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The new public health systemour role in improving and protecting health and

wellbeing; and the transition process

This presentation will cover…

1. Context of the public health reforms2. Vision for a new public health system3. What the new locally-led system will look like4. Local system transition5. Workforce and HR issues6. Discussion

Health and wellbeing reforms:

setting the context

Across the health and care system

• Rising demand and treatment costs

• Need for improved healthcare services – and reduced variation in health outcomes

• Need for better value for money

The modernisation programme will:

• Put clinicians and local communities in the driving seat

• Provide a greater voice for patients and the public

• Increase accountability – locally and nationally

• Support a greater focus on public health

Context

Ministers and the Department of Health

natio

nal

local

Patients and the public

Public Health NHS Adult Social Care

Overview of health and social care structures from April 2013

Public Health England (part of DH)

Care Quality Commission, including HealthWatch England

Social care

providers

NHS providers, inc:•Foundation Trusts & NHS Trusts•Primary care providers•Independent / 3rd sector providers

Localauthorities

NHS CB

NHS Trust Develop-

ment Authority

Monitor

CCGsLocal

authorities

National Institute for Health and Clinical Excellence

Health and Care Information Centre

Public health

providers

Local HealthWatch (formerly LINks)

Health and Wellbeing Boards (part of local authorities)

Modernisation timeline

Our vision for public health

A powerful case for change

The white paper Healthy Lives, Healthy People set out a powerful case for reforming the public health system:

• two out of three adults are overweight or obese

• smoking costs the NHS £2.7 billion per year

• rates of tuberculosis are rising

• inequalities in health remain: people in the poorest areas live on average 7 years fewer than those in the richest

• Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents.

We need a new approach to meet these and other public health challenges of the twenty-first century.

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

An effective public health system…

• Accounts for the changing nature, assets and strengths of the population – is vigilant for new health threats

• Ensures economic development creates health and wellbeing

• Advocates wise use of environmental resources • Promotes individual and community wellbeing• Helps people limit behaviours damaging to their health.• Secures equitable access to good quality health and social

care, with prevention incorporated into all contacts.• Systematically works to reduce health inequalities and

embeds health and wellbeing in all policies.

the new locally-led public health system

• Drive knowledge and analysis of population assets and needs.

• Consider whole population outcomes and set goals.• Inform all health and social care commissioning using

preventive approach.• Incorporate health and wellbeing across all local

authority work – and across the locality.• Use evidence and return on investment to inform

decisions.• Tackle health inequalities systematically focussed on

People, Place and Power.

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

New delivery system requiring wide range of partners– Government: DH lead but significant contributions

from DCLG, Justice, Home Office, DWP, DfE– PHE: Delivering health protection and supporting LAs

and the NHS– Local authorities: New public health functions build

on existing wider role– NHS: Delivering health care, every contact counts

and specific public health interventions

An effective public health system

Roles in the new Public Health System: Local Delivery

Local Authorities

CCGs/NHS CB

PHE (local units)

• Duty to improve health• Brings together holistic approach to health and wellbeing

• Employ DPH• Ringfenced PH budget• Mandated services

• Commissioning healthcare• Commissioning some public health services

• Local Health Protection Services (functions in development)

• Core offer to the NHS, including PH advice on health services

Health and Wellbeing Board

Coordinates local strategy through• JSNA• JSHWS• Review of commissioning plans

Public Health System Updates: autumn 2011

Department of Health is completing the policy design phase

• Public health Outcomes Framework

• Operating model for PHE

• Public health in local government: including grant conditions, mandatory services, and public health advice to the NHS.

• Public health funding: including shadow allocations for local authorities.

• Workforce strategy and other HR updates

Commitment to co-design

We are working with stakeholders to co-design these five system reform updates

• Regular discussions with local government

• Regular discussions with the profession

• Public Health Engagement Group, in autumn 2011, to provide advice and challenge

• Alongside ongoing engagement forums – including with and via the Regional Directors of Public Health and DsPH group

• NHS Future Forum review of the NHS’s role in the public’s health (due December)

TimelineEnd of 2010: White paper: Healthy Lives, Healthy People

July 2011: White paper response, confirming new public healthsystem structure

By end 2011: complete the operational design of the new system, including the PHE Operating Model, how the local system will work, and their links into the NHS.

Spring 2012: chief executive and senior team for Public Health England appointed.

April 2012: start of transition year

April 2013: Public Health England established

April 2013: Local authorities take on their new public health responsibilities

Key dates and activities

Baseline assessment

Sept 2011

Functions map

Oct 2011

Policy documents published

Dec 2011

PCT cluster transition plan including delivery

March 2012

Assessment

April 2012

HR concordat,

Nov 2011

Workforce and HR issues

PHE HR regime – exploring options for PHE terms and conditions

Directors of Public Health – devising an appropriate employment process

Regulation of non-medically qualified staff – seeking evidence to inform final decision

Public Health workforce strategy – working group developing consultation document

Local transfer: establish clarity on principles and terms and conditions of public health staff in LAs

Scope of HR / workforce Work

Aims of HR strategy

An HR regime and wider workforce strategy which supportsthe public health reforms through:• A secure transition of staff to PHE and LAs, retaining

crucial capacity and expertise in the system• Ensuring the supply of all expert staff, including

medically qualified public health consultants, nationally and locally both in transition and in the future

• Supporting the future mobility of public health specialists across the whole of the public health system

• To create meaningful careers in all settings

Public health reforms: to stay in touch…

• Sign-up for the Transforming Public Health bulletin:

www.dh.gov.uk/health/category/publications/bulletins/public-health-bulletin/

• Contact details for workforce and HR issues:– Andrew.Cooper@dh.gsi.gov.uk– Oonagh.McIntosh@dh.gsi.gov.uk

• Contact for other transition issues:

PublicHealthEngagement@dh.gsi.gov.uk

Questions and discussion