Changes to Public Health in the NHS, how will it work in the future?

Dr Mark KroeseUKGTN Public Health Advisor

Genetic Alliance UK 22nd Annual General Meeting

1 November 2011

Outline

1. Introduction to Public Health

2. Current Public Health structures in England

3. Proposed new structures for Public Health in England

4. Example of possible impact with specific reference to population screening services

5. Conclusion

Public Health is…..

“The Science and Art of

preventing disease, prolonging life and

promoting health through the organised

efforts of the society”

(Sir Donald Acheson, Public Health in England: Report of the Committee of Inquiry into the Future Development of the Public

Health Function, 1988 )

Three Key Domains

Health Improvement

Health Protection

Improving Health and Social

Services

Health Protection

• Infectious diseases • Chemicals and poisons • Radiation • Emergency response • Environmental health

hazards

Surveillance

Health Improvement

• Smoking• Alcohol• Obesity • Healthy eating• Physical activity• Sexual health

Improving Health Services

• Clinical effectiveness • Efficiency • Service planning • Audit and evaluation • Clinical governance • Equity

Wider determinants of health

Secretary of State for Health

Department of Health and NHS Executive

Strategic Health Authorities Strategic Direction and Performance Management

Primary Care Trusts Commissioning / Planning / Agreement of Secondary Care

PCT Provider Services

GPs, DentistsOptometrists, Pharmacists

Walk-in Centres, NHS DirectSocial Care

CareTrusts

MentalHealthTrusts

NHS Trusts

AmbulanceTrusts

Provision of all local health and care services

The Current Structure

Foundation Trusts

Monitor

GPs (PBC)

Ind’ Sector

Specialised services

Secretary of State for Health

Department of Health and NHS Executive

Strategic Health Authorities Strategic Direction and Performance Management

Primary Care Trusts Commissioning / Planning / Agreement of Secondary Care

PCT Provider Services

GPs, DentistsOptometrists, Pharmacists

Walk-in Centres, NHS DirectSocial Care

CareTrusts

MentalHealthTrusts

NHS Trusts

AmbulanceTrusts

Provision of all local health and care services

The Current Structure

Foundation Trusts

Monitor

GPs (PBC)

Ind’ Sector

CMOPH team

RDPHPH team

DPHPH team

Specialised services

In addition

• Health Protection Agency• Public Health Observatories• National NHS bodies e.g. NICE• Department for International Development • Universities

NHS White Paper Equity and Excellence (DH 2010) states that PCT responsibilities for local health improvement will transfer to local authorities (LAs)

NHS White Paper Healthy Lives, Healthy People (DH 2011) reiterated that each upper tier/unitary authority will lead a statutory Health and Wellbeing Board (HWB).

Power and responsibility for commissioning services devolved to the healthcare professionals closest to patients: GPs and their practice teams working in consortia.

Upper tier local authorities will have a role across the three domains of public health.

Prescribed functions to be delivered by local authorities will include:

• appropriate access to sexual health services

• Director of Public Health has a duty to ensure there are plans in place to protect the health of the population;

• ensuring NHS commissioners receive the public health advice they need

• the National Child Measurement Programme

• NHS Health Check assessment

• elements of the Healthy Child Programme

Proposed Structure

Proposed Structure

New integrated public health service – Public Health England - will include

1. Health Protection Agency (HPA)

2. National Treatment Agency for Substance Misuse (NTA)

3. Public Health Observatories

4. Cancer Registries

Public Health England will have three principal routes for funding services

• granting the public health ring-fenced budget to local government;

• asking the NHSCB to commission services, such as screening services, and the relevant elements of the GP contract; and

• commissioning or providing services directly, for example national purchasing of vaccines, national communication campaigns, or health protection functions

Roles in the new Public Health System

Local Authorities

CCGs/NHS CB

PHE (local units)

• Duty to improve health• Brings together holistic approach to health and wellbeing

• Employ DPH• Ringfenced PH budget• Mandated services

• Commissioning healthcare• Commissioning some public health services

• Local Health Protection Services (functions in development)

• Core offer to the NHS, including PH advice on health services

Health and Wellbeing Board

Coordinates local strategy through• JSNA• Review of commissioning plans

UK National Screening Committee

• criteria for appraising the viability, effectiveness and appropriateness of a screening programme

• developed policies on screening for dozens of conditions

• overseen the successful introduction of a number of national screening programmes in England

• raised the profile of screening within the NHS and with the general public

Screening programme

Antenatal screening programmes

Infectious diseases (IDSP)

Fetal anomalies and Down’s Syndrome (FASP)

Sickle cell and thalassaemia (SCTSP)

Newborn, infant and children

Sickle cell disease (SCTSP)

Disorders identifiable in newborn bloodspot (NBBSSP)

Cystic fibrosis, Medium chain acyl CoA dehydrogenase deficiency (MCADD), Phenylketonuria (PKU), congenital hypothyroidism

Hearing loss (NHSP)

Congenital conditions identifiable through physical examination (NIPESP)

Adult non cancer screening programmes

Diabetic retinopathy (NSPDR)

Abdominal aortic aneurysm (NAAASP)

Adult cancer screening programmes

Breast cancer (BCSP)

Cervical cancer

Bowel cancer

Issues to consider in future regarding screening

• NSC will exist as part of PHE

• Commissioning of screening services by NHSCB

• Antenatal screening services part of maternal care which will be commissioned by CCGs

• Local responsibility for population screening programmes remains unclear

Timeline

End of 2010: White paper: Healthy Lives, Healthy People

July 2011: White paper response, confirming new public healthsystem structure

By end 2011: complete the operational design of the new system, including the PHE Operating Model, how the local system will work, and their links into the NHS.

Spring 2012: chief executive and senior team for Public Health England appointed.

April 2012: start of transition year

April 2013: Public Health England established

April 2013: Local authorities take on their new public health responsibilities

Thank you