Public Health Transition

1. Public Health Transition Leeds : 1st February 2012 (Cllr) Jan Smithies

2. Why do Cllrs need to know this? • Major change in statutory roles and duties • New senior management team member: budgets and staff moving across • Priority setting re vision and PH Outcomes – officer or politician led? • Budgets and staff moving across • Could mean more/less money to your authority (‘health premium’) – incentive for improvement and inequality reduction • Key to effective H&WB leadership – DPH key lead officer for H&WB Board? • NHS will drive this change and agenda if LAs do not seize control and leadership • Huge potential to address local needs and priorities and halt social care budget expansion • Joined up nature of rest of LA key roles and health improvement/ tackling health inequalities • If going to work in partnership and sign of CCG plans MUST understand the role of clinical NHS work in tackling inequalities too

3. A question for you at the start At the end of this presentation how much is new and how much did you know already? If most is new who is (or is not) briefing you back in your Council?

4. What will the ‘big picture’ look like - PH in all?

5. Key transition completion dates * NHS Commissioning Board established in shadow form in October 2011 > full responsibilities from April 2013 * PHE England shadow form > full responsibilities from April 2013 * Abolition of Strategic Health Authorities April 2013 (but clustered from 9 to 4 in Autumn 2011) * Clinical Commissioning Groups (CCGs) > Pathfinders > shadow Boards > full accreditation > April 2013 ++ * Primary Care Trusts clusters formed from consolidation of PCTs > local arms of NHS Commissioning Board > will oversee clinical commissioning groups after April 2013 * HealthWatch England – start date Oct 2012 * Local HealthWatch - start date April 2013 * NHS trusts will become NHS Foundation Trusts by 2014 ++ * LAs take on health duties & responsibilities by April 2013

6. Public Health White paper > Govt Update & Response > Health and Social Care Bill Local authorities to take new responsibilities for public health Giving this role to local government opens new opportunities for community engagement and to develop holistic solutions to health and wellbeing embracing the full range of local services (e.g. health, housing, leisure, planning, transport, employment and social care). Local authorities’ new public health responsibilities will be supported by a ring-fenced budget. Directors of Public Health will lead this work, as the principal adviser on health to the local authority*

7. Public Health White paper > Govt Update & Response > Health and Social Care Bill Govt response to poor health, especially long term conditions, and mortality and morbidity gaps Key issues: • New local authority responsibilities for public health • New national body – Public Health England • Public Health Outcomes Framework • Public health has a clear priority – cross govt ministerial group chaired by Sec of State for Health • Commitment to reduce health inequalities is a priority • PH support to the NHS continues - via SLAs (?)

8. Local government and health Bill extends the role of local authorities by: • establishing new statutory roles (DPHs) and duties and powers in relation to public health and wellbeing • creating health and wellbeing boards • resourcing lead local responsibility for public health • producing a Joint Strategic Needs Assessment JSNA & joint Health & Wellbeing Strategy • providing a commissioning interface between clinical commissioning consortia and local authorities • leading on health and social care integration • formalising a lead role in local public involvement

9. LA priorities and services • Largely free to determine their own priorities and services • Required to provide a small number of mandatory services • sexual health services • NHS health checks • National Child Measurement Programme • providing public health advice to NHS Commissioners • ensuring plans are in place to protect the health of the public

10. HR/Workforce issues • Public Health Human Resources (HR) Concordat: provides principles for managing the HR processes to ensure fair treatment, consultation and involvement of staff & unions involved in the transition to the new system : more guidance imminent • Local areas can agree arrangements for local authorities to manage public health functions during the transition year • PCT clusters will retain statutory responsibilities for their existing functions until formal abolition on 31 March 2013 • LGA PH Workforce issues just out

11. Appointment of DPHs • Upper tier & unitary authorities will employ Directors of Public Health (DPHs) • Appointment process will be undertaken jointly with the Secretary of State via Public Health England (PHE) • Faculty of PH is central component of senior PH appointments • All appointments made during transition period (up to 1/4/2013) should reflect anticipated changes in policy statements on the role of the DPH in local gov from 1/4/2013 – fill vacancies do not wait • Government intends to issue statutory guidance on responsibilities of DPHs • Legal responsibilities should translate into the DPH acting as lead officer in a LA for health: championing health across the whole of the authority's business.

12. Appointment of DPHs cont. • Expect direct accountability between the DPH and LA Chief Executive for exercise of LAs public health responsibilities • Expect they will have direct access to Elected Members. • A template job description for the new role of DPH in local government: defines the necessary core technical and professional competencies • LAs may wish DPH to take on tasks in addition to the essential PH technical and professional responsibilities • The DH will publish further guidance, developed in partnership with local government, on the process for LAs to appoint DPH jointly with Public Health England

13. Transition planning • The NHS accountable for delivering a successful public health transition: needs to do so in co-production of the new system with local authority colleagues. • For 2012/13, as part of overall integrated plan, each PCT cluster must have comprehensive plans, for each local authority/PCT area, that support a robust transition to the new public health system. • During the transition year 2012/13, local govt will take on an increasingly active and leading role in ensuring a robust transition. • CCGs need to be involved in agreeing local arrangements with local authorities for the “core offer” of public health advice. • Each PCT cluster required to have an integrated plan, submitted through its SHA cluster to the DH by 5/4/2012 (1st draft by 31/1/11): must reflect JSNA • Publication of 2012/13 PCT financial allocations and shadow allocation for each LA will indicate level of resources available locally to support transition to new system.

14. Key elements of a transition plan • Contribute to the development of the vision and strategy for the new public health role in Las • Develop robust transition plans for functions systems and services • Prepare local systems for new commissioning and contracting • Ensure robust governance arrangements are in place during the transition year • Ensure delivery of the public health delivery plan for 2012/13 • Ensure new clinical governance systems are in place for all relevant services to be commissioned by the local authority • Prepare for and undertaking formal transfer of staff, including appropriate mechanisms for consulting with staff and trade unions • Test the new arrangements for specific public health functions, including emergency planning, resilience and response • Effective communications and engagement to give confidence to the public, providers and other stakeholders.

15. Key milestones • Agree a local transition plan for public health as part of the overall integrated plan, taking account of the checklist, by March 2011 • Develop a communication and engagement plan, first draft by March 2012 • Agree approach to the development & delivery of the local public health vision by June 2012 • Agree arrangements on public health information requirements and information governance by September 2012 • Test arrangements for the delivery of specific public health services, in particular screening and immunisation by October 2012 • Test arrangements for the role of public health in emergency planning, in particular the role of the PDPH and local authority based public health by October 2012 • Ensure an early draft of legacy and handover documents is produced by October 2012 • Ensure final legacy and handover documents produced by January 2013 • Agree arrangements for Las to take on public health functions – date for local determination. • Checklist for local use asking pertinent questions

16. Expected role of LA (‘receiver organisation') in transition • Be fully involved by the PCT cluster in the development of the local public health transition plan • Take the lead at the earliest opportunity in the development of the local public health transition plan • Agree delegated responsibility for delivery of public health services negotiated locally • Be signatory, through the chief executive, to the plans as evidence of their agreement to the plan • Other complementary roles outlined for DPHs, SHAs, NHSCB, DH, PHE as part of transition process

17. PH Outcomes Framework • Just out – consultation for next two months • Outcomes set for national and local levels • Mechanism for transparency, incentivisation and accountability • Easy for local areas to compare themselves across the country • Promote joint working where local organisations share common goals.. ‘therefore ..crucial to make the Framework work from day one, to break down barriers to delivery.’ • Expect to reduce the final number of indicators

18. PH Outcomes Framework cont. Five domains (with indicators under each): • health protection and resilience • tackling the wider determinants of ill health • promoting healthy choices and healthy lifestyles • preventing ill health • focusing on premature mortality and the health of the most vulnerable.

19. Interface of PH, health inequalities & social care • NHS gone from infectious disease focus in 1948 to LTCs, cancer and mental health in 21st century • 1 in every 7 GP appointments for LTCs* • Aging population in many areas (baby boom) – impact on social care budgets • 50% of adults with a mental health problem had a MH, behavioural or emotional problem before the age of 14 yrs • MH biggest spend of NHS than any other health condition • Marmot Review 2010 ‘disability free life expectancy’ – 17 year gap gradient but majority not fit for work by mid 60s** • Health Inequalities National Support Team’s priority action list PAL and workshop resources (HINST)*** • Social determinants AND quality and accessibility of health & social care • Old model of health and social care – deliver to, not with…co-production, co-creating health, shared decision-making … • Personal budgets… for social care (and health ??) • Shift from one size fits all

20. Co-production for health: a new model for a radically different world There was consensus across the agencies of the benefits of taking a holistic approach to delivery of health outcomes at the local level and what is needed to be in place to make this happen. Local Government is the place to orchestrate partnerships to drive health and wellbeing. This is a given. There are benefits for individual’s health, for community engagement, capital and capacity and for partner organisations to deliver shared outcomes, offsetting demand and cost. *

21. Co-production for health: a new model for a radically different world: Key Messages • Use transition to develop a new co-production model for health and wellbeing • Model will fail without elected members’ understanding and buy-in – they need to be at the helm • Establish focused, agreed priorities : meaningful outcomes for all partners • Put in place mechanism and infrastructure to ensure effective delivery • Use intelligence dynamically, creatively and succinctly and in relevant forms for different audiences • Promote an asset based approach to communities to understand and harness their assets and resource • Adopt a new approach to partnership and leadership whilst building on what has worked • PH workforce has to change delivers solutions to commissioners and providers • Build PH capacity across a whole range of workforces to deliver interventions at industrial scale.

22. Preparation toolkit for LAs: out this month? • Articulate the vision for public health transformation • Support councils in using the full potential of the public health team in delivering population health • Examples of PH/LA transition/ transformation to the new system • Demonstrate the role of public health in supporting the range of council services to deliver improvements in health • Support local areas to identify their development needs to deliver transformation • Can feed into the consultation http://www.policyandpractice.co.uk/resource/#link13

23. Key documents • DH: Transforming PH Bulletin: regular updates • LGA: Public Health Workforce issues: Jan 2012 (receiving organisations) • DH letter: Director of public health appointments: Jan 2012 • DH & LGA: Public health transition planning support for primary care trusts and local authorities: Jan 2012 • NHS Future Forum: Summary Report – second phase: Jan 2012 • DH: Public Health Human Resources (HR) Concordat: Nov 2011 • Faculty of PH: Guidance To Local Authorities On The Appointment Of A Director Of Public Health: Nov 2011 • DH: The new public health system: summary : Dec 2011 • DH: NHS Outcomes Framework 2012/13: Dec 2011 • DH: Transparency in Outcomes: A Framework in Adult SocialCare: April 2011

24. Further reading & useful websites *Kings Fundhttp://www.kingsfund.org.uk/Kings Fund link to lots of reading lists: http://www.kingsfund.org.uk/library/reading_lists.html *Health Foundationhttp://www.health.org.uk/ *Nestahttp://www.nesta.org.uk/home1 *Young Foundationhttp://www.youngfoundation.org/ *NHS Alliancehttp://www.nhsalliance.org/ *DHhttp://healthandcare.dh.gov.uk/(NHS Futures Forum; Public Health England Bulletin; Social Care Bulletin; HealthWatch) *Local Govt Improvement & Developmenthttp://www.idea.gov.uk/idk/core/page.do?pageId=1 (communities of practice; health improvement)

25. Contact Jan Smithies jan.smithies@virgin.net 07947 139066