The Changing National Context

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School of Medicine & Health


The Changing National Context

Presented by David HunterProfessor of Health Policy and Management13th November 2012

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A Little HistoryHistory tells us that local government played thegreatest historical role in the sanitary revolutionduring Britain’s rapid industrialisation Improved housing Cleared nuisances Introduced gas lighting Provided public bathing and washing facilities Infectious disease control through MOH

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Public Health and the NHS: a difficult relationshipWhile the NHS claimed from the outset to give high priority to the promotion of health…in reality this aspect of the service was never more than weakly developed, notwithstanding claims to the contrary, habitually made in ministerial speeches.

Charles Webster (1996)

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Local Government: public health’s natural home

Many people in local government believe it is their organisations, rather than health authorities, that are public health authorities.

Tony Elson (1999)

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The Main Determinants of Health

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New Public Health System (1) A tale of two parts

Return of public health locally to local government

Creation of Public Health England at centre

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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 Health and wellbeing strategy, including

JSNA Ring-fenced budgets (2013)

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Making it Happen (2)

‘Health premium’ Clinical Commissioning Groups Creation of Public Health England NHS Commissioning Board Public health outcomes framework

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Public Health Outcomes Framework4 domains Improving wider determinants of health Health improvement Health protection Health care public health and preventing

premature mortality

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Public Health Workforce Issues Risk of fragmentation of public health

workforce with transfer to local government and PHE

LAs lack expertise to plan and support public health specialists

Concerns about fate of multidisciplinary public health

Strategic vision for public health workforce not in place

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Progress with Health & Wellbeing Boards (1) Face considerable challenge to do things

differently and overcome tribalism Clarity needed about what HWBs want to

achieve: risk of distraction, focus on NHS acute hospitals reconfiguration issues

Central-local tension with HWBs caught in the middle

Risk of re-badging previous partnership arrangements

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Progress with Health & Wellbeing Boards (2)

Diversity to be expected – need to capture the learning

Risk of another layer adding to an already complex architecture and increasing transaction costs

Tough leadership challenge – do they come more complex or wicked?

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Strengthening the Evidence Base

NICE public health guidance being given a makeover to be more local government facing

Relationship between NICE and PHE NIHR School for Public Health Research

(SPHR)

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NICE’s Public Health ‘Offer’ Evidence reviews, briefings, guidance, quality

standards, other evidence based outputs Accreditation of other public health guidance

producers Methodological leadership and support on

optimal ways of reviewing and appraising evidence

QOF for public health

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Known Unknowns

Changing nature of DPH role Impact of ring-fenced public health budget How effective HWBs will be Nature of links to CCGs Future of public health workforce in NHS

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More Known Unknowns

What is the nature of the ‘support’ to be provided by Public Health England through its 4 Regions and 15 Centres?

A more evidence-informed culture in local government – role of NICE, PHE and others

Balance between tackling SDH and addressing the ‘nudge’ agenda: where does Marmot figure?

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Documents

The Changing National Context