A powerful case for change

1. Healthy Lives, Healthy PeopleUpdate and Way ForwardDan Berry and Rumku Basu-Owen13 September 2011

2. A powerful case for change The white paper Healthy Lives, Healthy People set out a powerful case for reforming the public health system: • two out of three adults are overweight or obese • rates of tuberculosis are rising • inequalities in health remain: people in the poorest areas live on average 7 years fewer than those in the richest • Major health threats, ranging from the risk of new pandemics to the potential impact of terrorist incidents. • We need a new approach to meet these and other public health challenges of the twenty-first century.

3. The new approach to public health Leadership role for local authorities – so services are shaped by local needs 1 Supported by a new integrated public health service, Public Health England 2 Stronger focus health outcomes supported by the public health Outcomes Framework 3 Public health as a clear priority across government – supported by resource 4 The commitment to reduce health inequalities as a priority across the system 5

4. Consultation process and response • Healthy Lives, Healthy Peoplepublished November 2010alongside consultations on outcomes framework and funding and commissioning • Sought views on Dr Scally’s professional regulation review • Over 2,100 written responses and 60 consultation events – with the public health profession, local authorities and voluntary sector • NHS Future Forum report in June 2011 • Healthy Lives, Healthy People: Update and Way Forward, published 14 July 2011: • Updates on our progress so far • Provides information to inform continued local preparations • Sets out where further development is required • This is subject to the Health and Social Care Bill

5. What respondents liked Enthusiasm for the new leadership role for local government Strengthening central government’s focus on public health The local system supported by a new integrated public health service – Public Health England Commitment to the ‘Marmot agenda’ for addressing health inequalities Proposals for a public health Outcomes Framework Proposed commissioning routes for public health… though with concerns about some of the detail.

6. Criticisms, concerns and suggestions Independent advice: preserving the ability to provide independent advice to local and national government More clarity on the role of the director of public health across the ‘three domains’. Fear of fragmenting commissioning responsibilities Questions about roles in incidents and emergencies Questions about the size and scope of the ring-fenced budget Clarity about specialist roles across the new system, the workforce transition, the importance of training and professional regulation.

7. Directors of Public Health: reaffirmed role in advising the LA, on health and wellbeing board, working with PHE and in population healthcare Given the importance of the Director of Public Health role, we would expect it to have Chief Officer status. Mandated functions kept to a minimum:including sexual health services and core offer of public health advice. More work to come Public Health England to operate across the three domains of public health. As an executive agency, able to provide expert and evidence-based advice Clear line of sight. Secretary of State is accountable to Parliament, leads the public health cabinet sub-committee and sets direction for PHE Commissioning responsibilities across PHE, local authorities and NHS Commissioning Board to empower communities and avoid fragmentation Workforce strategy to ensure a professional public health workforce and rewarding careers Gather further evidence from stakeholders on the most appropriatesystem for regulating public health professionals

8. Further developments • A number of issues require further development • We will step up work with stakeholders to develop credible policy and implementation plans over the coming months • We will produce in the autumn a series of Public Health System Reform Updates: • The public health Outcomes Framework • Operating model for PHE • Public health in local government and the DPH role • Public health funding • Workforce strategy

9. Commitment to co-design • We are committed to working with stakeholders during the autumn to co-design these five system reform updates • To support this, the CMO has established a Public Health Engagement Group, chaired by Chris Bull, chief executive of Herefordshire Council • The Public Health Engagement Group will: • Provide advice and challenge on the five system reform updates, working alongside DH policy leads • Support wider engagement with stakeholders • The Public Health Engagement Group will operate in the autumn alongside a range of existing engagement events

11. Contact details and further information • Update and Way Forward available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128120 • Contact the DH Public Health England transition team PublicHealthEngagement@dh.gsi.gov.uk • Contact the DH Public Health Development Unit PublicHealthDevelopmentUnit@dh.gsi.gov.uk • Information about the overall modernisation process (and where publications and letters are stored): http://healthandcare.dh.gov.uk/