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Update on Emerging Policy Changes: what they mean for health and wellbeing

Update on Emerging Policy Changes: what they mean for health and wellbeing. David Hunter. Continuing Policy Churn. Policy and organisational landscape is unstable, unclear and complicated Fate of Health and Social Care Bill still unknown

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Update on Emerging Policy Changes: what they mean for health and wellbeing

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  1. Update on Emerging Policy Changes: what they mean for health and wellbeing David Hunter

  2. Continuing Policy Churn • Policy and organisational landscape is unstable, unclear and complicated • Fate of Health and Social Care Bill still unknown • Bill has survived House of Commons but risks being rejected by House of Lords • Public health changes - little progress, great uncertainty still

  3. Recent Key Developments • 2nd white paper – Health lives, Healthy People: Update and way forward (July 2011) • Roger Boyle’s departure from DH (July 2011) • 2nd phase of NHS Future Forum (August 2011) • 38 Degrees – independent legal assessment of Health and Social Care Bill (August 2011) • Growing opposition from BMA, RCGP, RCN and members of House of Lords (August/September 2011) • Report stage of amended Health and Social Care Bill (September 2011) • Health and Social Care Bill passed by House of Commons (September 2011) with a majority of 65; enters Lords in October

  4. The Second White Paper: Highlights (1) • Bold, exciting vision for local authorities • LA role across 3 domains: health protection, health improvement, health service improvement • PHE to be established as an Executive Agency of DH • PHE to support local action, including ‘having a local presence’

  5. The Second White Paper: Highlights (2) • DsPH employed by LAs but joint appointment with PHE • Expectation that DPH will be directly accountable to local authority CEO • ‘Core public health’ offer from LAs to NHS • Reaffirmation of clear line of sight from SoS down to frontline re health protection

  6. Work in Progress: Unresolved Issues • Relationship between LAs and PHE: the makings of central-local tension? • Public health funding: little progress so far • Health premium: not generally welcomed • Public health outcomes framework • Workforce – risk of becoming fractured and ending single multidisciplinary composition; uncertainty about registration of specialists

  7. NHS Future Forum: Second Phase Four workstreams • Public health (focus on NHS involvement) • Information • Education and training • Integration

  8. Coming Soon… • Party conferences season - more criticism of health changes (September) • Fate of Health and Social Care Bill in Lords (October) • Report on Public Health Inquiry by House of Commons Health Committee (October/November) • Responses to consultation on public health white paper published in November 2010 (anytime)

  9. Known Unknowns (1) • Will the Bill be passed by Lords or be delayed? • Does the fate of the Bill matter - is it necessary for what the government seeks to do? • Ring-fenced funding for public health - what is it to be? • Accountability of DsPH - to LA CEOs or others? Who decides?

  10. Known Unknowns (2) • Will Health & Wellbeing Boards be different from previous partnerships?  • What is to be the future of public health in the NHS? • Will the public health workforce remain unified? • Will the changes work? • Do they increase bureaucracy and transaction costs? • How ready are local authorities to take on public health?

  11. Public Health Leadership in England is Failing There was a time when public health in England was driven by passionately articulated values and compelling research, a time when its leaders were concerned about social reform and political change....Yet today's leaders in public health prefer to collude with a mendacious government and preside over the decimation of public health in the NHS. Richard Horton, editor, The Lancet, 378: 1060, 17 September 2011-09-23

  12. Why? • Public health has become 'unconsciously anti-science’ • Public health leaders are taking part in ‘an utterly corrupt' responsibility deal • Public health leaders spend too much time looking inwards ignoring future challenges

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