Who’s Who in the Public Health
landscape
Prof Paul Johnstone
Director of Public Health NHS North of England
Regional Director (designate), Public Health EnglandNorth
Inform Voluntary Sector Event
28th Feb 2013
Outline
1. The health challenges in 21st C
2. The Future
3. Understanding the new landscape (PH and
NHS),
4. What this means to the VCS.
1. The health challenges in 21st C
• Living longer than ever before
– but higher rates of premature deaths compared to EU
• Inequalities gap remains challenging
– levelled and in some places reduced
– wider causes on inequality remain -poverty, income inequality,
environment, and poor empowerment, low engagement and
aspiration especially children and young people
• Lifestyles/ behaviours
– Some improvements but still a major cause of disease and
disability
• Disability
– long term conditions like diabetes, heart conditions, mental
health, high rates, high inequalities and high and unnecessary
dependency on hospital emergency care
On preventing premature mortality (ie
avoidable deaths before 75), UK does
badly than our peers
• Out of 19 similar ranked countries to UK in
Europe and elsewhere
• Sweden, Italy, Spain, Norway, NL, Germany, France, Ireland,
Greece, Fin, Belgium, Portugal, Denmark
• USA, Canada and Australia
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Heart Disease, 14th
Lung Cancer , 12th
Stroke 13th
Breast cancer 18th
Other cancers between 16-19th
The lifestyle causes of
premature mortality in the UK
Causes of the causes of ill health
(eg low income/poverty, housing, environment, education..)
Child poverty- huge inequality
60%
Percentage of children living in poverty: 2008 by England's local authorities
The proportion of children living in families in receipt of out of work benefits or in receipt of
tax credits where their reported income is less than 60 per cent of median income
40%
Kingston upon Hull UA (33%)
England average (22%)
20%
Harrogate DC (9%)
0%
Source: HM Revenue and customs 2011 - National Indicator 116
Local authorities in Yorkshire and the Humber
Living with disability (eg poor mobility, mental
illness and diabetes): Big variation in quality of life
Source : GP Patient Survey
Impact on public and 3rd sector
services
• Rising
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costs
demand
expectations
life expectancy but with
years of disability in some areas= inequality
threats to health (pandemics, terrorism)
public sector debt
– system malaise/ lack of democratic accountability/
Francis/Mid Staffordshire/ re-organisations
2. The Future
Recent past and future
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WHO
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Alma Ata Declaration
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Ottawa Charter 1986
Marmot (2008)
UK
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Health of the Nation (1992)
Choosing health (2006)
Marmot (2010)
Rising role of Local Govt and health
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LG Act 2000. Duty of Well being, joint NHS-LG Directors of Public Health, JSNA
2011 Localism Act – role of ‘place’
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Community and user power/ empowerment
2012 Health and Social Care Act
Asset based community development (ABCD)
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Health For All. 1978. Community health volunteers (as a social movement)
(John McKnight), build on assets rather and plug gaps/needs
5 Waves of Public Health
Social Movements: 5 waves of public
health since Victorian times
Four waves of public health Hanlon et al/Afternow
Fifth wave: well being, living well
Internal: Self responsibility, Mindfulness
External: Systems and society, sustainability, cohesion, volunteering,
ACTIVE CITIZENSHIP
3. Understanding the new landscape
(Public Health and NHS),
Overview of the changes
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PCTs and SHAs abolished April 2013
Clinical Commissioning Groups (CCGs) authorised
80% of commissioning budget managed by CCGs
Remainder (20%) managed by NHS Commissioning Board
– (specialised services, family practitioner services, some public
health)
• Public health responsibilities transfer to Local Authorities,
who are also responsible for HealthWatch locally
• Health and Wellbeing boards to develop
– Joint Strategic Needs Assessment and
– Joint Health and Wellbeing Strategy, co-ordinate work on public
health, social care and health services
Public Health Landscape in Yorkshire
and Humber
• 15 Local Authorities with DsPH and teams
‘local authorities to use their new responsibilities and
resources to put health and wellbeing at the heart of
everything they do’
‘health in all policies’
• One PHE Centre.
– ‘front door of PHE’
– Director: Dr Stephen Morton
• Part of PHE North Region. Director: Paul
Johnstone
The geographical distribution of Public Health England
PHE Centres
(Duncan Selbie Feb 2013)
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Front door of PHE
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Will assure services and expertise provided are truly focused on local needs.
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information and intelligence
support commissioning
Services for health protection, communications
‘Director is
– a full partner in the local public health system,
– which includes the voluntary and community sector, ‘
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Each Centre will provide leadership and support across all three domains of public
health – health protection, health improvement and healthcare public health. This
will include
– supporting local government in their leadership of the local public health system;
– supporting DsPH to access specialised advice and support;
– working with NHS Commissioning Board to support it in its role as a direct commissioner of
key services, including specialist services and national public health programmes;
– and providing leadership in responding to emergencies where scale is necessary.
PHE Regions
• Are co-terminus with those of the NHS CB and
other national partners and they also happily
map onto the nine regional local government
groupings.
• will nurture, assure and support the local public
health system and maintain an overview of the
whole system’s progress in implementing the
Public Health Outcomes Framework.
• They will have a special responsibility for
workforce development and we will be publishing
our strategy for this in March.
Health and wellbeing boards
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Vehicle for councillors,
commissioners and communities to
shared leadership of local health and
care systems, and to work with wider
partners to address the determinants
of health, and better the health and
wellbeing outcomes of the people in
their area.
Statutory minimum membership:
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Key roles:
At least one elected member
A representative from each clinical
commissioning group (CCG)
A representative from HealthWatch
The Director of Public Health (DPH)
The Director of Adult Social Services
(DASS)
The Director of Children’s Services
(DCS)
– develop a Joint Strategic Needs
Assessment (JSNA) for the locality
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– agree a joint heath and wellbeing
strategy ensure individual
commissioning plans (health, public
health and social care) align with the
joint heath and wellbeing strategy
Real work goes on in groups beneath the
statutory board
4. What this means to the VCS
Personal views
- As providers
- As Strategic community partners, champions
and co-producers
My messages to the VCS as providers
The days of grants are over – it is all about commissioning
• Organise yourselves so you have the support/infrastructure to be
able to tender for business
– (eg Wakefield via the web http://wakefieldwellbeing.org.uk/)
• You will be required to give performance reports to the
commissioner – ensure that targets you agree are challenging but
realistic (under-promise and over-deliver!)
• Demonstrate how you add social value – it is now a legal
requirement on commissioners to include social value in their
assessments (http://www.navca.org.uk/social-value-bill). VCS may
need to remind commissioners of this. VCS should have a big
advantage over other providers in this regard.
My messages to VCS as providers-2
• Establish a dialogue with commissioners
– How can VCS tender to have a fair chance?
• outcomes based commissioning, payment by results and large contracts can all
disadvantage small community groups
– Contact commissioners , your DPH or Health and Wellbeing Boards chair.
• Partner with another statutory/other providers in tendering
– this creates a win-win-win.
– VCS may be more likely to get the business, statutory providers able to
demonstrate social return and commissioners get a better, more integrated
service.
• Glass half full! Even in the face of huge cutbacks there are opportunities
through commissioning to get business.
– Eg all public health contracts (~£15m) in Wakefield will be reviewed over the
next 3 years with a view to re-tendering.
• More guidance being developed
– Eg NW and Oxford Brookes and NW (web link. ..)
– DH supported learning
sites http://www.commissioningboard.nhs.uk/2013/01/30/learn-sites/
• Acknowledgement to Dr Andrew Furber DPH Wakefield
My messages to VCS as strategic
partners
• Organise your organisation’s role for the local ‘place’ to be
the champion and advocate (ideally separately from
provider role)
• Engage with HealthWatch
• Build alliances with the new Health Team and others in the
council.
• You are or have access to communities and community
structures and have invaluable knowledge and intelligence
for PH and healthcare. Promote this as advocates
researchers and lobbyists.
• Engage as a co producer, in the process of formulating the
JSNA, to planning the Local health and wellbeing strategy,
to promoting and using it.
My messages to statutory sector
(Councils, NHS)
1.
2.
3.
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6.
7.
8.
Openly invite VCS to join HWWB public meetings (eg York)
Use your Health and Wellbeing Board and Strategy as a social
movement- not just consult but actively ‘co produce’.
Engage VCS through every opportunity, healthwatch, scrutiny, etc
For Foundation NHS trusts and providers -develop your memberships
with VCS and its role in place (employer, investor and procurer).
For CCGs/ commissioners, be a ‘place player’, be proud of your
contribution to your town, city or area.
For CCGs use you DPH as your ambassador in LG and on HWWB to
engage with VCS
Healthwatch should develop its relationship with local VCS– they will be
key in your role of the public’s advocate and have access to local
intelligence
Make all health data accessible to public and VCS, esp JSNAs, NHS
performance and quality of care.
Finally
• Dialogue with 3 Northern Regions VCS
organisation to further support ‘who’s who’
and what we can to do help.
Contacts Resources and References for
Information
David Hockney: Bigger Trees Near Warter or/ou Peinture Sur Le Motif Pour
LeNouvel Age Post-Photograpique 2007,
Acknowledgements (to complete)
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Paul Moore (YH Public Health Group, PHE YH Team)
Dr. Andrew Furber (DPH Wakefield)
Cllr Jonathan Owen (East Riding)
Tony Hunter (Cex NE Lincs Local Authority)
Philip Lewer (independent consultant)
Mark Gamsu (independent consultant)
Ginny Edwards (DH)
Tracey Sharp (Deputy Director PHE North (designate))
Diane Bell (PHE YH Team)
Alison Patey (PHE North team)
Paul Wheeler (NW PH Group)
More information on the health of
local areas
• Yorkshire and Humber Public Health Observatory
– www.yhpho.org.uk
– Email: yhpho-info@york.ac.uk
– Tel: 01904 567740
• Local Director of Public Health/ Local Authority
web site
• NICE support for Local Government
– www.nice.org.uk/localgovernment/Localgovernment
– Tobacco, workplace health, physical activity, health
inequalities, PH Outcomes, Alcohol, Behaviour
change, walking and cycling
JSNAs and joint health and wellbeing strategies – tools for
shared leadership
HWB provides forum for
What services do we need to commission (or derepositioning JSNA as truly jointly
commission), provide and shape; both separately and
owned and leading to joint
jointly? – commissioning plans
commissioning decisions to serve
the whole population.
So what are our priorities for collective action, and how will we achieve
them together? – the JHWS
Explicit link from
evidence to
service planning
What are we doing now, how well is it working and how efficient is
it? - a analysis on our progress
So what does that mean they need, now and in the future and what assets do
we have? – a narrative on the evidence - the JSNA
What does our population & place look like? –
evidence and collective insight
HEALTH & WELLBEING BOARD
Engagement
with users and
the public
The intention of JSNA is to
link local needs with
commissioning decisions –
by adding the layer of the
JHWS this link is being
made easier for local areas
to understand.
• Some good web links on local work
• http://www.york.gov.uk/info/200170/health_
and_wellbeing/341/york_health_and_wellbei
ng/3
• http://www.commissioningboard.nhs.uk/201
3/01/30/learn-sites/
• http://www.regionalvoices.org/