1. Julian Mallinson NHS Leicestershire County and Rutland
Healthy Lives, Healthy People: Our strategy for public health in England
Julian Mallinson
NHS Leicestershire County and Rutland

2. What is Public Health?
Public health is: The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society
Three domains of public health:
health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health)
health protection (including infectious diseases, environmental hazards and emergency preparedness)
health services (including service planning, efficiency, audit and evaluation).

3. A radical new approach
Not been enough focus on the root causes of ill health
Top-down initiatives and lectures from central government about the ‘risks’ are not the answer - centralisation has failed
Free up local government and local communities to decide how best to improve the health and wellbeing of their citizens
The NHS will continue to have a critical role to play but it cannot tackle all wider factors on its own
Responsibility needs to be shared right across society

4. Who is involved?
Individuals should feel that they are in the driving seat for all aspects of their and their family’s health, wellbeing and care
Local government is best placed to influence many of the wider factors that affect health and wellbeing
Voluntary organisations and community groups already make a vital contribution
Businesses must take more responsibility for the impact of their practices on people’s health and wellbeing
Employers from all sectors should look to support the health and wellbeing of their staff

5. No more targets but a Health Outcomes Framework
Domain 1 – Health protection and resilience: protecting people from major health emergencies and serious harm to health;
Domain 2 – Tackling the wider determinants of ill health: addressing factors that affect health and wellbeing;
Domain 3 – Health improvement: positively promoting the adoption of ‘healthy’ lifestyles;
Domain 4 – Prevention of ill health: reducing the number of people living with preventable ill health; and
Domain 5 – Healthy life expectancy and preventable mortality: preventing people from dying prematurely

6. Core values of freedom, fairness and responsibility applied
The Government will
recognise that protecting and improving people’s health covers a wide spectrum of issues that demand very different approaches
balance the freedoms of individuals / organisations with the need to avoid serious harm to others
consider different approaches for different groups of the population

7. What will Public Health be focussed on?
Children - strong universal public health & early education. Increased focus on disadvantaged families. Heavy emphasis on health visitors, schools, school nurses and families
Designing communities for active ageing & sustainability
Emphasis on transition points in life & ladder of intervention
Making it pay to work
Working collaboratively with business and voluntary sector through Public Health Responsibility Deal

8. The Public Health System
Lots of uncertainties – more detail to come
A new, dedicated and professional public health service, known as Public Health England
Local government will be given the responsibility, backed by ring-fenced budgets and new freedoms
Directors of Public Health in upper-tier and unitary local authorities will lead these efforts
Local statutory health and wellbeing boards
A new role for local government to encourage joined up commissioning plans across the NHS, social care, public health and other local partners

9. Local Authority PH Support for infectious disease control
Commissioning all sexual health services (except GP contraceptive services)
School vaccination programmes (HPV and school leaving booster)
Support for control of radiation, chemical and environmental hazards
Reducing excess winter deaths
Prevention of accidental injuries

10. Local Authority PH Public mental health
Some local nutrition activities
Physical activity
Obesity programmes (including NCMP)
Drug misuse services, prevention and treatment
Alcohol misuse services, prevention and treatment
Tobacco control
NHS Health Check programme
Workplace health

11. Local Authority PH Reducing birth defects
Prevention and early diagnosis of cancer and long term conditions
Support for emergency preparedness and pandemic flu
Public Health Intelligence
Childrens public health 5-19 years (including school nursing). [Note – 0-5years is responsibility of NHS commissioning board]

12. Local Authority PH
Community safety and violence prevention and response
Social exclusion
Note – all public health for those in prison or custody is responsibility of NHS Commissioning Board

13. Director of Public Health
Employed by local government and jointly appointed by the relevant local authority and Public Health England
Strategic leader for public health in local communities
Professionally accountable to the Chief Medical Officer
A public health professional, with training, expertise and skills needed to enable them to meet leadership and technical requirements of role

14. DPH Tasks Promoting health and wellbeing within local government;
Providing and using evidence relating to health and wellbeing;
Advising and supporting GP consortia on the population aspects of NHS services;
Developing an approach to improving health and wellbeing locally, including promoting equality and tackling health inequalities;
Working closely with Public Health England health protection units to provide health protection as directed by the Secretary of State for Health
Collaborating with local partners on improving health and wellbeing, including GP consortia, other local DsPH, local businesses and others

15. Making it happen
Subject to the passage of the Health and Social Care Bill, the Government plans to:
enable the creation of Public Health England, which will take on full responsibilities from 2012, including the formal transfer of functions and powers from the Health Protection Agency (HPA) and the National Treatment Agency for Substance Misuse (NTA);
transfer local health improvement functions to local government, with ring-fenced funding allocated to local government from April 2013; and
give local government new functions to increase local accountability and support integration and partnership working across social care, the NHS and public health

16. How will the system work in Rutland?
PCT public health team already co-located at Leicestershire County Council (early implementer)
Awaiting HR framework for clarity on full transfer
Ring fenced local budgets – How much? And what is included?
Potential SLA with Leicestershire CC for Rutland service – Need to agree shape
What opportunities through wider public health workforce at RCC?

17. How will the system work in Rutland?
Delivering huge agenda will require new ways of working – multi-skilled workers, aligned budgets and influence through partnerships
Roles for elected member and senior officer (director level) champions?
Health and Well-being Board key to joining up health and social care, including links with GP consortia
How do we mobilise our communities?

18. Questions to consider today
A: How can the move to the local authorities be used to ensure better integration with other factors known to affect public health, especially housing, environment, transport, employment, education?
B: How can we retain our connection with and influence over mainstream health?
C: How can we ensure a more appropriate balance of investment between prevention and cure?
D: How can we mobilise our communities for public health?