Public Health - Public Summary
Service Review
2014/15
Service Name:
Public Health Commissioning
Service Contact:
Bruce Bell
Date of review:
March 2014
Version No:
1.0
This document can be made available in a range of languages,
on tape, in Braille, large print and in other formats.
For further information please contact 01803 207227.
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
1
Introduction:
Public Health is concerned with the health of the whole population rather than the
health of an individual.
Since 1st April 2013, Torbay Council has assumed some of the legal duties to
improve the health of the local population from the NHS. Others are the responsibility
of Public Health England which is a new government agency that oversees national
public health programmes such as national immunisation programmes.
The Public Health Team works closely with different departments within Torbay
Council, the Southern Devon and Torbay Clinical Commissioning Group (CCG),
representatives of the NHS Commissioning Board and voluntary groups to create as
integrated an approach as possible to improve the health of Torbay residents. In all it
does, the Public Health Team seeks to ensure the health needs of disadvantaged
communities and vulnerable groups within the area are addressed and there is due
consideration made to addressing inequalities in health. The aim is to improve the
health of all people, but improving the health of the poorest, fastest.
Description of service
Torbay Council’s Public Health Team commissions a broad range of services to
improve the health of the population. This includes promoting and helping people to
live healthier lifestyles and ultimately contributing to people living longer and
healthier.
Some of these services are familiar to people such those that tackle smoking,
obesity, drug and alcohol misuse and promote nutrition and physical activity. Others
such as NHS Health Checks or the National Child Measurement Programme are
initiatives that are people are likely to be less acquainted with.
The Government expects that certain public health responsibilities are mandatory,
for example that there is appropriate access to sexual health services in the locality.
In addition, public health is responsible for local initiatives:
 To reduce seasonal mortality.
 To deal with health protection incidents, outbreaks and emergencies.
 Public health aspects of promotion of community safety
 Public heath aspects of promotion of social inclusion
 Public health aspects for reducing the impact of environmental risks.
It is a statutory function of public health within the local authority to provide
population healthcare advice to the NHS. Public Health expertise must be made
available to the Southern Devon & Torbay Clinical Commissioning Group to support
improvement in the quality of healthcare services; reduce health inequalities and
achieve positive health outcomes for Torbay.
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
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Public health currently employs 10 members of staff across all of the portfolios of
work. The team is currently out for recruitment for a number of posts.
Staffing costs cannot be apportioned into specific elements of public health provision
due to the mixed nature of most of the team portfolios cutting across commissioning,
core offer, health protection & infection control and epidemiology.
The total costs anticipated in 2014/15 for the employees referred to above is
£528,485 (including on costs).
Commissioning for Health Improvement:
What is
provided?
Why is it
provided?
Public Health commission a range of clinical services. Key services include

Stop smoking services

The lifestyles services to help people to live healthier lives - weight
management, eating a healthy diet and increasing physical activity.

Adult drug & alcohol treatment and other support to help people in their
recovery from substance misuse

Young person’s drug and alcohol service

NHS Health Check assessments to help prevent heart disease, stroke,
diabetes, kidney disease and certain types of dementia

Sexual health services

School nursing, including the National Child Measurement Programme
that measures children’s weight.
These services are commissioned to assist people to live healthier lifestyles and
therefore address the key behaviour-linked factors that are responsible for ill
health.
These interventions have been shown to be effective in improving people’s
health and wellbeing.
Some of these are mandatory to deliver:

NHS Health checks

Contraception services

Sexually Transmitted Infections testing and treatment services

The National Child Measurement Programme.
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
3
Who uses the
services /
what is the
demand?
Provision
Stop smoking
Lifestyles
Adult drug &
alcohol services
Target Group
Smokers aged 12 years
and above
Children, families and
adults
Adults aged 18 and over
who misuse drugs and
alcohol
Demand
800 individuals1
554 opiate misusers2
121 non-opiate misusers2
332 alcohol misusers2
Young person’s
Young people aged 17 and 90 substance misusers3
drug and alcohol
under who misuse drugs
service
and alcohol
NHS Health Check Adults aged 40-74 years of 2,882 individuals who have
Assessments
age who are not on a
received an NHS Health
‘disease register’
Check4
Sexual Health
Young people and adults
440 females having a Long
Services
with a sexual health need
Acting Reversible
Contraceptive inserted4
345 females having a IntraUterine Device inserted4
292 Emergency Hormonal
Contraceptives supplied5
430 Chlamydia screening
activity6
School Nursing
5-19 year olds
7482 Torbay Sexual
Medicines Service events7
9 secondary schools with
7512 pupils on their roll
(plus 7 additional special
schools and pupil referral
units)8
28 primary schools with
9342 pupils on their roll.8
1Commissioned
capacity for the stop smoking service, 2013-14
from Quarter 3 DOMES report for Torbay, 2013-14
3Taken from Quarter 2 Executive Summary for Torbay, 2013-14
4Quarters 1-3 GP activity for 2013-14.
5Quarters 1-3 pharmacy activity for 2013-14.
6Quarters 1-3 GP and pharmacy activity for 2013-14
7Commissioned capacity for the Torbay Sexual Medicines Service for 2013-14.
8School Nurse Annual Report 2014
2Taken
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
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How much
does it cost to
provide?
How well are
we providing
it?
The figures below are the expected end of year 2013/14 costs for the services.
Provision
Stop smoking
Contract Value
Part of the overall
lifestyles service costs
Lifestyles
£534,637
Adult drug & alcohol services
£2,545,007 1
Young person’s drug and alcohol service
£68,000 2
NHS Health Check Assessments
£95,000
Sexual Health Services
£1,831,916 3
School Nursing
£356,000
1 This is the total cost of all direct services and wrap around services for drug
and alcohol clients
2 This is only the costs applicable to Public Health; additional funding streams
are also accessed via the YOT (Youth Offending team) and Children’s Services
3 This is the total cost of all direct services including the hospital, GP’s and
Pharmacies.
Provision
Stop smoking
Lifestyles
Adult drug & alcohol
services
Young person’s drug
and alcohol service
NHS Health Check
Assessments
Sexual Health
Services
Detail
The smoking service is just below its annual target
of 800 4-week quitters for 2013-14. However, the
service has been hit markedly by e-cigarettes (the
use of these do not count as a 4 week quitter),
which is a regional and national effect challenging
all stop smoking services.
Torbay as a society has ongoing and emerging
issues in relation to obesity, alcohol and sedentary
lifestyles; therefore as a result Public Health are in
process of redesigning the existing provision to
optimise outcomes to meet the changing needs of
the community.
Torbay has been relatively consistent in meeting
most of its Key Performance Indicator’s (KPIs).
New service has just been implemented on 01
January 2014. Too early to identify performance
although the recommissioning of the service has
been in response to the need to ensure clinical
governance arrangements are future proofed.
There are no targets regarding health checks but
the aspiration is for GP practices to invite 20% of
the eligible population each year. For the first 3
quarters, they are just under the 15% expectation
for that point in the year at 14.4%.
Torbay delivers a suite of services designed to
promote & deliver good sexual health, improve
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
5
School Nursing
access to contraception and raise awareness of
the impact of risk taking behaviour such as
unprotected sex. Performance in terms of key
sexually transmitted infections such as Chlamydia
remains good although high positivity rates reflect
risk taking in younger people. Teenage conception
rates are now at the lowest since 1998.
Take up of school ages immunisations and the
child weighing and measuring programme are
good, although pressures on the service to
maintain safeguarding activities are causing
systemic pressures (new school age
immunisations have been introduced this year).
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
6
Health Protection and Infection Control:
What is
provided?
A range of Health Protection and Infection Control services are provided.
Key services include

Why is it
provided?
Who uses the
services /
what is the
demand?
How much
does it cost to
provide?
How well are
we providing
it?
Assurance that immunisation and screening uptake are in line with
national recommendations.
 Ensuring steps are taken if uptake is poor.
 Response and expert advice to local incidents for example outbreaks of
diarrhoea & vomiting or flu or increase in numbers of ‘healthcare
acquired infections’ (HCAI) in hospitals (acute and community)
 Local initiatives to ensure HCAI rates remain low for example C.difficile
cases and Sepsis
 Joint reviewing of root cause analysis of infectious diseases with the
CCG.
 Reviewing and updating of seasonal mortality plan
 Raising awareness of national priorities in communicable diseases
Health protection is mandatory under the Health and Social Care Act 2012





Local Populations
Health staff: Acute and Community
CCG
Local Authority
PHE
Up to 0.6 FTE is spent on this. It is staff time only. This includes support to the
CCG
Includes governance of screening and immunisations
Overview of communicable disease
Support to emergency planning function.
No current areas of concern.
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
7
Core Offer for NHS Healthcare services:
What is
provided?
We have a Memorandum of understanding with South Devon and Torbay CCG
to provide technical Public Health advice. This may include Health needs
assessments, Equity audits, advice on evaluation etc.
We also sit on a number of key CCG bodies such as
-
CCG Governing Body
-
Joined-up Cabinet
-
Pioneer Board
-
Clinical commissioning group
-
CCG Governance group
-
Cancer Clinical Pathway group
-
Mental Health re-design Group
-
Childrens re-design group
-
Primary care re-design group
Why is it
provided?
Ensuring that NHS commissioners receive the public health advice that they
require is mandatory under the Health and Social Care Act 2012
Who uses the
services /
what is the
demand?
The service is well received and valued by the CCG.
A survey and regular reports are discussed with CCG colleagues.
Ordinary
Residency
Numbers
How much
does it cost to
provide?
The cost is in public health personnel time.
Meant to be 25% of staff time – about 2.5FTEs
The provision is linked to the Health and Social care Act
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
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How well are
we providing
it?
A recent survey confirmed the service is well received. The survey was sent to
CCG colleagues. A copy is available in request
Epidemiology:
What is
provided?
Why is it
provided?
Who uses the
services /
what is the
demand?
How much
does it cost to
provide?
How well are
we providing
it?
Leadership to the development of the Joint Strategic Needs Assessment
(JSNA). Other data analysis reports on request
The JSNA informs strategy development in Torbay. It informs the following;
- Joint Health and well-being strategy
- CCG Strategic Plan
- ICO Full business case
- All Public Health strategies
- Other CCG and Torbay Council strategies
All partners: Police
- CCG
- Acute Trust
- Community Trust
- Council Departments
- Health watch
- Community Development Trust
-
Public Health staff time main resource (2.5 fte)
The JSNA is well received
It is evident in all major strategic documents as listed above in the bay
Disclaimer: These reviews provide a snapshot of council services and activities at the time they were
carried out, as we have tried to represent as far as we can the detail of what is provided.
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