1. 1 Thanks to Dr Tony Hill, Joint Director of Public Health, Lincolnshire Dr Chris Packham, Executive Director of Public Health, Nottingham How and what is the Joint Strategic Needs Assessment and how does it relate to this?

2. 2 What is 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 health improvement Lifestyles, inequalities in health, wider social influences of health health protection infectious diseases, environmental hazards, screening, immunisation, emergency preparedness health services quality service planning, modelling, effectiveness and efficiency, audit and evaluation, prioritisation.

3. 3 A radical new approach not been enough focus on the root causes of ill health free up local government and local communities to decide how best to improve the health and wellbeing of their citizens, the NHS will continue to have a critical role to play but it cannot tackle all the wider factors on its own responsibility needs to be shared right across society Informed by the JSNA and other drivers Same stakeholders as local partnerships PLUS GPs

4. 4 The life course approach and outcomes The best start in life Developing well Living well Working well Ageing well Low birth weight, maternal smoking, breast feeding, immunisation rates Childhood obesity, admissions for accidental injury, truancy rates Obesity and smoking rates, repeat domestic violence, wellbeing, late diagnosis of HIV, screening coverage Long term unemployment, sickness absence, people with long term illness in employment Mortality rates, falls, excess winter mortality, perceived community safety

5. 5 Public health domains and outcomes Domain One: Health Protection Audited emergency plans, surveillance systems, particulate matter (PM10) pollution levels, vaccination coverage, completed TB treatments, sustainability plans Domain Two: wider determinants of health Child and adult poverty, educational attainment, overcrowding, truancy, youth justice statistics, unemployment rates, fuel poverty, green space use, community safety and its perception, cycling rates, domestic abuse Domain Three: Health Improvement Healthy weight statistics in children, smoking prevalence, hospital-related alcohol admissions, physical activity rates, drug treatment: rates drug-free, teenage pregnancy rates, dental health Domain Four: Prevention of Ill-Health Hospital admissions due to self-harm, low birth weight, breastfeeding initiation, diabetes prevalence, work sickness, screening uptake for national programmes, Chlamydia diagnoses, maternal smoking, falls morbidity, NHS HealthCheck uptake, early stage cancer and HIV diagnoses. Domain Five: Healthy Life Expectancy Infant mortality, suicide rate, Cardiovascular disease rates, cancer mortality, COPD mortality, excess seasonal mortality

6. 6 The NHS Outcomes Framework 2011/12 Public Health Outcomes Framework 2010 Healthy Lives, Healthy People: Transparency in Outcomes Domain 1: health protection Domain 2: wider determinants Domain 3: health improvement Domain 4: reducing preventable illness Domain 1: prevent premature deathDomain 5: prevent premature death Domain 2: enhance QOF in long term conditions Domain 3: recovery from illness Domain 4: positive patient experience Domain 5: reducing avoidable healthcare harm

7. 7 What will Public Health be focussed on? children - strong universal public health & early education. Increased focus on disadvantaged families. Heavy emphasis on health visitors, schools, school nurses and families designing communities for active ageing & sustainability emphasis on transition points in life & ladder of intervention making it pay to work working collaboratively with business and voluntary sector through the Public Health Responsibility Deal Developing and refreshing the JSNA

8. 8 The Public Health System Local government will be given health responsibility, backed by ring-fenced budgets and new freedoms Directors of Public Health in upper-tier and unitary local authorities will lead these efforts local statutory health and wellbeing boards a new, dedicated and professional public health service, known as Public Health England a new role for local government to encourage joined up commissioning plans across the NHS, social care, public health and other local partners

9. 9 Director of Public Health employed by local government but jointly appointed by the relevant local authority and Public Health England strategic leader for public health in local communities professionally accountable to the Chief Medical Officer Practically accountable to CE Council and portfolio holder “a public health professional, with the training, expertise and skills needed to enable them to meet both the leadership and technical requirements of the role”

10. 10 Health protection (infection, CBRN protection, biological standards) Immunisation Public Health England (NHS Commissioning Board) Local authority: all school programmes All screeningNHS Commissioning Board Emergency preparedness and response and pandemic influenza preparedness Public Health England and Local authority Health intelligence and informationPublic Health England and Local authority NutritionPublic Health England and Local authority Sexual healthLocal authority (NHS Commissioning Board) Seasonal mortalityLocal authority Accidental injury preventionLocal authority Public mental healthLocal authority Physical activityLocal authority Obesity programmesLocal authority Drug misuseLocal authority Alcohol misuseLocal authority Tobacco controlLocal authority NHS Health Check ProgrammeLocal authority Health at workLocal authority Reducing and preventing birth defectsLocal authority and Public Health England Prevention and early presentation (LTC and cancer)Local authority Dental public healthLocal authority (PHE for surveys) Children ’ s public health for under 5s NHS Commissioning Board (health visiting) Children ’ s public health 5-19 Local authority (school nurses) Community safety and violence prevention and responseLocal authority Social exclusionLocal authority Public health care for those in prison or custodyNHS Commissioning Board Who commissions what between NHS and Local Authorities?

11. 11 Local Democratic Legitimacy; Health and Wellbeing Boards Likely to be statutory Also likely to be a statutory duty to address health inequalities on councils

12. 12 Final stage: 2013 Health & Wellbeing Boards are in place in each area ‘local democratic accountability to health care for the first time in almost 40 years’ The HWB is how councils exercise their lead role in integrating the commissioning of health, social care and public health services to better meet the needs of individuals and families JSNAs and Joint Health and Well-being Strategies key within this. The HWB Elected councillors, Director of Public Health, Plus Directors’ of Childrens and Adult services, GP consortia, Public representatives / HealthWatch, NHS Commissioning Board, others Health and healthcare and social care commissioning and coordination function (adults and children) Utilise JSNA as basis for commissioning

13. 13 Joint health and wellbeing strategy Consortia and the Local authority must prepare a Joint Health and Wellbeing Strategy, which at a minimum addresses the needs identified in the JSNA. This must consider the use of health act flexibilities (e.g. pooled budgets, lead commissioning) to support and promote integrated working between health and social care commissioners. This must have regard to the NHS Commissioning Board mandate to ensure consistency across the system Each commissioner must have regard to the joint strategic needs assessment and joint health and wellbeing strategy when deciding their commissioning plans. If the health and wellbeing board feel that commissioning plans have not had adequate regard to the joint health and wellbeing strategy, they can write to the NHS Commissioning Board, or local authority outlining their reasons.

14. 14 Overview and scrutiny Will operate outside / additional to Health and Well- Being Boards May be superceded in large cities by the ‘Majoral’ function and flexibilities (Localism Bill) which may see the return to committee (ie member) scrutiny