1. Public health and the Responsibility Deal
Graeme Henderson
20 April 2011
31 March 2011

2. What is our overall goal?
Healthy, engaged workforces
Well-managed organisations
A high-performing, resilient workforce
Enhanced productivity
Contributing to:
A well-functioning society
Better economic performance

3. Marmot Review: Health Inequalities
Getting people into work is of critical importance for reducing health inequalities. Clear link between unemployment, health inequalities and likelihood of return to work.
Policy objectives of Marmot :
Create fair employment and decent work for all
Improve access to good jobs and reduce long-term unemployment across the social gradient.
Make it easier for people who are disadvantaged in the labour market to obtain and keep work.
Improve quality of jobs across the social gradient
Therefore a cardinal aim is captured by the Policy objective: Create fair employment and decent work for

4. ‘Healthy Lives, Healthy People’ Our strategy for public health in England
Starting well: enabling good health in mothers before, during and after pregnancy and good parenting
Developing well: encouraging healthy habits and avoiding harmful behaviours
Growing up well: identifying, treating and preventing mental health problems and creating resilience and self-esteem
Living and working well: choosing lifestyles and behaviours that influence health and productivity
Ageing well: supporting resilience through social networks and activity and providing protection from preventable ill-health
Acts as the Government response for the Marmot review
The Government overall will take forward a range of policies to promote health and wellbeing throughout life
Of particular relevance today is the ambition on ‘working well’ - to make it pay to work, through comprehensive welfare reforms, creating new jobs through local growth and working with employers to unleash their potential as champions of public health

5. A new public health system
Public Health England – a national public health service
A return of public health leadership to Local Government
Professional leadership nationally and locally
Dedicated resources for public health at national and local levels
Focus on outcomes and evidence based practice supported by a strong information & intelligence system
Maintaining a strong relationship with the NHS, social care and civil society
Set out in the Health and Social Care Bill
There will be a new national public health service – Public Health England.
Local leadership will be at the heart of the new system. There will be a new public health budget that will be ring-fenced from within the overall NHS budget. The Department aims to ensure that funding for public health is not squeezed by other pressures.
There will be a focus on key outcomes, with transparency through a new public health outcomes framework. The new system will also draw together existing arrangements for gathering and analysing public health information and intelligence.
Health and wellbeing boards will bring together the key NHS, public health and social care leaders in each local authority area to work in partnership.

6. A new public health service – Public Health England
New public health service directly accountable to the Secretary of State for Health with a clear mission to;
Achieve measurable improvements in public health outcomes; and
Provide effective protection from public health threats
It will do this by;
Protecting people from infectious disease and biological, chemical and radiological threats;
Helping people and families to be able to take care of their own health and wellbeing; and
Inspiring challenging and commissioning partners from all sectors.
Public Health England will draw together organisations to make the system more coherent.
Its mission will span public health – protecting the public from health threats, improving the healthy life expectancy and wellbeing of the population and improving the health of the poorest, fastest.
It will work closely with the NHS to ensure that health services play a strong part in this mission and it will support them to do this.
It will be part of the Department of Health, accountable to the Secretary of State. It will not be a separate legal entity.
Subject to the passage of the Health and Social Care Bill, it will include the current functions of the Health Protection Agency and the National Treatment Agency. It will strengthen the national response on emergency preparedness and health protection, and provide a strong hub for evidence, information and evaluation, supporting local efforts.

7. The Department of Health’s role in public health
Public Health England will be the delivery arm of public health, outwards facing and supporting the front line
The core Department will continue to be responsible for national public health policy

8. The Director of Public Health
Will be jointly appointed by the relevant local authority and Public Health England and employed by the local authority with accountability to locally elected members and through them to the public.
Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population
Will play a key role in the proposed new functions of local authorities in promoting integrated working
Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children’s Services)
Will continue to be an advocate for the public’s health within the community
Will produce an authoritative independent annual report on the health of their local population
Directors of Public Health in upper-tier and unitary local authorities will lead public health efforts, building on the important existing role of local government in public health.
They will be employed by local government and jointly appointed by the relevant local authority and Public Health England. They will be the strategic leaders for public health in local communities, working to achieve the best possible public health and wellbeing outcomes across the whole local population, in accordance with locally agreed priorities.
Directors of Public Health will lead the development of the local Joint Strategic Needs Assessment and the joint health and wellbeing strategy.

9. Health and Well-Being Boards Membership
Statutory health and wellbeing boards in every upper-tier local authority – established in April 2013.
Minimum membership of:
At least one elected representative (a local councillor) nominated by the leader or elected mayor,
A representative of each of the relevant GP Consortia (those within the local authority area)
Directors of public health, adult social services, children's services
Local HealthWatch representative
A representative of the NHS Commissioning Board (in relation to their local commissioning responsibilities on request from the health and wellbeing board)
Other representatives can be appointed by the local authority and/or the health and wellbeing board

10. Health and Wellbeing Boards
Clear duties on GP Consortia and local authorities to prepare the joint strategic needs assessment – but do so through the health and wellbeing board.
A new joint health and wellbeing strategy, prepared by the health and wellbeing board and based on the needs identified in the JSNA , with a requirement to consider the use of health act flexibilities (such as pooled budgets) in developing the strategy.
Commissioners will each be required to have regard to the joint strategic needs assessment and the joint health and wellbeing strategy when developing their own commissioning plans
Health and wellbeing boards will have a duty to promote integrated working between health and social care commissioners, as well as promoting joint working with commissioners of services that impact on wider health determinants (for example, housing or education).

11. Outcomes Framework – links to health and work
NHS outcomes framework (confirmed):
Employment of people with long term conditions
Employment of people with mental illness
Public Health outcomes framework (consultation now closed)
Proportion of people with mental illness / disability in employment (PH)
Proportion of people in long term unemployment (PH)
Employment of people with long-term conditions (PH)
Work sickness absence rate (PH)

12. Working Well RETURN TO WORK SCHEMES Fit for Work Service pilots
Fit note
Reformed Welfare to Work Programme
OTHER INITIATIVES
Public Health Responsibility Deal
New provisions in the Equality Act 2010
Accreditation Process for occupational health services
Regional Growth Fund
Evidence and data
The White Paper outlined a range of measures across government to create the right framework to ensure that people enter, remain in or return to work. Many of these have alread been covered today.
New provisions in the Equality Act 2010 came into force on 1 October. The Act prohibits employers from asking health or health-related questions before offering employment, except where it is an intrinsic function of the job.
There is little evidence that pre-employment health screening identifies fitness for work.
This empowers occupational health professionals to divert resources away from pre-employment health screening to preventive initiatives for all staff in the work place.
Central government will also provide the evidence and data needed to raise awareness among employers of the clear case for investing in the health of their employees.

13. Public Health Responsibility Deal
Launched on 15 March.
An initiative of the Secretary of State for Health, the business community, the voluntary sector and NGOs, working together to:
recognise their vital role in improving people’s health
encourage and enable people to adopt a healthier diet
foster a culture of responsible drinking
encourage and assist people to be more physically active
actively support our workforce to lead healthier lives.
The Responsibility Deal is delivered through 5 networks:
Food
Alcohol
Physical activity
Behaviour change
Health at work

14. Responsibility Deal: Health at Work network
The aim of the Health at Work Network is to find ways to help employers use the workplace to improve the health of their employees.
Current work includes:
Publication of employers/employee guides on managing chronic conditions in the workplace
Local Business Partnerships: Unilever, Mars UK, Novo Nordisk, mentoring SMEs
Finding ways to make occupational health services more proactive and preventative
Future work:
Improving workplace adjustments particularly for people with mental health conditions
Helping children and young people to understand health risks before entering job market

15. Any Questions?