1. Healthy Lives, Healthy People A Strategy for Public Health in England
PHW 10.7
28 January 2011
Healthy Lives, Healthy People A Strategy for Public Health in England
Healthy Lives, Healthy People
Mark Dickinson

2. Rationale
“it is simply not possible to promote healthier lifestyles through Whitehall diktat and nannying about the way people should live … one-size-fits-all solutions are no good when public health challenges vary from one neighbourhood to the next. But we cannot sit back while … so many people are suffering … ill health and … health inequalities”
Healthy Lives, Healthy People

3. Key Messages “new approach that empowers individuals”
“local communities at the heart of public health”
“end central control”
“financial incentives to reward progress”
“simplifying the way we organise things nationally”
“work with industry and other partners”
Healthy Lives, Healthy People

4. White Paper Structure Seizing opportunities for better health
A radical new approach
Health and wellbeing throughout life
A new public health system
Making it happen
Healthy Lives, Healthy People

5. Seizing Opportunities
Healthy Lives, Healthy People

6. Seizing Opportunities
Starting well - Improve maternal health to give children a better start in life
Developing well - Improve child health and development to improve educational attainment and health in later life
Living well - Change adult behaviour to reduce premature death and illness
Working well – Being in work is good for health and good health is good for the economy
Ageing well – e.g. Prevent excess winter deaths
Healthy Lives, Healthy People

7. Seizing Opportunities
“it is not better treatment but prevention … which is likely to deliver greater overall increases in life expectancy”
Importance of health inequalities and the social gradient of health is acknowledged
Healthy Lives, Healthy People

8. Seizing Opportunities
Strategic focus on the outcomes that matter most
Focus on what works to make the biggest difference
Harness efforts across society
Local government in a leadership role
Healthy Lives, Healthy People

9. A Radical New Approach
Healthy Lives, Healthy People

10. New Approach Public health system must:
Reach out – address root causes and involve individuals, families and communities
Be responsive - owned and shaped by communities
Be resourced – ring fenced funding and incentives to improve
Be rigorous – professionally led, evidence based, efficient and effective
Be resilient – protecting against current and future health threats
Healthy Lives, Healthy People

11. New Approach
Health Protection must be led by central government with “a strong system to the front line”
Beyond that, local leadership and wide responsibility is key
A ‘ladder’ of interventions will be used to decide the least intrusive approach possible
Voluntary approaches before regulation
Healthy Lives, Healthy People

12. Reaching Out Individuals be in the ‘driving seat’
Local government is best placed to influence many of the wider determinants of health
NHS continues to have a crucial role
Voluntary sector makes a vital contribution
Businesses must take more responsibility
Healthy Lives, Healthy People

13. Being Responsive
There have been too many central initiatives and targets
Time to free up local government and communities to determine local action with the NHS and partners
New freedoms and funding for local government
Outcomes framework and a ‘Health Premium’
Healthy Lives, Healthy People

14. Being Resourced Public Health budgets have been squeezed
Need to prioritise Public health
Ring-fenced funding from within the overall NHS budget
Still subject to running cost reductions and efficiency improvements
Allocated to local authorities
Healthy Lives, Healthy People

15. Being Rigorous System has let the workforce down
Public Health England will be established
“uniting force for a wider family of professionals”
Need to build and apply the evidence base
Improve the use of evidence and evaluation
Healthy Lives, Healthy People

16. Being Resilient Current Health protection system is fragmented
Need a stronger, more integrated system:
‘enhanced’ functions of the Secretary of State”
Clearer accountabilities
Public Health England leading
Healthy Lives, Healthy People

17. Health & Wellbeing Throughout Life
Healthy Lives, Healthy People

18. Health & Wellbeing Throughout Life
Empower local government
Take a coherent approach to different stages of life and key transitions instead of tackling risk factors in isolation
Give every child the best start in life
Make it pay to work
Design communities for active ageing and sustainability
Work collaboratively with business and the voluntary sector
Healthy Lives, Healthy People

19. Public Health Responsibility Deal
Collaboration with business and the voluntary sector
Five networks:
Food
Alcohol
Physical activity
Health at work
Behavioural change
Healthy Lives, Healthy People

20. A New Public Health System
Healthy Lives, Healthy People

21. New Public Health System
Devolved responsibilities, freedoms and ring-fenced funding
New Director of Public Health role
Public Health England
Public Health Outcomes Framework
School for Public Health Research
Policy Research Unit on Behaviour and Health
Healthy Lives, Healthy People

22. New Public Health System
Public Health will be part of the NHS Commissioning Board’s mandate
Public health support for national and local commissioning
Incentives for GPs to play an active role in Public Health
CMO will be the leading advocate for Public health “within, across and beyond government”
Healthy Lives, Healthy People

23. Directors of Public Health
Employed by local government and jointly appointed by Public Health England
In upper-tier local government and unitary authorities
Strategic leaders for Public health and health inequalities in local communities
Work in partnership with the local NHS and across the public, private and voluntary sectors
Healthy Lives, Healthy People

24. Directors of Public Health
Critical Tasks:
Promoting health and wellbeing in local government
Providing and using evidence
Advising and supporting GP consortia
Developing a local approach to improving health and reducing health inequalities
Working closely with Public Health England Health Protection Units
Healthy Lives, Healthy People

25. Public Health England To be created within the Department of Health
Will:
“maintain the principles and practice of independent scientific and public health advice”
Support local action through funding, provision of evidence and data and professional leadership
Lead Health Protection (including current HPA functions) and have local Health Protection Units
Healthy Lives, Healthy People

26. Public Health England Will include: Protected budget:
Elements of Public health currently within DH and Strategic Health Authorities
Public Health Observatories
Cancer Registries
Protected budget:
Will be subject to a “planned reduction of one-third of non front line administration costs, while protecting front line services”
Healthy Lives, Healthy People

27. Local Government Role Existing communicable disease role will remain
Upper tier and unitary local authorities will have a duty to “take steps to improve the health of their population”
Partners in statutory local Health and Wellbeing Boards
Healthy Lives, Healthy People

28. Funding for Public Health
National Public Health Budget
Public Health England could be responsible for over £4bn
Details still to be worked out
Local Public Health Budget
Public Health England will allocate ring-fenced budgets to local authorities
“weighted for inequalities”
Healthy Lives, Healthy People

29. Funding for Public Health
‘Public Health Premium’
To incentivise action to reduce inequalities
Will apply to the part of local Public health budgets for health improvement
Baseline weighted to areas with most need
Incentive payments to reward improvement
Healthy Lives, Healthy People

30. Funding for Public Health
Separate consultation paper on “the funding and commissioning routes for public health”
Healthy Lives, Healthy People

31. Public Health Outcomes Framework
Separate consultation paper
Aims to:
Use indicators which are meaningful to the public
Focus on major causes and impacts of illness and inequalities
Take legal duties into account
Take a ‘life course’ approach
Healthy Lives, Healthy People

32. Public Health Outcomes Framework
Aims to interlink and align with the NHS and Adult Social Care Outcomes Frameworks
Vision:
“To improve and protect the nation’s health and to improve the health of the poorest, fastest”
Healthy Lives, Healthy People

33. Public Health Outcomes Framework
Based on 5 Domains
Health Protection and Resilience
Tacking the wider determinants of health
Health improvement
Prevention of ill health
Healthy life expectancy and preventable mortality
Healthy Lives, Healthy People

34. Making it Happen
Healthy Lives, Healthy People

35. Making it Happen White Paper published November 2010
Health Bill published January 2011
Consultation to end March 2011
Papers on specific topics during 2011
Public Health England in shadow form from 2011 and to be established 2012
New local authority legal duties and functions from 2013
Whole process in alignment with wider NHS reform
Healthy Lives, Healthy People

36. Questions, Concerns and Implications
Healthy Lives, Healthy People

37. Questions and Concerns
The funding has not been calculated or identified
Will there be enough resources?
Will local authorities receive additional funding to match additional responsibilities
Is the proposed role of Director of Public Health doable?
Healthy Lives, Healthy People

38. Concerns Identified by the HPA Board
How to ensure independence of scientific and public health advice, nationally and locally?
How to maintain income generation?
How will the relationship between Public Health England and the DsPH work?
How will emergency preparedness, response and resilience be maintained and strengthened?
Healthy Lives, Healthy People

39. Implications for Public Health Wales
Access to independent advice
Cohesion of cross border emergency preparedness and response
Divergence in the roles and responsibilities of public health
Implications for training
Implications for career mobility
Expectations of local government
Healthy Lives, Healthy People

40. Consultation Questions
Healthy Lives, Healthy People

41. Consultation Questions
Role of GPs and GP practices in public health: Are there additional ways in which we can ensure that they will continue to play a key role in areas for which Public Health England will take responsibility?
Public health evidence: What are the best opportunities to develop and enhance … information and intelligence?
Healthy Lives, Healthy People

42. Consultation Questions
Public health evidence: How can Public Health England address gaps such as:
Insights of behavioural science
Tackling wider determinants
Achieving cost effectiveness
Tackling inequalities?
Healthy Lives, Healthy People

43. Consultation Questions
Public health evidence: What can wider partners contribute to improving evidence?
Regulation of public health professionals: We would welcome views on Dr Gabriel Scally’s report. Which organisation would best provide a system of voluntary regulation
Healthy Lives, Healthy People