Healthy Lives, Healthy People: Our Strategy for Public Health in England The White Paper in a nutshell

Key Underlying Themes Need to focus the nation’s resources on the root causes of ill health Responsibility needs to be shared right across society Local government best placed to influence many of the wider factors affecting health and wellbeing

Key Underlying Themes Greater emphasis on personal responsibility and efforts to influence personal choice Reluctance to legislate or regulate to eliminate personal choice unless all other interventions fail

Key Underlying Themes Local government and local communities empowered to improve health Resources for public health and prevention will be ring-fenced so it can no longer be ‘raided’ for treatment

Key Policy Proposals

S.o.S Department of Health CMO NHS Commissioning Board Public Health England Secretary of State will devolve running of health services to NHS Commissioning Board Department of Health will retain responsibility for Public Health National Public Health Service will be called ‘Public Health England’ Chief Medical Officer provides independent advice to SoS, leads professional network for Public Health England, and holds DsPH to account

S.o.S Department of Health Health Protection Screening Immunisations Health Improvement PH Research Sexual Health PH Intelligence Child Health Promotion 15% QOF Drugs & Alcohol Smoking Obesity Health Checks Nutrition Health Visiting School Nursing Local HPUs CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH >= £4bn Public Health England £ Possibly up to, or more than, £4bn to be taken from NHS budget and given to PH England PH England will directly deliver some functions (mainly national emergency response, Screening, Research & Intelligence, local Health Protection Units) PH England will devolve some PH commissioning to NHS Commissioning Board All Public Health Commissioning & Provision will be guided by a National PH Outcomes Framework with 5 domains of outcome indicators

S.o.S Department of Health Health Protection Screening Immunisations Health Improvement PH Research Sexual Health PH Intelligence Child Health Promotion 15% QOF Drugs & Alcohol Smoking Obesity Health Checks Nutrition Health Visiting School Nursing Local HPUs CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH >= £4bn Public Health England £ PH England Budget will pay for Drugs & Alcohol services, Health Checks, and approximately 15% of QOF payments to GPs for PH related outcomes NHS Commissioning Board will be expected to commission primary care provision of some screening, immunisations, contraception and dental public health PH England budget will eventually include health visiting and school nursing services although they will be provided by the NHS and commissioned by NHS Board for the next five years Old HPA, LHO, NTA functions will transfer to PH England

S.o.S Department of Health Local Councils Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes) DPH with team of PH professionals Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH GP Consortium Service Providers Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector >= £4bn Public Health England £ £ £ £ £ Includes HV & School Nurses for 5 years Ring fenced budget, adjusted for need, under section 31 of LG Act 2003, to be given to local government, with LA Chief Executive as accountable officer Health Premium additional funding will reward councils for achievement of agreed PH Outcomes under the PH Outcomes Framework DPH to be jointly appointed by PH England and Local Government (can be fired by SoS for health protection failure and by LG for failure across full spectrum of responsibilities) DPH to be supported by team of PH Professionals (yet to be defined) LG will lead on commissioning of health improvement, sexual health services, production of JSNA and support to GP consortia

S.o.S Department of Health Local Councils Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes) DPH with team of PH professionals Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH GP Consortium Service Providers Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector >= £4bn Public Health England £ £ £ £ £ Includes HV & School Nurses for 5 years DPH role to include emergency planning and protection against public health threats, health improvement and tackling health inequalities, acting as principal adviser to elected members and officers, acting as advocate of the public’s health in the community, analysing and interpreting evidence, working closely with GPs, and producing and independent annual report on health of local population Detailed workforce strategy for PH Autumn 2011 Local flexibility for LG to structure itself to discharge PH and DPH responsibilities HR Framework for staff transfer to LG early 2011 PH ring fenced budget allocated in shadow form April 2012

S.o.S Department of Health Health Protection Screening Immunisations Health Improvement PH Research PH Intelligence Child Health Promotion 15% QOF Drugs & Alcohol Smoking Obesity Health Checks Nutrition Health Visiting School Nursing Local HPUs Local Councils Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes) DPH with team of PH professionals Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH Health & Wellbeing Board Elected members, DAS, DCS, DPH, GP Consortium, HealthWatch GP Consortium Service Providers Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector >= £4bn Public Health England £ £ £ £ £ Includes HV & School Nurses for 5 years Statutory H&WB Board to include minimum of elected members, DAS, DCS, DPH, GP Consortia, local HealthWatch and where appropriate NHSCB Boards may invite voluntary groups, clinicians and providers GP Consortia, LA and DPH have equal and explicit obligation to prepare JSNA through Board Board to develop joint H&WB strategy based on JSNA, providing overarching framework for more detailed commissioning plans for NHS, Social Care, Public Health and other services

S.o.S Department of Health Health Protection Screening Immunisations Health Improvement PH Research PH Intelligence Child Health Promotion 15% QOF Drugs & Alcohol Smoking Obesity Health Checks Nutrition Health Visiting School Nursing Local HPUs Local Councils Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes) DPH with team of PH professionals Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH Responsibility Deal Health & Wellbeing Board Elected members, DAS, DCS, DPH, GP Consortium, HealthWatch GP Consortium Service Providers Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector >= £4bn Public Health England £ £ £ £ £ Includes HV & School Nurses for 5 years New ‘Responsibility Deal’ with business and other partners Voluntary agreements with time limits for responsible action five networks on food, alcohol, physical activity, health at work and behaviour change to be launched early 2011

S.o.S Department of Health Health Protection Screening Immunisations Health Improvement PH Research Sexual Health PH Intelligence Child Health Promotion 15% QOF Drugs & Alcohol Smoking Obesity Health Checks Nutrition Health Visiting School Nursing Local HPUs Local Councils Ring Fenced Budget s.31 (+ Health Premium ‘Reward’ based on achieving PH outcomes) DPH with team of PH professionals Health Improvement, Sexual Health Services, Health Protection, Immunisations, JSNA, Child Health Promotion, Support to GP Consortia, Independent PH Annual Report CMO Public Health Outcomes Framework health protection & resilience, tackling wider determinants of ill health, health improvement, prevention of ill health, healthy life expectancy and preventable mortality NHS Commissioning Board Screening, Immunisations PH QOF, Contraception, Dental PH Responsibility Deal Health & Wellbeing Board Elected members, DAS, DCS, DPH, GP Consortium, HealthWatch GP Consortium Service Providers Primary Care, Community Health, Secondary Care, Other Public Sector Services, Private Sector, Third Sector >= £4bn Public Health England £ £ £ £ £ Includes HV & School Nurses for 5 years

Unanswered Questions Exactly how big a % of NHS spend will be included in the ring-fenced budget? Exactly what will it be ring-fenced for? Will the % allocated to prevention be sufficient to achieve the scale of public health improvement required?

Unanswered Questions How are the public health functions and responsibilities to be effectively balanced / shared between Public Health England, Local Government and the NHS (and GLA in London)? Who should be defined as the public health professional workforce? Who will employ them?

Unanswered Questions What powers will the Health & Wellbeing Board have to influence delivery of public health outcomes? Where does mental health improvement fit?

When are these questions likely to be answered? Local Areas encouraged to shape structures required to discharge public health functions now Shadow form Public Health England to be established during 2011

When are these questions likely to be answered? Key documents on health visitors, mental health, tobacco control, Outcomes Framework – Winter 2010/11 Key documents on Responsibility Deal, obesity, physical activity, social marketing, sexual health & teenage pregnancy, pandemic flu – Spring 2011

When are these questions likely to be answered? Key documents on health protection, emergency preparedness, public health workforce strategy – Autumn 2011 Shadow public health ring-fenced budget – Spring 2012