Public Health Reform
&
the Voluntary Community & Faith sector
Dominic Harrison
@BWDDPH
Impact of the NHS on Life Expectancy and Infant Mortality 1900-2021?
Source: House of Commons Research Paper, 1999. 99/111
A Century of Change: Trends in UK Statistics since 1900.
NHS Reform Context
 From 1/4/13 NHS will become ‘a system not an organisation’.
 Current Government policy is for NHS to be a commissioned
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‘brand’ of health services provided to specific standards
delivered by ‘plurality of providers’ who will be allowed into
the ‘market’ by accreditation.
Specialist Public Health Services, Statutory (DPH) functions
and NHS prevention spend programmes transfer to Local
Government from 1/4/13.
Local Government will lead the Public Health transition from
October ‘12– March ’13.
The new public health system in England will be 50% local
government and 50% Public Health England.
Local Government Specialist PH Services must allocate 40%
of its capacity to providing NHS advice (principally to CCG –
detailed in MOU)
Responsibility
Secretary of State
Is in charge of all
Department of Health
North
Lancashire
ICCG ?
Regional/Lancashire
& Cumbria
Sets policy for all
Health Care Strategy & System Management
1 NCB
SHA Cluster
(4 NCB)
PCT Cluster
(50 NCB)
National
Commissioning
Board/PHE
Performance manages all
Spends about 20% of Local NHS
Budget
Local Authority
Holds all to account for health improvement/outcome
delivery
Social Care Commissioning (£50m) & Public Health
Commissioning (£15m from 2015)
Clinical Commissioning
Group
Commissions Local NHS services
Spends 75% of Local Budget
Local Authority Public Health
Service
Advises all on prevention & outcome
delivery – spends about 5% (current)
local NHS Budget
Clinical Senate
Advises CCG
Childrens and Health Scrutiny
Committee/Healthwatch/HWB
New local ‘web of Scrutiny’
Health-Watch
Represents community to all /CQC
Commissioning Support Unit
Supports the CCG to commission
Health and Wellbeing Board
Local
(for policy, performance, commissioning, scrutiny ,accountability,
governance, engagement)
Institution
Public Health
England (EA)
National
NHS(CCG, Local Government Health , Wellbeing & SC System)
Spatial Level
Christie Report: 2011
Delivering Public Sector Outcomes
Community
Services
Policy
Alcohol, obesity, healthy eating, physical activity, tobacco control, road traffic
collisions, etc
NHS Public Health/Prevention Spend Transfer to LAs
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
tobacco control;
alcohol and drug misuse services;
obesity and community nutrition initiatives
increasing levels of physical activity in the local population
assessment and lifestyle interventions as part of the NHS Health Check Programme;
public mental health services;
dental public health services;
accidental injury prevention;
population level interventions to reduce and prevent birth defects;
behavioural and lifestyle campaigns to prevent cancer and long term conditions;
local initiatives on workplace health;
supporting, reviewing and challenging delivery of key public health funded and NHS
delivered services such as immunisation programmes;
comprehensive sexual health services (this includes testing and treatment for sexually
transmitted infections, contraception outside of the GP contract, termination of pregnancy,
and sexual health promotion and prevention
local initiatives to reduce excess deaths as a result of seasonal mortality;
role in dealing with health protection incidents and emergencies (Annex B)
promotion of community safety, violence prevention and response; and
local initiatives to tackle social exclusion.
1:This is 11/12 budget inflation uplifted from 10/11 data. Actual 13/14 will depend on ARCA ‘formula’
2: Commissioning budget (5% current PCT commissioning spend) = £230K & SPHS =£900K
Health Outcomes Frameworks
Public Health, NHS and Adult Social Care
Public Health
Adult Social Care and Public
Health:
Maintaining good health
and wellbeing.
Preventing avoidable ill
health or injury, including
through reablement or
intermediate care services
and early intervention.
Adult Social
Care
NHS and Public Health:
Preventing ill health
and lifestyle diseases
and tackling their
determinants.
Awareness and early detection of
major conditions
Adult Social Care and NHS:
Supported discharge from
NHS to social care.
Impact of reablement or
intermediate care services
on reducing repeat
NHS emergency admissions.
Supporting carers and
involving in care planning.
ASC, NHS and Public Health:
The focus of Joint Strategic Needs Assessment: shared local
health and wellbeing issues for joint approaches.
Place
People
Services
What outcomes are the PH Function:
delivering on : Post 2013
1. Strategic Priorities (whole system) Health Improvement (CCG,BWD
BC, Third Sector, Community) e.g. COPC /CCG Care Strategy
2. DPH Statutory duties (NHS, BwD BC, PHE) e.g. HWB Board
3. BWD Borough Council Corporate Plan Health Targets
4. £10.5m PH Prevention Service delivery targets (contributing to NHS
outcome targets) e.g. sexual health
5. Integrated Commissioning Network Service Priority targets e.g.
wellbeing /LTC Service
6. Public Health Outcomes Framework Targets e.g. TB control
(integrated PH/Childrens/Social Care Outcome Priorities)
7. Health and Wellbeing Board Priority Targets e.g. child death rate
8. CCG MOU outcome delivery (service targets /analysis etc)
9. Shared BC Directorate (HIAP) targets e.g.20mph, Housing, domestic
violence etc
10.Shared PCC targets e.g. Violence prevention
CCG / PH / Local Government Commissioning
Local Government /
Others e.g.PCC?
CCG
Shared services
NHS
Local Government
PH
Integrated Commissioning NetworkJoint decision making and accountability
Recommendation
Decision making at
agreed delegated level
Ratification
Corporate Strategy
Council
Executive
Board
Health and wellbeing
strategy
Health and
Wellbeing
Board
Executive Joint
Commissioning
Group (Exec JCG)
Joint
Commissioning and
Recommendation
Group (JCRG)
Joint business cases
Single Integrated Plan
CCG Board
Members
Chris Clayton
Harry Catherall
Joe Slater
Cllr Khan
Officers
Sally McIvor
Debbie Nixon
Dominic
Harrison
Officers
Sally McIvor
Debbie Nixon
Dominic Harrison
Linda Clegg
1.ACRA’s interim recommendations would
see councils in the poorest areas receiving
less money than is currently spent by the
NHS on these services.
Public Health Funding Formula Risk:
Unfair, Unjust & avoidable aspects of ACRA
Recommendations
2. This reduction in spending on public
health services in poor areas would
compound the effect of other budget cuts
that have disproportionately affected these
same areas- further exacerbating health
inequalities.
3.The “health premium” component of the
public health allocation to local authorities
could further shift resources away from
deprived areas than is implied by the
proposed formula.
4. The use of SMR<75 in the ACRA formula
does not sufficiently reflect the differences
in the level of poverty between areas that
are the main causes of health inequalities.
Figure 1. Change in funding per head of population that would result from
moving from 2010-11 baseline funding to proposed target allocation. Assumes
total budget for public health services taken on by Local Authorities is £2.2 as
estimated by the Department of Health.