Healthy Lives, Healthy People
Strategy for Public Health in England
November 2010
Jane Miller
Deputy Director of Public Health
NHS Lewisham
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The best possible health and well being for people in Lewisham
What is public health?
• ‘The science and art of promoting and protecting
health and wellbeing, preventing ill health and
prolonging life through the organised efforts of society’
(Faculty of Public Health definition)
There are three domains to public health;
• Health improvement (including people’s lifestyles as
well as inequalities in health and the wider social
influences of health),
• Health protection (including infectious diseases,
environmental hazards and emergency preparedness)
• Health services (including service planning, efficiency,
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audit
and evaluation).
The best possible health and well being for people in Lewisham
Health Background
Poor mental health is estimated to be responsible for nearly a quarter of
the overall burden of long-standing poor health
Smoking claims over 80,000 lives a year
10/04/2015
1.6 million people are dependent on alcohol
Britain has amongst the worst levels of obesity in the world
Over half a million new sexually transmitted infections were diagnosed
last year, and one in ten people getting an infection will be re-infected
within a year
People in the poorest areas
10/04/2015
10/04/2015
10/04/2015
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10/04/2015
people
in richer areas
expect to live up to 7 years less than
The best possible health and well being for people in Lewisham
A Radical New Approach
• representative – owned by communities and shaped
by their needs
• resourced – with ring-fenced funding and incentives
to improve
• rigorous – professionally-led, focused on evidence,
efficient and effective
• resilient – strengthening protection against current
and
future threats to health.
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The best possible health and well being for people in Lewisham
Public Health Paper
• Commitment to public health
• Inequalities
• Recognition of relationship of mental health to physical
health
• Recognition of role of local authorities in improving
health and wellbeing
• National public health service – Public Health England
• Importance of health protection
• Intention to protect public health funding
• Public Health into GP Commissioning
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The best possible health and well being for people in Lewisham
A New Public Health System
• Public Health England – a national public health service
• A return to 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
• Maintaining a strong relationship with the NHS, social care and
civil society
• Set out in the Health and Social Care Bill
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The best possible health and well being for people in Lewisham
Working together locally
• Local authorities will lead local action on public health, playing
an important new role in promoting people’s health and wellbeing,
with new freedoms to make a major impact on health
improvement and health inequalities
• Health and Wellbeing Boards - Local authorities will play a
leading role in driving collaboration
• Directors of Public Health will be the strategic leaders for public
health and health inequalities in local communities, working in
partnership with the local NHS and across the public, private and
voluntary sectors
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The best possible health and well being for people in Lewisham
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
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The best possible health and well being for people in Lewisham
Director of Public Health
• Will be the principal adviser on health to the local authority,
elected members and officers, on the range of local authority
functions and their impact on the health of the local population
• Will be play a key role in the proposed new functions of local
authorities in promoting integrated working
• With Directors of Adult Social Services and Directors of Children’s
Services and GP Consortia lead the development of the local
Joint Strategic Needs Assessment (JSNA) and a Health and
Wellbeing strategy
• Will continue to be an advocate for the public’s health within the
community
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The best possible health and well being for people in Lewisham
Director of Public Health
• Will be jointly appointed by 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 produce an independent annual report on the health of their
local population
• Accountable to the Secretary of State for Health for
responsibilities relating to health protection and professionally
accountable to the Chief Medical Officer
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The best possible health and well being for people in Lewisham
Public health funding and
commissioning
Public
health
budget
Department of Health
NHS
budget
Public Health England
(within the Department of
Health)
Funding for commissioning
specific public health services
Ringfenced
public
health
grant
Local authorities
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NHS
commissioning
architecture
(Commissioning
Board and
Consortia)
Providers
GPs
integration
Health and
wellbeing
boards
integration
JSNA & Joint Strategic
Health and Wellbeing Plans
The best possible health and well being for people in Lewisham
Outcomes Framework
Vision
Figure 2 – A frame work for public health outcomes
To improve and protect the nation’s health and well-being and to improve the health of the poorest fastest.
•
Increasing healthy life expectancy
•
Reducing the healthy life expectancy gap between the least deprived and most deprived communities
Domains
Domain 1 – Health protection and resilience
Protect the population’s health from major emergencies and remain resilient to harm
DETERMINANTS OF ILL HEALTH
OUTCOMES OF ILL HEALTH
Domain 2 – Tackling
the wider determinants
of health
Domain 3 – health
improvement
Domain 4 – prevention
of ill-health
Domain 5 - healthy life
expectancy and
preventable mortality
tackling factors which
affect health and
wellbeing
Helping people to live
healthy lifestyles make
healthy choices and reduce
the gap in health inequalities
Reducing the number of
people living with
preventable ill health
and reduce the gap in
health inequalities
Preventing people from
dying prematurely and
reduce the gap in health
inequalities
Public health indicators (of which, some will be used locally to attract the Health Premium)
Indicators
• The Domains above set out the high-level goals for public health. Each domain will require a national local
balance for delivery, with an onus on local delivery across the NHS, social care services public health and other
local partners, and with strong leadership from the Director of Public Health.
• Outcomes for public health will be measured by indicators, which are supported by centrally collated and
analysed data sets. This should include indicators that target different age groups, and target communities that
experience differential outcomes in health.
• It will be for each local area to determine how they will wish to use these indicators for local transparency in
response to local needs identified through their Joint Strategic Needs Assessment, and considered within their
local Joint Health and Well-being Strategies.
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The best possible health and well being for people in Lewisham
Domain 1: Health protection and resilience: protect the
population’s health from major emergencies and remain
resilient to harm.
• Life years lost from air pollution as measured by fine particulate
matter.
• Public sector organisations with a board approved sustainable
development management plan.
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The best possible health and well being for people in Lewisham
Domain 2 – Tackling the wider determinants of ill health:
tackling factors which affect health and wellbeing.
•
•
•
•
•
•
•
Children in poverty
School readiness: foundation
stage profile attainment for
children starting Key Stage 1
Rates of adolescents not in
education employment or training
at 16 and 18 years of age
Truancy rates
First time entrants to the youth
justice system
Proportion of people in long-term
unemployment
Proportion of people with longterm conditions
•
•
•
•
•
•
•
Housing overcrowding rates
Proportion of people with mental
illness and/or disability in settled
accommodation
Statutory homeless households
Fuel poverty
Access and utilisation of green
space
Killed and seriously injured
casualties on England's roads
Cycling participation
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The best possible health and well being for people in Lewisham
Summary timetable
(subject to Parliamentary approval of legislation)
Consultation on:
• specific questions set out in this White Paper;
Dec 2010–March
• the public health outcomes framework; and
2011
• the funding and commissioning of public health.
Set up a shadow-form Public Health England within the
Department of Health Start to set up working arrangements
with local authorities, including the matching of PCT
During 2011
Directors of Public Health to local authority areas
Develop the public health professional workforce strategy
Autumn 2011
Public Health England will take on full responsibilities,
including the functions of the HPA and the NTA Publish
shadow public health ring-fenced allocations to local
April 2012
authorities
15 ring-fenced allocations to local authorities
Grant
The best possible health and well being for people in Lewisham
April 2013