1. Public Health Reform & the Voluntary Community & Faith sector Dominic Harrison @BWDDPH

2. Source: House of Commons Research Paper, 1999. 99/111 A Century of Change: Trends in UK Statistics since 1900. Impact of the NHS on Life Expectancy and Infant Mortality 1900-2021?

3. NHS Reform Context From 1/4/13 NHS will become ‘a system not an organisation’. Current Government policy is for NHS to be a commissioned ‘brand’ of health services provided to specific standards delivered by ‘plurality of providers’ who will be allowed into the ‘market’ by accreditation. Specialist Public Health Services, Statutory (DPH) functions and NHS prevention spend programmes transfer to Local Government from 1/4/13. Local Government will lead the Public Health transition from October ‘12– March ’13. The new public health system in England will be 50% local government and 50% Public Health England. Local Government Specialist PH Services must allocate 40% of its capacity to providing NHS advice (principally to CCG – detailed in MOU)

4. National Performance manages all Spends about 20% of Local NHS Budget Secretary of State Department of Health National Commissioning Board/PHE Health and Wellbeing Board Clinical Commissioning Group Clinical Senate Local Authority Public Health Service SHA Cluster (4 NCB ) Childrens and Health Scrutiny Committee/Healthwatch/HWB PCT Cluster (50 NCB) Commissioning Support Unit North Local Regional/Lancashire & Cumbria Advises all on prevention & outcome delivery – spends about 5% (current) local NHS Budget New local ‘web of Scrutiny’ Supports the CCG to commission Lancashire Advises CCG Commissions Local NHS services Spends 75% of Local Budget Holds all to account for health improvement/outcome delivery Sets policy for all Is in charge of all ResponsibilityInstitutionSpatial Level Health-WatchRepresents community to all /CQC NHS(CCG, Local Government Health, Wellbeing & SC System) (for policy, performance, commissioning, scrutiny,accountability, governance, engagemen t) Public Health England (EA) Local Authority Social Care Commissioning (£50m) & Public Health Commissioning (£15m from 2015) ICCG ? 1 NCB Health Care Strategy & System Management

5. Christie Report: 2011

6. Delivering Public Sector Outcomes Services Policy Community Alcohol, obesity, healthy eating, physical activity, tobacco control, road traffic collisions, etc

7. 1.tobacco control; 2.alcohol and drug misuse services; 3.obesity and community nutrition initiatives 4.increasing levels of physical activity in the local population 5.assessment and lifestyle interventions as part of the NHS Health Check Programme; 6.public mental health services; 7.dental public health services; 8.accidental injury prevention; 9.population level interventions to reduce and prevent birth defects; 10.behavioural and lifestyle campaigns to prevent cancer and long term conditions; 11.local initiatives on workplace health; 12.supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as immunisation programmes; 13.comprehensive sexual health services (this includes testing and treatment for sexually transmitted infections, contraception outside of the GP contract, termination of pregnancy, and sexual health promotion and prevention 14. local initiatives to reduce excess deaths as a result of seasonal mortality; 15. role in dealing with health protection incidents and emergencies (Annex B) 16. promotion of community safety, violence prevention and response; and 17. local initiatives to tackle social exclusion. NHS Public Health/Prevention Spend Transfer to LAs

8. 1:This is 11/12 budget inflation uplifted from 10/11 data. Actual 13/14 will depend on ARCA ‘formula’ 2: Commissioning budget (5% current PCT commissioning spend) = £230K & SPHS =£900K

9. Health Outcomes Frameworks Public Health, NHS and Adult Social Care Adult Social Care Public Health NHS Adult Social Care and Public Health: Maintaining good health and wellbeing. Preventing avoidable ill health or injury, including through reablement or intermediate care services and early intervention. Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeat emergency admissions. Supporting carers and involving in care planning. ASC, NHS and Public Health: The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches. NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants. Awareness and early detection of major conditions

10. Place People Services

12. What outcomes are the PH Function: delivering on : Post 2013 1.Strategic Priorities (whole system) Health Improvement (CCG,BWD BC, Third Sector, Community) e.g. COPC /CCG Care Strategy 2.DPH Statutory duties (NHS, BwD BC, PHE) e.g. HWB Board 3.BWD Borough Council Corporate Plan Health Targets 4.£10.5m PH Prevention Service delivery targets (contributing to NHS outcome targets) e.g. sexual health 5.Integrated Commissioning Network Service Priority targets e.g. wellbeing /LTC Service 6.Public Health Outcomes Framework Targets e.g. TB control (integrated PH/Childrens/Social Care Outcome Priorities) 7.Health and Wellbeing Board Priority Targets e.g. child death rate 8.CCG MOU outcome delivery (service targets /analysis etc) 9.Shared BC Directorate (HIAP) targets e.g.20mph, Housing, domestic violence etc 10.Shared PCC targets e.g. Violence prevention

13. Local Government CCG / PH / Local Government Commissioning CCG PH NHS Local Government / Others e.g.PCC? Shared services

14. Council Executive Board Health and Wellbeing Board CCG Board Executive Joint Commissioning Group (Exec JCG) Integrated Commissioning Network- Joint decision making and accountability Corporate StrategySingle Integrated Plan Ratification Decision making at agreed delegated level Recommendation Joint business cases Health and wellbeing strategy Joint Commissioning and Recommendation Group (JCRG) Officers Sally McIvor Debbie Nixon Dominic Harrison Linda Clegg Officers Sally McIvor Debbie Nixon Dominic HarrisonMembers Chris Clayton Harry Catherall Joe Slater Cllr Khan

15. 1. ACRA’s interim recommendations would see councils in the poorest areas receiving less money than is currently spent by the NHS on these services. 2. This reduction in spending on public health services in poor areas would compound the effect of other budget cuts that have disproportionately affected these same areas- further exacerbating health inequalities. 3.The “health premium” component of the public health allocation to local authorities could further shift resources away from deprived areas than is implied by the proposed formula. 4. The use of SMR<75 in the ACRA formula does not sufficiently reflect the differences in the level of poverty between areas that are the main causes of health inequalities. Figure 1. Change in funding per head of population that would result from moving from 2010-11 baseline funding to proposed target allocation. Assumes total budget for public health services taken on by Local Authorities is £2.2 as estimated by the Department of Health. Public Health Funding Formula Risk : Unfair, Unjust & avoidable aspects of ACRA Recommendations