The New Public Health System Dr Rashmi Shukla CBE, Director of Public Health Public Health England Transition Team 1

new roles and responsibilities The new public health system new roles and responsibilities leadership role for local authorities and partners supported by a new integrated public health service, Public Health England working alongside the NHS, with its continuing role of promoting health through clinical services. And other agencies and sectors clear priorities stronger focus on health outcomes, supported by the Public Health Outcomes Framework public health as a clear priority for Government, backed by ring fenced resources 2

Roles in the new public health system Duty to improve health Brings together holistic approach to health and wellbeing Employ DPH and PH staff Ring fenced PH budget Mandated services Local Authorities CCGs/NHS Commissioning Board Population health advice to the NHS, including advice on health services Commissioning healthcare Commissioning some public health services Duty to reduce inequalities Public Health England Supporting local authorities and others by: Delivering services Leading for public health Developing the workforce Health and Wellbeing Board Coordinates local strategy through: Joint Strategic Needs Assessment Joint Health and Wellbeing Strategy review of commissioning plans 3

A pathway from causes of illness to A stronger focus on outcomes.... The Public Health Outcomes Framework sets the scope of public health focuses on outcomes not targets alignment & integration across public health, the NHS and social care takes a life-course approach designed to also address the causes of the causes of ill health A pathway from causes of illness to caring for people 4

Wellbeing Causes of illness to caring for people …. Germ theory and modern medicine 19th century urban improvement – sewers / housing Wellbeing Lifestyles

The role of the NHS …. NHS Commissioning Opportunities for prevention New public health responsibilities Opportunities for prevention Build prevention of poor health into day-to-day business Make every contact count Use every contact to improve wellbeing, mental and physical health NHS workforce 1.4 million staff as advocates for changes for better health and wellbeing

April 2013 DH – to set public health policy (and PHOF) PHE* – to support delivery (through LG and the NHS, and other partners) and links to NHS CB PHE functions: Health Protection: Health Improvement; Information, Intelligence and Evidence Local Health and Wellbeing Boards (links to CCGs) – JSNAs and Health & Wellbeing Strategies Local Government – local public health delivery *Structure of PHE published on 26 July 2012

What is PHE? Public Health England has been established to protect and improve the nation’s health and wellbeing, and to reduce health inequalities. PHE will provide national leadership for the delivery of improved public health. Working with key delivery partners including local government, and the NHS, to secure improved health outcomes PHE will: provide the evidence, intelligence and professional leadership work through partners and directly with the public to promote healthier lifestyles act as an advocate for the public’s health and transparent reporting through publication of the PH Outcomes Framework provide a nationwide service to protect the public from threats to health deliver a programme of world class research in support of protecting and improving health

Objectives for Public Health England and Models for Change Public Health England’s remit spans full range of public’s health. The delivery chains differ and will require different relationships, levers and ways of working. The maturity and history of the different delivery chains mean PHE will face very different tasks in establishing itself as a credible full spectrum PH body. Mission Outcomes Levers/Delivery Models Key task To improve and protect health and wellbeing, and reduce inequalities Improvement across the PHOF wider determinants health improvement health protection health care Health Protection end to end delivery chains clear command structure to SoS expertise in large scale response Ensure credible and consistent local delivery Retain international reputation Health Improvement supporting LA, intelligence, evidence into practice advocacy and publication of outcomes professional relationship limited national interventions Build new 21st century capability in support of LA in holistic response to health and wellbeing Health Care specific PH specialist contributions section 7A management supporting NHS, intelligence, evidence into practice advocacy and publication of outcomes Establish explicit PH support to NHS from current implicit practice

Taking Shape: Senior Leadership

Taking Shape: National Presence

PHE delivery structures: 4 Regions, 15 Centres North East Midlands and East of England 4 Regions: Supporting transparency and accountability across the system – leading strategic discussions with partners e.g. NHS CB, LAs and others Providing professional support and leadership to the public health system including joint appointment of DsPH, clinical and medical supervision and professional guidance and leadership Overseeing PHE Centres – ensuring delivery of consistently high quality services Ensuring delivery of the national Emergency Planning, Resilience and Response strategy across their region 15 centres: Provision of Health Protection Services maintaining and building on the services offered by HPUs Building PHE’s relationship with Local Authorities –professional support for health improvement including building on the NTA role to oversee drug and alcohol treatment services Ensuring the local NHS has access to high quality PH advice, supporting the local DPH relating to the NHS Employment and professional development of Immunisation and Screening teams who will be embedded with NHS CB LATs Development of the specialist and wider public health workforce supporting LAs and managing PHE’s relationship with the LETBs Provide PH specialists to support specialised commissioning and dental commissioning – for those NHS CB LATs with this responsibility South of England London

Northern and Yorkshire Eight Network Team areas Northern and Yorkshire Knowledge and intelligence teams (drawing on capacity from the public health observatories and the cancer registries) providing analytical and knowledge management support and advice to PHE and partners Cancer registration and NDTMS teams collecting and quality assuring data from service providers Quality Assurance teams for cancer and non-cancer screening (based on QARCs, and a new function for PHE) assuring safe and effective screening for a range of diseases Network teams: all the above, plus colleagues in Regions and Centres as appropriate, within a particular geographical area cooperating and collaborating on corporate aspects (e.g. estates, IT), resources (e.g. shared administrative support) and/or specific projects (e.g. children and maternity; liver disease etc.) North West East Midlands East of England West Midlands NDTMS = National Drug (and alcohol) Treatment Monitoring System QARCs = Quality Assurance Reference Centres 8 network teams Knowledge and intelligence teams (drawing on capacity from the public health observatories and the cancer registries) providing analytical and knowledge management support and advice to PHE and partners Cancer registration and NDTMS teams collecting and quality assuring data from service providers Quality Assurance teams for cancer and non-cancer screening (based on QARCs, and a new function for PHE) assuring safe and effective screening for a range of diseases Network teams: all the above, plus colleagues in Regions and Centres as appropriate, within a particular geographical area cooperating and collaborating on corporate aspects (e.g. estates, IT), resources (e.g. shared administrative support) and/or specific projects (e.g. children and maternity; liver disease etc.) South West London South East 13

LOCAL – Health and Wellbeing Boards Joint Strategic Needs Assessment (includes assets) Joint Health and Wellbeing Strategies Key Local Priorities – and links to Outcome Frameworks Links to Clinical Commissioning Groups Local Public Health Departments – links to LA functions and Primary Care and Communities

From transition to transformation …. Public Health England Transition Team _ _ _ Support for PCTs and Local Authorities during the transitional phase _ _ _ Communication and data sharing infrastructures Web resources Assuring local transition plans Finalising policy