The New Public Health System

Dr Rashmi Shukla CBE, Director of Public Health Public Health England Transition Team

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leadership role for local authorities and partners

working alongside the NHS, with its continuing role of promoting health through clinical services. And other agencies and sectors

stronger focus on health outcomes, supported by the Public Health Outcomes Framework

supported by a new integrated public health service, Public Health England

public health as a clear priority for Government, backed by ring fenced resources

The new public health system

new roles and responsibilities

clear priorities

Roles in the new public health system

Local Authorities

CCGs/NHS Commissioning

Board

Public Health England

• Duty to improve health• Brings together holistic approach to

health and wellbeing• Employ DPH and PH staff• Ring fenced PH budget• Mandated services

• Commissioning healthcare• Commissioning some public health

services• Duty to reduce inequalities

Supporting local authorities and others by:• Delivering services• Leading for public health• Developing the workforce

Population health advice to the NHS, including advice on health services

Health and Wellbeing Board

Coordinates local strategy through:• Joint Strategic Needs Assessment• Joint Health and Wellbeing Strategy• review of commissioning plans

A stronger focus on outcomes....

The Public Health Outcomes Framework

• sets the scope of public health

• focuses on outcomes not targets

• alignment & integration across public health, the NHS and social care

• takes a life-course approach

• designed to also address the causes of the causes of ill health

A pathway from causes of illness to caring for people

Causes of illness to caring for people ….

19th century urban improvement – sewers / housing

LifestylesWellbeing

Germ theory and modern medicine

NHS Commissioning•New public health responsibilities

Opportunities for prevention •Build prevention of poor health into day-to-day business

Make every contact count•Use every contact to improve wellbeing, mental and physical health

NHS workforce•1.4 million staff as advocates for changes for better health and wellbeing

The role of the NHS ….

April 2013

• DH – to set public health policy (and PHOF)• PHE* – to support delivery (through LG and the

NHS, and other partners) and links to NHS CB– PHE functions: Health Protection: Health

Improvement; Information, Intelligence and Evidence

• Local Health and Wellbeing Boards (links to CCGs) – JSNAs and Health & Wellbeing Strategies

• Local Government – local public health delivery

*Structure of PHE published on 26 July 2012

What is PHE?

Public Health England has been established to protect and improve the nation’s health and wellbeing, and to reduce health inequalities.

PHE will provide national leadership for the delivery of improved public health. Working with key delivery partners including local government, and the NHS, to secure improved health outcomes

PHE will:• provide the evidence, intelligence and professional leadership

• work through partners and directly with the public to promote healthier lifestyles

• act as an advocate for the public’s health and transparent reporting through publication of the PH Outcomes Framework

• provide a nationwide service to protect the public from threats to health

• deliver a programme of world class research in support of protecting and improving health

Objectives for Public Health England and Models for Change

To improve and protect health and wellbeing, and reduce inequalities

Improvement

across the PHOF• wider determinants

•health improvement

•health protection

•health care

Mission Outcomes Levers/Delivery Models

Health Protection• end to end delivery chains• clear command structure to SoS• expertise in large scale response

Health Improvement• supporting LA, intelligence, evidence into practice• advocacy and publication of outcomes• professional relationship• limited national interventions

Health Care• specific PH specialist contributions• section 7A management• supporting NHS, intelligence, evidence into practice• advocacy and publication of outcomes

Key task

•Ensure credible and consistent local delivery

•Retain international reputation

•Build new 21st century capability in support of LA in holistic response to health and wellbeing

•Establish explicit PH support to NHS from current implicit practice

Public Health England’s remit spans full range of public’s health. The delivery chains differ and will require different relationships, levers and ways of working. The maturity and history of the different delivery chains mean PHE will face very different tasks in establishing itself as a credible full spectrum PH body.

Taking Shape: Senior Leadership

Taking Shape: National Presence

PHE delivery structures: 4 Regions, 15 Centres

North East

Midlands and East of

England

South of England

London

Eight Network Team areas

• Knowledge and intelligence teams (drawing on capacity from the public health observatories and the cancer registries) providing analytical and knowledge management support and advice to PHE and partners

• Cancer registration and NDTMS teams collecting and quality assuring data from service providers

• Quality Assurance teams for cancer and non-cancer screening (based on QARCs, and a new function for PHE) assuring safe and effective screening for a range of diseases

• Network teams: all the above, plus colleagues in Regions and Centres as appropriate, within a particular geographical area cooperating and collaborating on corporate aspects (e.g. estates, IT), resources (e.g. shared administrative support) and/or specific projects (e.g. children and maternity; liver disease etc.)

Northern and Yorkshire

North West

West Midlands

East Midlands

South West

South East

London

East of England

LOCAL – Health and Wellbeing Boards• Joint Strategic Needs Assessment (includes

assets)• Joint Health and Wellbeing Strategies• Key Local Priorities – and links to Outcome

Frameworks• Links to Clinical Commissioning Groups• Local Public Health Departments – links to LA

functions and Primary Care and Communities

_ _ _ Support for PCTs and Local Authorities during the transitional phase _ _ _

From transition to transformation ….

Public Health England Transition Team

Communication and data sharing infrastructures

Web resources Assuring local transition plans

Finalising policy