement

Enterprise & Industry

Economic & Financial Affairs

Education & Culture

Employment, SocialAffairs & Inclusion

Environment

EuropeAid

Eurostat

Human Resources & Security

Humanitarian Aid& Civil Protection

Informatics

Internal Market & Services

Maritime Affairs & Fisheries

Mobility & Transport

Regional Policy

Interpretation

Joint Research Centre

Justice

Research & Innovation

Secretariat General

Service for ForeignPolicy instruments

Taxation & Customs

Trade

Translation

Office of Rail Regulation

Ofgem

Ordnance Survey

Serious Fraud Office

Supreme Court of the United Kingdom

Treasury Solicitor's Department

Ofqual

Ofsted

UK Statistics Authority

Water Services Regulation Authority

UK Trade and Investment

The Charity Commission

Competition and Markets Authority

Government Actuary’s Department

HMRC

Land Registry

Crown Prosecution Service

Food Standards Agency

NS&I

National Crime Agency

National Archives

Forestry Commission

EU and UK Government departments with impact on obesity

McKinsey & Company | 22

Interventions sit across a wide range of stakeholders

Schools

Local government

Employers

The NHS

Fast food restaurants

Retailers

Central government

Food producers

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The public

So what about the Accountants?

CIPFA – Aligning Public Services : Spend mapping