Equity and Excellence; Liberating the NHS: Reform of the Public

Health System

Dr Giri RajaratnamDeputy Regional Director of Public Health, East MidlandsMidlands and The East Cluster SHA

Health inequalities across Nottingham

Why more of our kids end up arrested, homeless or in hospital over drugs

Model of Health Health and Wellbeing

Variations in health, ill health and wellbeing

Ill health and need for care

Heart disease, mental health, respiratory disease, cancers, musculo-skeletal, dementia, frailty etc

Lifestyles & Behaviour

Smoking Nutrition Physical Activity Sexual practices Substance Misuse

Wider Determinants of health & the Environment

Housing Education Employment Safety Culture Poverty

200,000

250,000

150,000

100,000

50,000

0

1996- 50,000

1997 1998 1999 2000 2001 2002

Year

Dea

ths

Pote

ntial

ly A

vert

ed

Deaths potentially averted by medical advances

Deaths potentially averted by eliminating education-associated excess mortality

Deaths potentially averted per year in the United States by medical advances and by eliminating education-associated excess mortality: 1996-2002

Source: Woolf et all. American Journal of Public Health 2007; 97(4): 679 - 683

The Need For Reform1. Demography and communities2. Empowering Patients & Public Health3. Outcome Focus4. Productivity increases equivalent to £20b5. International comparisons (particularly cancer) of

performance6. Competition as a stimulant for innovation,

improvement and productivity7. A better balance between private, public and 3rd

sector provision of services

The Health and Care landscape in 2013

S of S and DH

PH (England)NHS CB

PH in LA

CCG

Health & Well-being Board

Local Government

HealthWatchCommunitiesO&SC

JSNA to H&WB strategy to Commissioning Plans

NHS Commissioning Board and Clinical Commissioning Groups

Functions1.Understanding health care needs and commissioning services for registered populations2.Ensuring NHS response to major incidents.3.Commissioning selected public health interventions (Immunisations and screening)4.To co-operate with local authorities and participate in the local Health and Wellbeing Group5.To involve patients and the public

The New Public Health SystemTHE NEW DUTY (Local Government)“To take such steps as it considers appropriate for improving the health of the people in its area”

Includes:1.Commissioning services2.Focus on the most disadvantaged3.Supporting, engaging and developing local communities4.Ensuring all local government responsibilities are delivered in a way that they promote health & wellbeing.

Local GovernmentDelivering the new Duty

1. Ring fenced financial allocation2. Specialist Public Health Workforce including

Director of Public Health3. Legislation to support access to data4. Creation of the Health and Wellbeing Board 5. National Institute for Health and Clinical Excellence

and Social Care Institute for Excellence6. Three overlapping Outcome Frameworks (public

health, NHS and Social care)

Health & Wellbeing Board

1. Leadership group for all aspects of health and wellbeing in a locality

2. Involvement of key local leaders3. Duty to promote integration; planning,

commissioning and provision 4. Key outputs: Joint Strategic Needs Assessment and

Health Wellbeing Strategy5. Review Outcomes for local communities

Public Health England

Purpose1.Deliver, support and enable improvements in health and wellbeing2.Lead on the design, delivery and maintenance of systems to protect the populations against existing and future threats to public health3.Support local public health teams to deliver their functions4.Support NHS CB to commission services such as screening and immunisation5.Producing benchmarked information on the public health outcome framework indicators

Accountability (1)

1. Health & Wellbeing Boards and Local Authorities: accountable to local communities and Overview & Scrutiny Committee

2. CCGs accountable to NHS CB3. Public Health England and NHS CB accountable to

Secretary of State for Health through mandates4. Health & Wellbeing Boards accountable for leading

and co-ordinating for health, social and care systems for delivering appropriate outcomes for local communities.

Accountability (2)

1. Three outcome frameworks. Use of incentives aimed at both CCGs and LAs.

2. NO PERFORMANCE MANAGEMENT3. Transparency of information: regular publication

of benchmarked data related to the indicators listed in the three outcome frameworks.

Taking Advantage

1. Thinking about wellbeing and ill health within your community

2. Understanding how the different factors affect health in your local communities

3. Designing interventions or approaches that best meet local needs and designing indicators to help guide implementation

4. Ownership of local communities and leaders

In Conclusion

Opportunities for:1.Enabling the telling of the local story (Outcomes

Frameworks)2.Ensuring “joined up” planning, commissioning and providing 3.Supporting communities and individuals4.Shaping the place: physically and psychologically

Timeline for ChangeMar 2012Local transition plans completedApr 2012• Local areas agree arrangements for any in year delegation of functions and

secondments/assignment of transferring staff in line with guidanceBy Oct 2012• Local area test arrangements for delivery of specific public health services

in particular screening and immunisation, and Emergency ResponseOct 2012• Agree arrangements on public health information requirements and

information governance Jan 2102• Ensure final legacy and handover documents completedApr 2013• Local authorities formally take on new responsibilities