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School of Medicine & Health
The Changing National Context for Health and
Wellbeing
David Hunter
School of Medicine & Health
New Public Health System (1)
A tale of two parts
Return of public health locally to local government:Natural home or poisoned chalice?
Creation of Public Health England at centre:Renewed focus on public health or loss of
independence?
School of Medicine & Health
New Public Health System (2) Key drivers
‘Centralisation has failed’
Localism at heart of new system: principle of subsidiarity
Professional ownership and leadership
Central government focus on emergency preparedness and health protection (HPA)
More nudge, less shove
‘Responsibility deals’: working with business
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Making it Happen (1)
Transfer of DsPH to local government (2013)
Health and Wellbeing Boards (early adopters)
Health and wellbeing strategy, including JSNA
Ring-fenced budgets (2013)
School of Medicine & Health
Making it Happen (2)
‘Health premium’
GP consortia
Creation of Public Health England (from 2012)
NHS Commissioning Board
Public health outcomes framework
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Will it Ever Happen?
NHS Future Forum – pause, listen, report (by early June)‘cosmetic, phony, ornamental exercise’
Post local election positioning by political parties
Bill’s fate may lie with the House of Lords
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Are the Public Health Changes Unravelling?
Fate of the Health and Social Care Bill hangs in the balance
Secretary of State for Health is being sidelined
Responsibility deals have not been a success to date
BMA call for public health to remain part of the NHS
FPH want PHE to be a special health authority independent from DH
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Known UnknownsChanging nature of DPH role, new culture, working in a politically-led locally based organisation: elected members make decisions
Centre-local balance unclear
Managing dual accountability: to local authority, and to Secretary of State in DH
Ring-fencing: aid or barrier?
Links with GP consortia: GPs not strong on public health
Future of public health in NHS
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More Known UnknownsHealth and Wellbeing Boards: how effective will they be?
Balance between tackling SDH and addressing the ‘nudge’ agenda: where does Marmot figure?
Implications for NICE’s public health role: role in local government
Future of Public Health Observatories
Impact of localism and Big Society
Impact of spending cuts
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Unknown UnknownsPerformance management: hands-on DH (PHE) versus hands-off DCLG and DfE
Balance between must-dos and may-dos in conditions for public health grant
Local public health budget equal to or greater than the public health grant?
Resourcing of public health team beyond the DPH
New breed of DsPH - new titles, skills
School of Medicine & Health
More Unknown Unknowns
?
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