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?

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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)

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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

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More Unknown Unknowns

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