School of Medicine & Health Update on Emerging Policy Changes: what they mean for health and wellbeing David Hunter

School of Medicine & Health Continuing Policy Churn Policy and organisational landscape is unstable, unclear and complicated Fate of Health and Social Care Bill still unknown Bill has survived House of Commons but risks being rejected by House of Lords Public health changes - little progress, great uncertainty still

School of Medicine & Health Recent Key Developments 2 nd white paper – Health lives, Healthy People: Update and way forward (July 2011) Roger Boyle’s departure from DH (July 2011) 2 nd phase of NHS Future Forum (August 2011) 38 Degrees – independent legal assessment of Health and Social Care Bill (August 2011) Growing opposition from BMA, RCGP, RCN and members of House of Lords (August/September 2011) Report stage of amended Health and Social Care Bill (September 2011) Health and Social Care Bill passed by House of Commons (September 2011) with a majority of 65; enters Lords in October

School of Medicine & Health The Second White Paper: Highlights (1) Bold, exciting vision for local authorities LA role across 3 domains: health protection, health improvement, health service improvement PHE to be established as an Executive Agency of DH PHE to support local action, including ‘having a local presence’

School of Medicine & Health The Second White Paper: Highlights (2) DsPH employed by LAs but joint appointment with PHE Expectation that DPH will be directly accountable to local authority CEO ‘Core public health’ offer from LAs to NHS Reaffirmation of clear line of sight from SoS down to frontline re health protection

School of Medicine & Health Work in Progress: Unresolved Issues Relationship between LAs and PHE: the makings of central-local tension? Public health funding: little progress so far Health premium: not generally welcomed Public health outcomes framework Workforce – risk of becoming fractured and ending single multidisciplinary composition; uncertainty about registration of specialists

School of Medicine & Health NHS Future Forum: Second Phase Four workstreams Public health (focus on NHS involvement) Information Education and training Integration

School of Medicine & Health Coming Soon… Party conferences season - more criticism of health changes (September) Fate of Health and Social Care Bill in Lords (October) Report on Public Health Inquiry by House of Commons Health Committee (October/November) Responses to consultation on public health white paper published in November 2010 (anytime)

School of Medicine & Health Known Unknowns (1) Will the Bill be passed by Lords or be delayed? Does the fate of the Bill matter - is it necessary for what the government seeks to do? Ring-fenced funding for public health - what is it to be? Accountability of DsPH - to LA CEOs or others? Who decides?

School of Medicine & Health Known Unknowns (2) Will Health & Wellbeing Boards be different from previous partnerships? Will Health & Wellbeing Boards be different from previous partnerships? What is to be the future of public health in the NHS? Will the public health workforce remain unified? Will the changes work? Do they increase bureaucracy and transaction costs? How ready are local authorities to take on public health?

School of Medicine & Health Public Health Leadership in England is Failing There was a time when public health in England was driven by passionately articulated values and compelling research, a time when its leaders were concerned about social reform and political change....Yet today's leaders in public health prefer to collude with a mendacious government and preside over the decimation of public health in the NHS. Richard Horton, editor, The Lancet, 378: 1060, 17 September

School of Medicine & Health Why? Public health has become 'unconsciously anti-science’ Public health leaders are taking part in ‘an utterly corrupt' responsibility deal Public health leaders spend too much time looking inwards ignoring future challenges