Health and Wellbeing
Accelerating transformation and impact
Professor Kevin A. Fenton MD PhD FFPH
National Director, Health and Wellbeing
National Leading Health and Wellbeing Programme 2013/2014
14 January 2014
Transformation: The new public health system
Public Health England: Mission; role; priorities
Accelerating progress: Scale of the ambition
Challenges and Opportunities
Leadership: In public health; across the system
The new public health system
Health System Transformation
• Health & Social Care Act 2012: wholesale
system change across health and social care
• National Health Service reform
• Refocusing on public health and prevention
• Localism
• Focusing on outcomes not targets
• Changes implemented from 1 April 2013
The new PH system provides an opportunity
for renewed action and improved outcomes
Local authorities
DH responsible to parliament
New public health functions, helping to
tackle wider determinants of health
Cross-government senior officials
group to improve health outcomes
CMO to provide independent advice
to government
Public Health England
Lead on improving health and
coordinate protecting health
Promote population health and
wellbeing (DPHs)
New, integrated national expert body
NHS England
Strengthened health protection
Delivering health care, tackling
Supporting whole system with
expertise, evidence and intelligence
Making every contact count
Specific public health interventions,
such as cancer screening
Local leadership in public health
• Health and wellbeing boards: central to local
government’s role as public health leaders.
• No one size fits all. Boards differ depending on
Local priorities
Local partners, stakeholders, agendas
Local assets, including VCs and businesses
• Democratic legitimacy
Elected council members
Healthwatch represent views of local people
Health and wellbeing boards
• Nearly all have produced joint strategic needs
assessments (JSNA) and joint health and
wellbeing strategies (JHWS)
• Public health and health inequalities: top priority
• Keen to play bigger role in commissioning services
Source: The King’s Fund. Health and wellbeing boards. One year on. 31 October 2013
Public Health England
Mission; Role; Priorities
Public Health England
System Leadership: Work transparently, provide government, local
government, the NHS, MPs, industry, public health professionals and the
public with evidence-based professional, scientific and delivery expertise
and advice
Protection: Ensure there are effective national and local arrangements
for preparing, planning and responding to health protection concerns and
emergencies, including the future impact of climate change
Local Support: Support local authorities and clinical commissioning
groups by providing evidence and knowledge on local health needs,
alongside practical and professional advice on what to do to improve
PHE’s outcomes focused priorities for
Help people to live longer and healthier
Reduce the burden of disease and
Protect the country from infectious
diseases and environmental hazards
Support families to give children and
young people the best start in life
Improve health in the workplace
PHE’s Health and Wellbeing priorities
1 Support people to live healthier lives via NHS Health Checks
2 Promote tobacco control and reduce smoking
3 Promote healthy weight and tackle childhood obesity
4 Improve recovery rates from drug dependency
5 Improve sexual health and reduce the burden of STIs
6 Develop a national programme on mental health
7 Lead gold standards for vaccination and screening programmes
8 Make the case for promoting wellbeing, prevention and early
intervention as the best approach to improving health
9 Partner NHS England to maximise improvements in public health
Accelerating progress
Scale of the ambition
Accelerating impact on NCDs
• There is a rising tide of Non-Communicable
Disease (NCD) in England.
• Many NCDs: associated with inequalities in
• UK’s underperformance on premature mortality
• Focus on major drivers of disease, disability,
disadvantage and death
Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 9971020
We need new approaches, new vision
• Focus on the risk factors, upstream causes
• Maximise impact by working with range of
• Shift national focus to prevention and wellbeing:
campaigns and engagement
• Translate evidence into best practice
The burden of disease: risk factors
The Lancet, Early Online Publication, 5 March 2013doi:10.1016/S0140-6736(13)60355-4
Focus on the risk factors
• NHS Health Check implementation:
- World-leading risk awareness, risk assessment,
risk and disease management programme
- Aimed at 15m people (aged 40-74)
- Top ten risk factors for premature death/disability
- Prevent 1,600 heart attacks and strokes, detect
20,000 cases of diabetes or kidney disease earlier,
avoid 3,250 premature deaths over 5 years
Focus on the risk factors
• High blood pressure
About 30% of adults in England have
high blood pressure1, of whom over 4
million are undiagnosed2.
Of those in treatment, almost 40% have
not reduced their blood pressure
enough to be deemed ‘controlled’3.
High blood pressure is the second
biggest risk factor of disease leading to
premature mortality in this country5.
It is a major risk factor for stroke, heart
attack, heart failure, chronic kidney
disease and cognitive decline
1. Health Survey for England 2011, defined as 140/90mmHg or above, adults as 16+ / 2. Health Survey for England 2011 (34% undetected in women, 39% undetected in men) and ONS mid-2012
England population estimates. Note, the DH CVD outcomes strategy estimated 6.8m (47%) undiagnosed / 3. Health Survey for England 2011 (63% of all men and 61% of women receiving drug
treatment now with blood pressure below 140/90mmHg) / 4. Joffres et al. (2013) ‘Hypertension prevalence, awareness…’, BMJ / 5. Global burden of disease: UK study 2013
Maximising impact: working together
• PHE engagement with voluntary and
commercial sector: potential for wider impact of
NHS Health Check
• PHE support for Health and Wellbeing Boards
(15 Centres, local information and intelligence):
evidence to inform local health strategy
• PHE work with NICE: translate evidence into
practice, improve quality and standards
National focus on prevention
Campaigns to shift the debate to health promotion
Be clear on cancer
National bowel
campaign: 40% rise
in two-week referrals
Regional lung
campaign:14% rise
in diagnoses
Smokefree Homes
& Cars
37% who saw ads
reduced their
second-hand smoke
85,000 smokefree
kits distributed
Smart Restart
150,000 families
(300,000 children)
signed up
700,000 engaged in
App downloaded
more than 100,000
200,000 registered
for support products
Evidence and best practice
• Data that are relevant to local public health
leaders (Longer Lives, Health Profiles, Excess
Winter Deaths Index)
• Data that highlight new developments (NCMP:
prevalence of obesity reduced for Year 6
• Evaluation of interventions (NHS Health Check)
Source: National Child Measurement Programme – England, 2012-13 school Year (NS). Health & Social Care
Information Centre. December 11 2013. Accessed at:
Challenges: change and complexity
• Changes to public health landscape: require
new structures, new relationships
• How will this impact on commissioning and
pathways of care (eg: in STIs)
• Economic hardships: how do we assess their
impact on public health?
• Our mission to improve health and address
inequalities: extremely complex problems
Opportunities: local agenda, integration
• We have an unparalleled opportunity to drive
system transformation
• The new national focus on health and wellbeing
follows and complements local government
• A focus on health in all policies: integrating
health considerations into broad range of policy
areas (employment, education, social policy)
In public health; across the system
Leadership in public health
• We need to change the narrative: from
healthcare to health and resilience
• We need to set out the case for evidence-based
interventions to improve health and wellbeing at
all levels
Health and Wellbeing Framework
Leadership in public health
• Monitor impact and effectiveness of
• Highlight areas of concern where there is
potential impact on public health
• Set the bar high: a number of other countries
have better record on premature mortality than
Source: Murray C et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381:
Leadership across the system
Leverage opportunities for cross-government health agenda
Crime and
• Good housing drives health
• 20,000 excess deaths each
• Reduces risk of illness by
up to 50%
• 2/3 of adults obese or overweight
• Work a key health determinant
• Poor health keeps people out
of work
• 1/3 children in Y6 obese or
• Cost of obesity to NHS £5bn a year
• Leading cause of premature
• Estimate cost to economy £13bn
• Isolation significant driver of poor
• Poor environments lead to social
• Alcohol a factor in 44% of
violent crime
• Foundations for every
aspect of development laid
in childhood
Concluding thoughts
• Greater investment in strengthening health
improvement programmes could be part of
solution on NCDs
• We need to focus on integrated, upstream
• Even in environment of localism, areas with
limited resources can focus on cost effective
population approaches
Thank you
National Leading Health and Wellbeing Programme 2013/2014
14 January 2014
Professor Kevin A. Fenton
National Director, Health and Wellbeing
Email: [email protected]
Twitter: @ProfKevinFenton