1. School of Medicine & Health The Changing National Context for Health and Wellbeing David Hunter

2. 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?

3. 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

4. School of Medicine & Health 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)

5. 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

6. School of Medicine & Health 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

7. School of Medicine & Health 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

8. School of Medicine & Health Known Unknowns Changing 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

9. School of Medicine & Health More Known Unknowns Health 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

10. School of Medicine & Health Unknown Unknowns Performance 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

11. School of Medicine & Health More Unknown Unknowns ?