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  1. West Midlands Councils12 July 2012Health reform:implications for local government and our communities Fiona Campbell

  2. The main changes • Health and Social Care Act 2012 • Hands off role for Sec of State and DH • How health services are commissioned • Who provides services • Competition • Public health transfer to local government • Health and Wellbeing Boards • HealthWatch • £20bn cut in budget this round and next

  3. How health services are commissioned • NHS Commissioning Board set up • PCTs and SHAs abolished • Clinical Commissioning Groups set up • Groups of GP practices (with additional members) • Not to cross LA boundaries • 80% of NHS budget • Authorised by NHS Commissioning Board • Supported by Commissioning Support Orgs

  4. Who provides services • All NHS Trusts to become Foundation Trusts • Any qualified provider • EU procurement and competition rules • Cap on private provision lifted to 49%

  5. Competition and role of Monitor • Increased role for Monitor re financial robustness and competition • License all providers • Discourage anti-competitive behaviour • But enable integration (?!) • Specify essential services • Deal with failing Trusts

  6. Public health transfer to local government • DPH and public health team transfer to LA by April 2013 (but much is already happening) • DPH to report to CE and be part of mgmt • But also to be overseen by Public Health England • Ring-fenced budget • DPH must make an “offer” of public health services to NHS (ie CCGs) • LAs to provide certain mandatory services, others optional

  7. Health and Wellbeing Boards • A committee of local authority by April 2013 (shadow boards currently operating) • “System leader” role • Certain required members (eg CCG) • Oversee Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy • Duty to involve patients and public in above • Duty to promote joint commissioning and integrated services

  8. HealthWatch • National HealthWatch to be part of Care Quality Commission • Local HealthWatch to replace Local Involvement Networks • Funding through local government • HealthWatch to cover both health and social care

  9. General implications • More private providers and probably big corporations • More private provision in NHS Trusts • Clinicians to become managers and administrators – in some cases will bring in private sector or other external organisations • Speculation about possible charging for currently free services • Competition between providers • Commercial confidentiality (although FT Boards to meet in public)

  10. Implications for local government • Significant new roles • Public health • “System leader” in Health and Wellbeing Boards • Funder and supporter of HealthWatch • New relationships • Locally – with CCGs, HealthWatch, vol sec, NCB hubs • Nationally – with DH, NCB, Public Health England, HealthWatch England

  11. Public Health • Domains of public health • Health improvement • Health protection • Health services

  12. Mandatory functions for local government • appropriate access to sexual health services • ensuring there are plans in place to protect the health of the population, including immunisation and screening plans • ensuring NHS commissioners receive the public health advice they need eg on health needs assessment, evaluating evidence, drugs and technologies • the National Child Measurement Programme (NCMP) • appointing Medical Examiner to certify deaths

  13. LA health commissioning • tobacco control and smoking cessation services • alcohol and drug misuse services • public health services for children and young people aged 5-19 (including Healthy Child Programme 5-19) (and in the longer term all public health services for children and young people) • the National Child Measurement Programme • interventions to tackle obesity such as community lifestyle and weight management services • locally-led nutrition initiatives • increasing levels of physical activity in the local population • NHS Health Check assessments • public mental health services • dental public health services • accidental injury prevention • population level interventions to reduce and prevent birth defects • behavioural and lifestyle campaigns to prevent cancer and long-term conditions • local initiatives on workplace health • supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as immunisation and screening programmes • comprehensive sexual health services (including testing and treatment for sexually transmitted infections, contraception outside of the GP contract and sexual health promotion and disease prevention) • local initiatives to reduce excess deaths as a result of seasonal mortality • the local authority role in dealing with health protection incidents, outbreaks and emergencies • public health aspects of promotion of community safety, violence prevention and response • public health aspects of local initiatives to tackle social exclusion • local initiatives that reduce public health impacts of environmental risks.

  14. Joint Strategic Needs Assessment Joint Health and Wellbeing Strategy • JSNA and JHWS to be produced by CCGs and Local Authorities “through” the Health and Wellbeing Board • Opportunity to link social care, public health, environmental health and health services for both adults and children • Needs and strategy should reflect ALL local government functions (eg planning and environment, housing, education, employment)

  15. Challenges for LAs • Taking on a significant “new” function at a time of severe financial constraints • Understanding the wide remit and responsibilities of DsPH • Mainstreaming public health across local govt • Preserving what is good in existing partnerships • Protecting current joint commissioning and integrated provision • How to be a “system leader” in the face of powerful CCGs and even more powerful acute trusts • Tackling health inequalities in an increasingly unequal society.

  16. Opportunities for LAs • Strategic leader for health improvement and tackling health inequalities • Mainstream health across all LA functions • Educate CCGs and NHS about health role of local govt. • Local cllrs can develop rels with GPs • Integrate care pathways and services across sectors • Higher public profile on health issues