Public Health Transition Sheffield s approach to the Govt s proposals

1. Public Health TransitionSheffield�s approach to the Govt�s proposals

2. Context Health & Social Care Bill � currently in the House of Lords It has incorporated the Govt�s response to the NHS Future Forum�s report during the �pause�. In summary, the proposals include: Consortia of GPs work in Clinical Commissioning Groups (CCGs) to commission the majority of local health services NHS Commissioning Board � created to hold CCGs to account and commission some services Abolition of PCTs and Strategic Health Authorities Transfer of local leadership of Public Health from the NHS to Local Authorities Creation of Public Health England (PHE) Health & Wellbeing Boards (HWBs) � at local level HealthWatch � 'consumer champion' including replacing LINk

3. Public Health White Paper (PHWP) As part of the NHS proposals, Govt produced a White Paper on Public Health. Less coverage than NHS proposals but significant: Public Health England � exec agency of DH � with some PH responsibilities at local level Majority of NHS public health function transfer to councils Councils to have a ringfenced PH budget Directors of PH � employed by councils Joint responsibility for the Joint Strategic Needs Assessment (JSNA) & the Joint Health & Wellbeing Strategy (JHWS) Supported by an outcomes framework

4. What is public health? Definition in the Govt�s Public Health White Paper (from Faculty of Public Health): �The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society� Three main domains: health improvement health protection health services

5. Determinants of Health

6. This is the latest draft we�ve seen. The indicators from the consultation document (and thus in the handout) don�t necessarily tally with this as the original framework in the consultation draft had 5 domains.This is the latest draft we�ve seen. The indicators from the consultation document (and thus in the handout) don�t necessarily tally with this as the original framework in the consultation draft had 5 domains.

7. PH Budget Ringfenced � potentially �4bn+ for LAs overall To be taken from NHS (PCTs) to fund PHE and LA PH work Current PH budget in Sheffield is around �40m Approx �29m on LA functions, �11m on PHE functions Currently fully committed! Publication of �shadow� allocations by end of 2011 Health Premium � an incentive payment to reward progress in addressing inequalities (relative to extent of challenge at local level) Population health measures � seen as most �pragmatic� approach Govt are considering three potential approaches: �Utilisation� � based on modelling the statistical relationship between the current levels of public health activity and need across the country (ie higher/lower expenditure in small areas provides information on relative need) �Cost effectiveness� � based on potential gains in public health outcomes relative to spend (ie the most cost effective interventions) �Population health measures� � based on measures of health outcomes (eg Standardised Mortality Ratios). Areas with poorer health would receive higher allocations. Population health measures � seen as most �pragmatic� approach Govt are considering three potential approaches: �Utilisation� � based on modelling the statistical relationship between the current levels of public health activity and need across the country (ie higher/lower expenditure in small areas provides information on relative need) �Cost effectiveness� � based on potential gains in public health outcomes relative to spend (ie the most cost effective interventions) �Population health measures� � based on measures of health outcomes (eg Standardised Mortality Ratios). Areas with poorer health would receive higher allocations.

8. Public Health � strong LA role Duty to �take steps to improve the health of their population� from April 2013 Directors of Public Health to be jointly appointed with PHE Ringfenced PH budget Co-ordinate, commission and deliver public health improvements to meet local health priorities Accountable to Public Health England for funding and for progress against outcomes framework (ie, accountable to DoH) Councils in ideal place to address �underlying causes� of ill health (ie disadvantage, poor housing, lifestyles issues). Use the �power of general competence� to support the health and wellbeing improvements (Localism Bill)

9. SCC likely public health responsibilities tobacco control; alcohol and drug misuse services; obesity and community nutrition initiatives increasing levels of physical activity in the local population assessment and lifestyle interventions as part of the NHS Health Check Programme; 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; Not expected to go through all these. Pick a few examples and I assume they�ll have handouts. Maybe raise the concerns about the �role in dealing with health protection�.Not expected to go through all these. Pick a few examples and I assume they�ll have handouts. Maybe raise the concerns about the �role in dealing with health protection�.

10. Public Health in SCC (current) SCC / NHSS already has in place: Director of Public Health working across both organisations SCC Director of Health Improvement with small team Jointly appointed Public Health Consultants in CYPF and Communities portfolios Public health leads and action plans in each portfolio WHO Healthy City status Health Inequalities Action Plan Local infrastructure � VCF relationships, local health plans Strong needs assessment and population analysis PH responsibilities give us the tools to deliver Better Health & Wellbeing and will contribute to a number of our Corporate Plan priorities and outcomes.

11. Sheffield Inequalities Action Plan Modelled on the latest evidence from Marmot Multi Agency approach 3 year plan Focus on: Give every child the best start in life Enable all children young people and adults to maximise their capabilities and have control over their lives Create fair employment and good work for all Ensure healthy standard of living for all Create and develop healthy and sustainable places and communities Strengthen the role and impact of ill health prevention

12. Sheffield PH Vision Public Health being led from the City Council will: broaden the scope of public health activity, and so to have an impact on a much wider range of factors that determine health and ill health for the people of Sheffield turn Sheffield City Council into a Public Health organisation to enable more mainstream spend upstream (prevention). Aims: to promote good health; to prevent and tackle ill-health; to reduce health inequalities; to enable all of us as citizens to make healthier lifestyle choices; to develop public health capacity and know-how across organisations and communities; to provide PH leadership across the City.

13. Sheffield Public Health Vision A vision statement which sets out Sheffield�s PH aspirations beyond 2011 Available on request

14. Public Health (future) Strong joint working ethos already in place Transition plan in place NHS PH staff already working closely with SCC Assessing current and potential budget along with staffing resources Mainstream PH in SCC so that every contact a person has with the council benefits their health �Hub & spoke� model in SCC and GPCC. Work with GPs and all Sheffield communities to deliver our Health Inequalities Action Plan Core role in the Health &�Wellbeing Board to set the Joint Health & Wellbeing Strategy for Sheffield We will look to do whole system assessment (eg. as Change for Life did for obesity, like food plan for food resilience) for other areas such as Workplace health

15. Issues Budget � still not be outlined to councils HR impact � not been addressed by DH yet Priorities Vs Responsibilities Relationship with PHE / Primary Care (CCG) Emergency planning Balance of spend and constraints How we become a PH organisation