Public Health Reform &

the Voluntary Community & Faith sector

Dominic Harrison@BWDDPH

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Impact of the NHS on Life Expectancy and Infant Mortality 1900-2021?

NHS Reform Context

From 1/4/13 NHS will become ‘a system not an organisation’.

Current Government policy is for NHS to be a commissioned ‘brand’ of health services provided to specific standards delivered by ‘plurality of providers’ who will be allowed into the ‘market’ by accreditation.

Specialist Public Health Services, Statutory (DPH) functions and NHS prevention spend programmes transfer to Local Government from 1/4/13.

Local Government will lead the Public Health transition from October ‘12– March ’13.

The new public health system in England will be 50% local government and 50% Public Health England.

Local Government Specialist PH Services must allocate 40% of its capacity to providing NHS advice (principally to CCG – detailed in MOU)

National Performance manages all

Spends about 20% of Local NHS Budget

Secretary of State

Department of Health

National Commissioning

Board/PHE

Health and Wellbeing Board

Clinical Commissioning Group

Clinical Senate

Local Authority Public Health Service

SHA Cluster

(4 NCB)

Childrens and Health Scrutiny Committee/Healthwatch/HWB

PCT Cluster (50 NCB)

Commissioning Support Unit Regional/Lancashire & Cumbria

Advises all on prevention & outcome delivery – spends about 5% (current)

local NHS Budget

New local ‘web of Scrutiny’

Supports the CCG to commission

Advises CCG

Commissions Local NHS services Spends 75% of Local Budget

Holds all to account for health improvement/outcome delivery

Sets policy for all

Is in charge of all

ResponsibilityInstitutionSpatial Level

Health-Watch Represents community to all /CQC

Public Health England (EA)

Local Authority Social Care Commissioning (£50m) & Public Health Commissioning (£15m from 2015)

1 NCB Health Care Strategy & System Management

Christie Report: 2011 Christie Report: 2011

Delivering Public Sector Outcomes

Alcohol, obesity, healthy eating, physical activity, tobacco control, road traffic collisions, etc

1. tobacco control; 2. alcohol and drug misuse services; 3. obesity and community nutrition initiatives 4. increasing levels of physical activity in the local population 5. assessment and lifestyle interventions as part of the NHS Health Check Programme; 6. public mental health services; 7. dental public health services; 8. accidental injury prevention; 9. population level interventions to reduce and prevent birth defects; 10. behavioural and lifestyle campaigns to prevent cancer and long term conditions; 11. local initiatives on workplace health; 12. supporting, reviewing and challenging delivery of key public health funded and NHS

delivered services such as immunisation programmes; 13. comprehensive sexual health services (this includes testing and treatment for sexually

transmitted infections, contraception outside of the GP contract, termination of pregnancy, and sexual health promotion and prevention

14. local initiatives to reduce excess deaths as a result of seasonal mortality; 15. role in dealing with health protection incidents and emergencies (Annex B)16. promotion of community safety, violence prevention and response; and 17. local initiatives to tackle social exclusion.

NHS Public Health/Prevention Spend Transfer to LAs

1:This is 11/12 budget inflation uplifted from 10/11 data. Actual 13/14 will depend on ARCA ‘formula’2: Commissioning budget (5% current PCT commissioning spend) = £230K & SPHS =£900K

Health Outcomes Frameworks Public Health, NHS and Adult Social Care

Adult Social Care

Public Health

NHS

Adult Social Care and Public Health:

Maintaining good healthand wellbeing.

Preventing avoidable ill health or injury, including

through reablement orintermediate care services

and early intervention.

Adult Social Care and NHS:Supported discharge fromNHS to social care.Impact of reablement orintermediate care serviceson reducing repeat emergency admissions.Supporting carers and involving in care planning.

ASC, NHS and Public Health:The focus of Joint Strategic Needs Assessment: shared local

health and wellbeing issues for joint approaches.

NHS and Public Health:Preventing ill healthand lifestyle diseasesand tackling theirdeterminants.Awareness and early detection of major conditions

Place People Services

What outcomes are the PH Function: delivering on : Post 2013

1. Strategic Priorities (whole system) Health Improvement (CCG,BWD BC, Third Sector, Community) e.g. COPC /CCG Care Strategy

2. DPH Statutory duties (NHS, BwD BC, PHE) e.g. HWB Board3. BWD Borough Council Corporate Plan Health Targets4. £10.5m PH Prevention Service delivery targets (contributing to NHS

outcome targets) e.g. sexual health5. Integrated Commissioning Network Service Priority targets e.g.

wellbeing /LTC Service 6. Public Health Outcomes Framework Targets e.g. TB control

(integrated PH/Childrens/Social Care Outcome Priorities)7. Health and Wellbeing Board Priority Targets e.g. child death rate 8. CCG MOU outcome delivery (service targets /analysis etc)9. Shared BC Directorate (HIAP) targets e.g.20mph, Housing, domestic

violence etc 10.Shared PCC targets e.g. Violence prevention

Local Government

CCG / PH / Local Government Commissioning

CCG

PH

NHSLocal Government /

Others e.g.PCC?

Council Executive

BoardHealth and Wellbeing

Board

CCG Board

Executive Joint Commissioning

Group (Exec JCG)

Integrated Commissioning Network- Joint decision making and accountability

Corporate Strategy Single Integrated Plan

Joint business cases

Health and wellbeing strategy

Joint Commissioning and Recommendation

Group (JCRG)

OfficersOfficersSally McIvorDebbie Nixon

Dominic HarrisonLinda Clegg

OfficersOfficersSally McIvorDebbie Nixon

Dominic Harrison

MembersMembers Chris Clayton

Harry CatherallJoe Slater Cllr Khan

1.ACRA’s interim recommendations would see councils in the poorest areas receiving less money than is currently spent by the NHS on these services.

2. This reduction in spending on public health services in poor areas would compound the effect of other budget cuts that have disproportionately affected these same areas- further exacerbating health inequalities.

3.The “health premium” component of the public health allocation to local authorities could further shift resources away from deprived areas than is implied by the proposed formula.

4. The use of SMR<75 in the ACRA formula does not sufficiently reflect the differences in the level of poverty between areas that are the main causes of health inequalities.

Figure 1. Change in funding per head of population that would result from moving from 2010-11 baseline funding to proposed target allocation. Assumes total budget for public health services taken on by Local Authorities is £2.2 as

estimated by the Department of Health.

Public Health Funding Formula Risk: Unfair, Unjust & avoidable aspects of ACRA

Recommendations