The Role of Local Government in Public Health Tuesday 10 July 2012.

The Role of Local Government in Public Health Tuesday 10 July 2012

Conference Chair Cllr Robin Brown, Northamptonshire County Council

Equity and Excellence; Liberating the NHS: Reform of the Public Health System Dr Giri Rajaratnam Deputy Regional Director of Public Health, East Midlands Midlands and The East Cluster SHA

Health inequalities across Nottingham

Why more of our kids end up arrested, homeless or in hospital over drugs

Model of Health Health and Wellbeing Variations in health, ill health and wellbeing Ill health and need for care Heart disease, mental health, respiratory disease, cancers, musculo-skeletal, dementia, frailty etc Lifestyles & Behaviour Smoking Nutrition Physical Activity Sexual practices Substance Misuse Wider Determinants of health & the Environment Housing Education Employment Safety Culture Poverty

200,000 250,000 150,000 100,000 50,000 0 1996 - 50,000 199719981999200020012002 Year Deaths Potentially Averted Deaths potentially averted by medical advances Deaths potentially averted by eliminating education-associated excess morta lity Deaths potentially averted per year in the United States by medical advances and by eliminating education-associated excess mortality: 1996-2002 Source: Woolf et all. American Journal of Public Health 2007; 97(4): 679 - 683

The Need For Reform 1.Demography and communities 2.Empowering Patients & Public Health 3.Outcome Focus 4.Productivity increases equivalent to £20b 5.International comparisons (particularly cancer) of performance 6.Competition as a stimulant for innovation, improvement and productivity 7.A better balance between private, public and 3 rd sector provision of services

The Health and Care landscape in 2013 S of S and DH PH (England) NHS CB PH in LA CCG Health & Well-being Board Local Government HealthWatch Communities O&SC JSNA to H&WB strategy to Commissioning Plans

NHS Commissioning Board and Clinical Commissioning Groups Functions 1.Understanding health care needs and commissioning services for registered populations 2.Ensuring NHS response to major incidents. 3.Commissioning selected public health interventions (Immunisations and screening) 4.To co-operate with local authorities and participate in the local Health and Wellbeing Group 5.To involve patients and the public

The New Public Health System THE NEW DUTY (Local Government) “To take such steps as it considers appropriate for improving the health of the people in its area” Includes: 1.Commissioning services 2.Focus on the most disadvantaged 3.Supporting, engaging and developing local communities 4.Ensuring all local government responsibilities are delivered in a way that they promote health & wellbeing.

Local Government Delivering the new Duty 1.Ring fenced financial allocation 2.Specialist Public Health Workforce including Director of Public Health 3.Legislation to support access to data 4.Creation of the Health and Wellbeing Board 5.National Institute for Health and Clinical Excellence and Social Care Institute for Excellence 6.Three overlapping Outcome Frameworks (public health, NHS and Social care)

Health & Wellbeing Board 1.Leadership group for all aspects of health and wellbeing in a locality 2.Involvement of key local leaders 3.Duty to promote integration; planning, commissioning and provision 4.Key outputs: Joint Strategic Needs Assessment and Health Wellbeing Strategy 5.Review Outcomes for local communities

Public Health England Purpose 1.Deliver, support and enable improvements in health and wellbeing 2.Lead on the design, delivery and maintenance of systems to protect the populations against existing and future threats to public health 3.Support local public health teams to deliver their functions 4.Support NHS CB to commission services such as screening and immunisation 5.Producing benchmarked information on the public health outcome framework indicators

Accountability (1) 1.Health & Wellbeing Boards and Local Authorities: accountable to local communities and Overview & Scrutiny Committee 2.CCGs accountable to NHS CB 3.Public Health England and NHS CB accountable to Secretary of State for Health through mandates 4.Health & Wellbeing Boards accountable for leading and co-ordinating for health, social and care systems for delivering appropriate outcomes for local communities.

Accountability (2) 1.Three outcome frameworks. Use of incentives aimed at both CCGs and LAs. 2.NO PERFORMANCE MANAGEMENT 3.Transparency of information: regular publication of benchmarked data related to the indicators listed in the three outcome frameworks.

Taking Advantage 1.Thinking about wellbeing and ill health within your community 2.Understanding how the different factors affect health in your local communities 3.Designing interventions or approaches that best meet local needs and designing indicators to help guide implementation 4.Ownership of local communities and leaders

In Conclusion Opportunities for: 1.Enabling the telling of the local story ( Outcomes Frameworks ) 2.Ensuring “joined up” planning, commissioning and providing 3.Supporting communities and individuals 4.Shaping the place: physically and psychologically

Timeline for Change Mar 2012 Local transition plans completed Apr 2012 Local areas agree arrangements for any in year delegation of functions and secondments/assignment of transferring staff in line with guidance By Oct 2012 Local area test arrangements for delivery of specific public health services in particular screening and immunisation, and Emergency Response Oct 2012 Agree arrangements on public health information requirements and information governance Jan 2102 Ensure final legacy and handover documents completed Apr 2013 Local authorities formally take on new responsibilities

Opportunities and threats for LAs and their services Alyson Morley Senior Adviser (Health Transformation) www.local.gov.uk

Summary Opportunities Threats Role of district councils Current support for public health transition LGA’s future support offer to system leaders

Why local government? “Differences in access to health care matter, as do differences in lifestyle, but the key determinants of social inequalities in health lie in the circumstances in which people are born, grow, live, work and age” Professor Sir Michael Marmot Fair Society, Healthy Lives 2010

Opportunities Focus on health, not just treating sickness Whole population, place-based focus and strategic overview of needs and resources Wider determinants of health Stronger local political and clinical leadership of health agenda Community engagement and voice of the ‘patient’ Integrated plans and commissioning Localism – needs, plans, action

Contribution of district councils Closer to local people and customers – vital input to JSNA and communications on health reforms Provider/commissioners of key services – housing, leisure, planning, environmental health etc and employers Closer correlation with clinical commissioning groups – possibly District councils are already engaged and committed to health and wellbeing – they have a strong base on which to build

Threats to all councils Commitment – are LAs up for the challenge? Capacity – are LAs up to the challenge? Maintaining stability in transition Will HWBs be effective? Will CCGs engage with HWBs? Centralising tendencies of Public Health England, NHS Commissioning Board and Care Quality Commission Resources – PH and Healthwatch funding Will systems, priorities and services change?

Making health reforms work at district level Working with county HWB –Contribution to joint strategic needs assessment –Contribution to joint health and wellbeing strategy –Public health presence at district level Working with other districts Working with CCG Working with Healthwatch Role of Leader and Portfolio holder for health and wellbeing

Current support for health reform – Health and wellbeing boards Principles of support offer available at national and regional level 1.Alignment with other activities 2.No duplication – builds on existing regional activity and adds value 3.Making a difference – support is action and outcome focused 4.Sustainability – building in future needs and support

National support for HWBs leadership HWB leadership support offer National HWB development tool – to help evaluate progress Knowledge Hub on HWBs – currently hosted by DH with 900+ members. Open to anyone: https://knowledgehub.local.gov.uk/. https://knowledgehub.local.gov.uk/ Disseminating evaluation and learning Regional Simulation events Chairs’ networks Other activities Bespoke support Joint activity with NHS Leadership Academy to provide support to 75 HWBs Contact lorna.shaw@local.gov.uk for more informationlorna.shaw@local.gov.uk

National support – Healthwatch Local Healthwatch will be the consumer champion for public health, as well as health and social care services Crucial to have the patient and public voice in public health planning and provision Healthwatch is ‘lagging behind’ development of other partners – we need to keep a space for them National support programme in place

National support – public health JSNA guidance, principles and case studies From transition to transformation web resource National events on specific public health issues LGA annual public health conference – January 2013

Future sector-led support LGA Inform –Web-resource to benchmark with other councils –Capacity/demand for public health information System-wide peer challenge – Across all domains of the health reform agenda –With key partners –Demand from health systems –Testing the approach with all system leaders

Next steps What do you want LGA and other national organisations to provide? What is your current experience of support? What needs to improve? alyson.morley@local.gov.uk

Cllr Tony Roberts MBE Newark and Sherwood District Council

Refreshment Break

Workshops Workshop 1 Health Watch in the East Midlands, The Role for the authority and the Frontline Councillor Delegates with Orange dots attend this workshop first, in Suite 1 Workshop 2 Improving Health and Tackling Inequalities through Partnership Delegates with Green dots attend this workshop first, in Suite 2

Healthwatch in the East Midlands The role for the authority and frontline councillor Ged Taylor East Midlands Programme Director Health Transitions

Topics covered Role of Healthwatch Fit with health reforms Transition from LINk Role of councils Role of councillors

What is Healthwatch? Healthwatch will be new consumer champion for health and social care Exist in 2 forms : –Local Healthwatch ( x 152) –Healthwatch England Local Healthwatch – established April 2013 Healthwatch England – established October 12- statutory committee of Care Quality Commission – funded by Dept Health

What is Healthwatch? Local Healthwatch will: Have a seat on Health & Wellbeing Boards Enable local people to share views & concerns about local health and social care services Provide & signpost people to information about health and social care services & how to access Provide evidenced feedback to commissioners of health and social care services Advise and support individuals when something goes wrong & support complaints

What is Healthwatch? Local Healthwatch will: Carry forward existing functions of LINk Have additional powers including advice & information about access to choices & advocacy Be independent, commissioned by the local authority with statutory functions Be a social enterprise Be inclusive and reflect the diversity of the local community it serves

What is Healthwatch? Healthwatch England Provide leadership, guidance & support to local Healthwatch organisations Receive alerts & concerns about services from local Healthwatch organisations Provide advice to Secretary of State, NHS Commissioning Board, Monitor & local authorities

Local Authority Responsibilities Local Healthwatch will be funded by local authorities – LAs receive non ring-fenced funds LAs will commission a local Healthwatch in their area - flexibility as to how they commission Will need to work with existing LINks to manage transition to new organisations Will evaluate and monitor local Healthwatch performance Provide an advocacy service for people making complaints about NHS services (ICAS)

Role of councillors Health Overview & Scrutiny to remain as is O&S can scrutinise commissioning of HW HW can ask for information from councils HW can inspect LA social care services O&S provides bridge between LINk & HW Can open doors for Healthwatch Joint O&Ss for wider service reviews

Role of councillors Scrutiny at County and District level – a layered approach County – Executive (Clinical Commissioning Groups & Health and Wellbeing Boards) Scrutiny (O&S) District – Health & Wellbeing Board members, scrutiny, local issues, wider determinants of health, prevention, services contributing to health & wellbeing

Lunch break

Workshops Workshop 1 Health Watch in the East Midlands, The Role for the authority and the Frontline Councillor Delegates with Green dots attend the Health Watch workshop, in Suite 1 Workshop 2 Improving Health and Tackling Inequalities through Partnership Delegates with Orange dots attend the Health Inequalities workshop, in Suite 2