Healthy People, Healthy Lives

• Our strategy for public health in England• Transparency in Outcomes• Funding and Commissioning routes for public health

The Health Background

• Britain has amongst the worst levels of obesity in the world.

• Smoking claims over 80,000 lives a year.

• 1.6 million people are dependent on alcohol.

• Over half a million new sexually transmitted infections were diagnosed last year, and one in ten people getting an infection will be re-infected within a year.

• Poor mental health is estimated to be responsible for nearly a quarter of the overall burden of long-standing poor health.

• People in the poorest areas expect to live up to 7 years less than people in richer areas.

The New Approach

• representative – owned by communities and shaped by their needs

• resourced – with ring-fenced funding and incentives to improve

• rigorous – professionally-led, focused on evidence, efficient and effective

• resilient – strengthening protection against current and future threats to health.

A New Public Health System

• Public Health England – a national public health service• A return of public health leadership to Local Government• Professional leadership nationally and locally• Dedicated resources for public health at national and local levels• Focus on outcomes and evidence based practice• Maintaining a strong relationship with the NHS, social care and

civil society• Set out in the forthcoming Health and Social Care Bill

Public Health England

• New public health service directly accountable to the Secretary of State for Health with a clear mission to;1. Achieve measurable improvements in public health outcomes; and

2. Provide effective protection from public health threats

• It will do this by;1. Protecting people from infectious disease and biological, chemical

and radiological threats;

2. Helping people and families to be able to take care of their own health and wellbeing;

3. Inspiring challenging and commissioning partners from all sectors;

4. Upholding excellence in all public health practices.

The Director of Public Health 1

• Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population

• Will be play a key role in the proposed new functions of local authorities in promoting integrated working

• Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children’s Services)

• Will continue to be an advocate for the public’s health within the community

• Will produce an authoritative independent annual report on the health of their local population

The Director of Public Health 2

• Will be jointly appointed by the relevant local authority and Public Health England and employed the local authority with accountability to locally elected members and through them to the public.

• accountable to the Secretary of State for Health for responsibilities relating to health protection and professionally accountable to the Chief Medical Officer

• Councils will have the power to dismiss DsPHs for serious failings across the full spectrum of their responsibilities, whilst the Secretary of State for Health will have the power to dismiss them for serious failings in the discharge of their health protection functions

The New Approach - Transparency in Outcomes

• Reflects the responsibility :

– of communities;

– of local authorities and their partners; and

– the role of Government in improving and protecting health

• The approach proposed shifts the focus to public health outcomes

Principles of the Outcomes Framework

• outcome indicators which will be meaningful to people and communities

• a focus on major causes and impacts of health inequality , disease and premature mortality;

• the use of data collated and analysed nationally to reduce the burden on local authorities

Public Health Outcomes Framework

Preventing people from dying prematurely and

reduce the gap in health inequalities

Reducing the number of people living with

preventable ill health and reduce the gap in

health inequalities

Helping people to live healthy lifestyles make

healthy choices and reduce the gap in health inequalities

tackling factors which affect health and

wellbeing

DETERMINANTS OF ILL HEALTH OUTCOMES OF ILL HEALTH

To improve and protect the nation’s health and well-being and to improve the health of the poorest fastest. • Increasing healthy life expectancy • Reducing the healthy life expectancy gap between the least deprived and most deprived communities

Domain 2 – Tackling the wider determinants

of health

Domain 3 – health improvement

Domain 4 – prevention of ill-health

Domain 5 - healthy life expectancy and

preventable mortality

Do

ma

ins

Ind

ica

tors

V

isio

n

Domain 1 – Health protection and resilience

Protect the population’s health from major emergencies and remain resilient to harm

Public health indicators (of which, some will be used locally to attract the Health Premium)

• The Domains above set out the high-level goals for public health. Each domain will require a national local balance for delivery, with an onus on local delivery across the NHS, social care services public health and other local partners, and with strong leadership from the Director of Public Health.

• Outcomes for public health will be measured by indicators, which are supported by centrally collated and analysed data sets. This should include indicators that target different age groups, and target communities that experience differential outcomes in health.

• It will be for each local area to determine how they will wish to use these indicators for local transparency in response to local needs identified through their Joint Strategic Needs Assessment, and considered within their local Joint Health and Well-being Strategies.

Figure 2 – A frame work for public health outcomes

Domain 1

Domain 2

Domain 3

Domain 4

Domain 5

Public health ring-fenced resource

Defining Commissioning responsibilities

• Table A details activities that will be funded by the PH budget – column 2

• Table A sets out the proposed primary commissioning routes for the PH funded services – column 3

Possible allocation approaches

• ‘Utilisation’ – modelling the statistical relationship between current patterns of PH activity and need across the country

• ‘Cost-effectiveness’ – potential gains in health outcomes across the country

• ‘Population health measures’ – measures of health outcomes such as SMR or Disability Free LE – higher allocation to areas of poorer health taking into account HI

Proposal: Pace-of-change policy

Health Premium

• Applies to that part of the PH budget which is for health improvement

• Building on baseline allocation – LAs to receive the health premium based on progress made in improving health and reducing health HI – based on elements of the PH Outcomes Framework

• Simple Premium – driven by a formula developed with local government, PH experts and academics

• Greater premium for disadvantaged areas – if progress is made – recognising they face the greatest challenges

• A premium that does not distort local decisions: needs to incentivise health improvements such that inequalities are reduced as overall health improves

• Funded from within the funds available for PH – opportunities to reprioritise discretionary central public health funding. Part of the progressive rebalancing of central and local budgets

• Sliding scale premium depending on the size and extent of LAs progress: relative to local authorities’ position in terms of relative health outcomes

Healthy Lives, Healthy People

Consultation closes:- Our strategy for public health in England – 8th March 2011- Transparency in Outcomes – 31st March 2011- Funding and Commissioning routes for public health – 31st march 2011

General InformationFind consultation documents at:www.consultations.dh.gov.uk/healthy-people

Respond to consultations at:publichealthengland@dh.gsi.gov.uk

Salford Consultation Response led by the Public Health Team – Comments to Glenna.Smith@salford.nhs.uk