the role of local government in public health tuesday 10 july 2012
TRANSCRIPT
The Role of Local Government in Public Health
Tuesday 10 July 2012
Conference Chair
Cllr Robin Brown, Northamptonshire County Council
Equity and Excellence; Liberating the NHS: Reform of the Public
Health System
Dr Giri RajaratnamDeputy Regional Director of Public Health, East MidlandsMidlands and The East Cluster SHA
Health inequalities across Nottingham
Why more of our kids end up arrested, homeless or in hospital over drugs
Model of Health Health and Wellbeing
Variations in health, ill health and wellbeing
Ill health and need for care
Heart disease, mental health, respiratory disease, cancers, musculo-skeletal, dementia, frailty etc
Lifestyles & Behaviour
Smoking Nutrition Physical Activity Sexual practices Substance Misuse
Wider Determinants of health & the Environment
Housing Education Employment Safety Culture Poverty
200,000
250,000
150,000
100,000
50,000
0
1996- 50,000
1997 1998 1999 2000 2001 2002
Year
Dea
ths
Pote
ntial
ly A
vert
ed
Deaths potentially averted by medical advances
Deaths potentially averted by eliminating education-associated excess mortality
Deaths potentially averted per year in the United States by medical advances and by eliminating education-associated excess mortality: 1996-2002
Source: Woolf et all. American Journal of Public Health 2007; 97(4): 679 - 683
The Need For Reform1. Demography and communities2. Empowering Patients & Public Health3. Outcome Focus4. Productivity increases equivalent to £20b5. International comparisons (particularly cancer) of
performance6. Competition as a stimulant for innovation,
improvement and productivity7. A better balance between private, public and 3rd
sector provision of services
The Health and Care landscape in 2013
S of S and DH
PH (England)NHS CB
PH in LA
CCG
Health & Well-being Board
Local Government
HealthWatchCommunitiesO&SC
JSNA to H&WB strategy to Commissioning Plans
NHS Commissioning Board and Clinical Commissioning Groups
Functions1.Understanding health care needs and commissioning services for registered populations2.Ensuring NHS response to major incidents.3.Commissioning selected public health interventions (Immunisations and screening)4.To co-operate with local authorities and participate in the local Health and Wellbeing Group5.To involve patients and the public
The New Public Health SystemTHE NEW DUTY (Local Government)“To take such steps as it considers appropriate for improving the health of the people in its area”
Includes:1.Commissioning services2.Focus on the most disadvantaged3.Supporting, engaging and developing local communities4.Ensuring all local government responsibilities are delivered in a way that they promote health & wellbeing.
Local GovernmentDelivering the new Duty
1. Ring fenced financial allocation2. Specialist Public Health Workforce including
Director of Public Health3. Legislation to support access to data4. Creation of the Health and Wellbeing Board 5. National Institute for Health and Clinical Excellence
and Social Care Institute for Excellence6. Three overlapping Outcome Frameworks (public
health, NHS and Social care)
Health & Wellbeing Board
1. Leadership group for all aspects of health and wellbeing in a locality
2. Involvement of key local leaders3. Duty to promote integration; planning,
commissioning and provision 4. Key outputs: Joint Strategic Needs Assessment and
Health Wellbeing Strategy5. Review Outcomes for local communities
Public Health England
Purpose1.Deliver, support and enable improvements in health and wellbeing2.Lead on the design, delivery and maintenance of systems to protect the populations against existing and future threats to public health3.Support local public health teams to deliver their functions4.Support NHS CB to commission services such as screening and immunisation5.Producing benchmarked information on the public health outcome framework indicators
Accountability (1)
1. Health & Wellbeing Boards and Local Authorities: accountable to local communities and Overview & Scrutiny Committee
2. CCGs accountable to NHS CB3. Public Health England and NHS CB accountable to
Secretary of State for Health through mandates4. Health & Wellbeing Boards accountable for leading
and co-ordinating for health, social and care systems for delivering appropriate outcomes for local communities.
Accountability (2)
1. Three outcome frameworks. Use of incentives aimed at both CCGs and LAs.
2. NO PERFORMANCE MANAGEMENT3. Transparency of information: regular publication of
benchmarked data related to the indicators listed in the three outcome frameworks.
Taking Advantage
1. Thinking about wellbeing and ill health within your community
2. Understanding how the different factors affect health in your local communities
3. Designing interventions or approaches that best meet local needs and designing indicators to help guide implementation
4. Ownership of local communities and leaders
In Conclusion
Opportunities for:1.Enabling the telling of the local story (Outcomes
Frameworks)2.Ensuring “joined up” planning, commissioning and providing 3.Supporting communities and individuals4.Shaping the place: physically and psychologically
Timeline for ChangeMar 2012Local transition plans completedApr 2012• Local areas agree arrangements for any in year delegation of functions and
secondments/assignment of transferring staff in line with guidanceBy Oct 2012• Local area test arrangements for delivery of specific public health services
in particular screening and immunisation, and Emergency ResponseOct 2012• Agree arrangements on public health information requirements and
information governance Jan 2102• Ensure final legacy and handover documents completedApr 2013• Local authorities formally take on new responsibilities
Opportunities and threats for LAs and their services
Alyson Morley
Senior Adviser (Health Transformation)
www.local.gov.uk
Summary
• Opportunities
• Threats
• Role of district councils
• Current support for public health transition
• LGA’s future support offer to system leaders
Why local government?
“Differences in access to health care matter, as do differences in lifestyle, but the key determinants of social inequalities in health lie in the circumstances in which people are born, grow, live, work and age”
Professor Sir Michael MarmotFair Society, Healthy Lives2010
Opportunities
• Focus on health, not just treating sickness• Whole population, place-based focus and
strategic overview of needs and resources• Wider determinants of health• Stronger local political and clinical leadership of
health agenda• Community engagement and voice of the ‘patient’• Integrated plans and commissioning• Localism – needs, plans, action
Contribution of district councils
• Closer to local people and customers – vital input to JSNA and communications on health reforms
• Provider/commissioners of key services – housing, leisure, planning, environmental health etc and employers
• Closer correlation with clinical commissioning groups – possibly
• District councils are already engaged and committed to health and wellbeing – they have a strong base on which to build
Threats to all councils• Commitment – are LAs up for the challenge?• Capacity – are LAs up to the challenge?• Maintaining stability in transition• Will HWBs be effective?• Will CCGs engage with HWBs?• Centralising tendencies of Public Health
England, NHS Commissioning Board and Care Quality Commission
• Resources – PH and Healthwatch funding• Will systems, priorities and services change?
Making health reforms work at district level
• Working with county HWB– Contribution to joint strategic needs assessment– Contribution to joint health and wellbeing strategy– Public health presence at district level
• Working with other districts• Working with CCG• Working with Healthwatch• Role of Leader and Portfolio holder for health
and wellbeing
Current support for health reform – Health and wellbeing boards
Principles of support offer available at national and regional level
1. Alignment with other activities2. No duplication – builds on existing
regional activity and adds value3. Making a difference – support is action
and outcome focused4. Sustainability – building in future needs
and support
National support for HWBs leadershipHWB leadership support offerNational• HWB development tool – to help evaluate progress• Knowledge Hub on HWBs – currently hosted by DH with 900+
members. Open to anyone: https://knowledgehub.local.gov.uk/.
• Disseminating evaluation and learningRegional • Simulation events• Chairs’ networks• Other activitiesBespoke support• Joint activity with NHS Leadership Academy to provide
support to 75 HWBsContact [email protected] for more information
National support – Healthwatch
• Local Healthwatch will be the consumer champion for public health, as well as health and social care services
• Crucial to have the patient and public voice in public health planning and provision
• Healthwatch is ‘lagging behind’ development of other partners – we need to keep a space for them
• National support programme in place
National support – public health
• JSNA guidance, principles and case studies
• From transition to transformation web resource
• National events on specific public health issues
• LGA annual public health conference – January 2013
Future sector-led support
• LGA Inform– Web-resource to benchmark with other councils
– Capacity/demand for public health information
• System-wide peer challenge– Across all domains of the health reform agenda
– With key partners
– Demand from health systems
– Testing the approach with all system leaders
Next steps
• What do you want LGA and other national organisations to provide?
• What is your current experience of support?
• What needs to improve?
Cllr Tony Roberts MBENewark and Sherwood District Council
Refreshment Break
Workshops
Workshop 1 Health Watch in the East Midlands, The Role for the authority and the Frontline Councillor
Delegates with Orange dots attend this workshop first, in Suite 1
Workshop 2 Improving Health and Tackling Inequalities through Partnership
Delegates with Green dots attend this workshop first, in Suite 2
Healthwatch in the East MidlandsThe role for the authority and frontline
councillor
Ged TaylorEast Midlands Programme Director
Health Transitions
Topics covered
• Role of Healthwatch
• Fit with health reforms
• Transition from LINk
• Role of councils
• Role of councillors
What is Healthwatch?
• Healthwatch will be new consumer champion for health and social care
• Exist in 2 forms :– Local Healthwatch ( x 152)– Healthwatch England
• Local Healthwatch – established April 2013
• Healthwatch England – established October 12- statutory committee of Care Quality Commission – funded by Dept Health
What is Healthwatch?
Local Healthwatch will:• Have a seat on Health & Wellbeing Boards• Enable local people to share views & concerns
about local health and social care services• Provide & signpost people to information about
health and social care services & how to access• Provide evidenced feedback to commissioners
of health and social care services• Advise and support individuals when something
goes wrong & support complaints
What is Healthwatch?
Local Healthwatch will:• Carry forward existing functions of LINk• Have additional powers including advice &
information about access to choices & advocacy• Be independent, commissioned by the local
authority with statutory functions • Be a social enterprise• Be inclusive and reflect the diversity of the local
community it serves
What is Healthwatch?
Healthwatch England
• Provide leadership, guidance & support to local Healthwatch organisations
• Receive alerts & concerns about services from local Healthwatch organisations
• Provide advice to Secretary of State, NHS Commissioning Board, Monitor & local authorities
Local Authority Responsibilities
• Local Healthwatch will be funded by local authorities – LAs receive non ring-fenced funds
• LAs will commission a local Healthwatch in their area - flexibility as to how they commission
• Will need to work with existing LINks to manage transition to new organisations
• Will evaluate and monitor local Healthwatch performance
• Provide an advocacy service for people making complaints about NHS services (ICAS)
Role of councillors
• Health Overview & Scrutiny to remain as is
• O&S can scrutinise commissioning of HW
• HW can ask for information from councils
• HW can inspect LA social care services
• O&S provides bridge between LINk & HW
• Can open doors for Healthwatch
• Joint O&Ss for wider service reviews
Role of councillors
• Scrutiny at County and District level – a layered approach• County – Executive (Clinical
Commissioning Groups & Health and Wellbeing Boards) Scrutiny (O&S)
• District – Health & Wellbeing Board members, scrutiny, local issues, wider determinants of health, prevention, services contributing to health & wellbeing
Lunch break
Workshops
Workshop 1 Health Watch in the East Midlands, The Role for the authority and the Frontline Councillor
Delegates with Green dots attend the Health Watch workshop, in Suite 1
Workshop 2 Improving Health and Tackling Inequalities through Partnership
Delegates with Orange dots attend the Health Inequalities workshop, in Suite 2
Healthwatch in the East MidlandsThe role for the authority and frontline
councillor
Ged TaylorEast Midlands Programme Director
Health Transitions
Topics covered
• Role of Healthwatch
• Fit with health reforms
• Transition from LINk
• Role of councils
• Role of councillors
What is Healthwatch?
• Healthwatch will be new consumer champion for health and social care
• Exist in 2 forms :– Local Healthwatch ( x 152)– Healthwatch England
• Local Healthwatch – established April 2013
• Healthwatch England – established October 12- statutory committee of Care Quality Commission – funded by Dept Health
What is Healthwatch?
Local Healthwatch will:• Have a seat on Health & Wellbeing Boards• Enable local people to share views & concerns
about local health and social care services• Provide & signpost people to information about
health and social care services & how to access• Provide evidenced feedback to commissioners
of health and social care services• Advise and support individuals when something
goes wrong & support complaints
What is Healthwatch?
Local Healthwatch will:• Carry forward existing functions of LINk• Have additional powers including advice &
information about access to choices & advocacy• Be independent, commissioned by the local
authority with statutory functions • Be a social enterprise• Be inclusive and reflect the diversity of the local
community it serves
What is Healthwatch?
Healthwatch England
• Provide leadership, guidance & support to local Healthwatch organisations
• Receive alerts & concerns about services from local Healthwatch organisations
• Provide advice to Secretary of State, NHS Commissioning Board, Monitor & local authorities
Local Authority Responsibilities
• Local Healthwatch will be funded by local authorities – LAs receive non ring-fenced funds
• LAs will commission a local Healthwatch in their area - flexibility as to how they commission
• Will need to work with existing LINks to manage transition to new organisations
• Will evaluate and monitor local Healthwatch performance
• Provide an advocacy service for people making complaints about NHS services (ICAS)
Role of councillors
• Health Overview & Scrutiny to remain as is
• O&S can scrutinise commissioning of HW
• HW can ask for information from councils
• HW can inspect LA social care services
• O&S provides bridge between LINk & HW
• Can open doors for Healthwatch
• Joint O&Ss for wider service reviews
Role of councillors
• Scrutiny at County and District level – a layered approach• County – Executive (Clinical
Commissioning Groups & Health and Wellbeing Boards) Scrutiny (O&S)
• District – Health & Wellbeing Board members, scrutiny, local issues, wider determinants of health, prevention, services contributing to health & wellbeing
Refreshment break
Be Pragmatic, Flexible, Progressive.
CCG Perspective11th May 2012
Phil Mettam
CO (Designate)
Delivering Greater Outcomes for the People of Bassetlaw
Be Pragmatic, Flexible, Progressive.
Where we have been New arrangements Creating opportunities GP perspective What will success look like.
Delivering Greater Outcomes for the People of Bassetlaw
Be Pragmatic, Flexible, Progressive.
Where have we been?
PCT’s strategic commissioner of population health.
Mixed picture – outcomes and inequalities.
Period of growth to austerity. Markets and collaboration.
Delivering Greater Outcomes for the People of Bassetlaw
Be Pragmatic, Flexible, Progressive.
Role of the LSP – alternative? Governance of the CCG. HWB – alignment of strategies
(unitary/mulit-tier) New commissioning arrangements e.g.
children.
New arrangements
Delivering Greater Outcomes for the People of Bassetlaw
Be Pragmatic, Flexible, Progressive.
Improved engagement with clinicians Leads’/members’ meetings Prescribing – reduced C Diff/Budget QIPP clinical focus – reinvest in quality Primary care strategy with NHSCB in future
GP Perspective(Dr Steve Kell, Clinical Chair)
Delivering Greater Outcomes for the People of Bassetlaw
Be Pragmatic, Flexible, Progressive.
What will success look like
Pragmatic, flexible, progressive. Quality/safety, clinical leadership,
excellent engagement. Improved services (short-term), improved
outcomes (long-term). Transformed care (long-term). Sustainable partnerships and organisation.
Be Pragmatic, Flexible, Progressive.
What has Public Health got to offer Local Authorities?
Dr Tony HillJoint Director of Public Health
NHS Lincolnshire & Lincolnshire CC
What is Public Health about then?• Health Protection• Health Improvement• Healthcare Public Health
• Reducing Health Inequalities
What about the way PH works?• Basic science is Epidemiology – Who gets What
and Where and When and How!• Foundation stones are
– Assessing population need– Using evidence of what works– The social determinants of health are paramount– Prevention is better than cure– Many outcomes can only be achieved by working with
others
Local government’s new public health functions
• commissioning a range of services from a range of providers from different sectors
• tackling the causes of ill-health & reducing health inequalities eg the way they operate the planning system
• promoting and protecting health• promoting social justice and safer communities• key partnerships with other agencies
What are the links with LA services?• Children’s services• Adult Social Care• Community Safety• Spatial Planning• Leisure and Recreation• Housing• Transport and Highways
Both Top tier and District services
What are the links with the NHS?
• Continued public health advice and support to CCGs• Co-production of JSNA and JHWS with HNS
colleagues• Public Health advice and advocacy to NHS
Commissioning Board through Public Health England on Specialised Commissioning
• Oversight of Health Protection, Screening etc systems
USP of Public Health
• Can offer specialist knowledge and advice • Linkages between different organisations
(especially in NHS) resulting in– Integrated approaches – Excellent Ageing– Better outcomes – Spatial Planning, Worklessness– Better value for money – Joint Commissioning of
prevention services for children
• System Leadership - JHWS
Any Questions?
Conference close