1. Public health reform
A Scotland where everybody thrives

2. Why Reform is needed

3. Why Reform is needed Significant & persistent inequalities
Scotland’s poor relative health
Significant & persistent inequalities
Scotland
Unsustainable pressures on health and social care services

4. Public Health Reform Programme

5. Public Health Review - the need for change in the public health function
simplify the public health landscape at the national level
clear public health priorities
clarifying and strengthening DsPH role
a stronger voice for the public’s health
stronger application of evidence, and technology to policy and practice
specialist public health support for CPPs and IJBs
public health workforce development – specialist and wider workforce

6. Agreed actions for public health reform
Enable the whole system to work effectively together and support local public health activity
Develop and establish shared public health priorities for Scotland 
Establish a new national public health body – Public Health Scotland

7. Public Health Reform Programme
Public health reform is an equal partnership between Scottish Government and COSLA
The programme is being taken forward as a collaborative process involving the wider system in designing the future public health landscape
Public Health Scotland, shared priorities and a focus on local partnerships are the foundations of the reform programme
Scotland’s public health priorities provide catalyst for the whole system to focus on key public health challenges
Public Health Scotland will provide strong leadership to improve healthy life expectancy and reduce health inequalities

8. What would modern ‘public health’ look like in Scotland….?
Retain and maintain what's worked in protecting and improving the public’s health
The whole system working together to improve the public’s health:
Environments that support, encourage, drive and enable health
Where healthy behaviours are the norm
Individuals take responsibility and are able to manage their own health
Creating a “a culture for health’’ in Scotland
These four waves of population health improvement build on each other and remain hugely relevant today. There will be many things that we must continue to do that are in previous waves (e.g. dealing with cholera outbreaks, developing new vaccinations, scaling up effective interventions in the early years). However, some commentators believe that even Wave 4 has now peaked in its influence and new approaches are inevitable to tackle the ‘ingenuity gap’ that remains. These are variously described in the literature but cluster around:
Obesity and sedentary lives
Addiction
Mental wellbeing
Social isolation
The marked differences between our more affluent and less affluent citizens.
Climate change and its consequences
Sally Davies and colleagues say a fifth wave that is ‘cultural’ is coming – one where we need to create a culture for health, where healthy behaviours are the norm and where the institutional, social and physical environment support this mindset. But there is no single magic bullet. Some commentators focus on concerted efforts to influence vested interests and industries, while others focus on community action and the opportunities technology presents.

9. Vision for public health reform
The vision for public health reform is “a Scotland where everybody thrives”.
Ambition…
Scotland to be a world leader in improving the public’s health, using knowledge, data and intelligence in innovative ways, creating a culture for health in Scotland, with an economic, social and physical environment which drives, enables and sustains healthy behaviours, and where individuals take ownership of their health.

10. Public Health Scotland

11. Public Health Scotland – Bringing Together National Public Health
NHS Health Scotland
ISD
Health Protection Scotland
Public Health Scotland
Depending on outcomes of work on the Specialist Public Health Workforce, this could include Public Health Departments in boards as part of the total Pubic Health Scotland delivery model.
But to meet Scotland’s public health challenges, Public Health Scotland must be more than the sum of its parts.

12. Public Health Scotland – Ambition
Deliver an organisation equipped to meet Scotland's future public health challenges
Focus on improving healthy life expectancy and reducing health inequalities
Support a whole system approach focused on working together to make the biggest difference to people’s health
Integral to a public health function in Scotland that is high profile, informed by high quality evidence, professional expertise, and provides authoritative leadership
Focused on delivering improvements in the public’s health across Scotland at the local level on issues that matter to local communities

13. Public Health Scotland – Target Operating Model
Public Health Scotland’s Target Operating Model describes how the new organisation will work to support and enable the wider public health system to achieve the ambitions of public health reform.

14. Public Health Scotland’s TOM: listening to stakeholders and staff
350 staff at face to face engagement events
100s of stakeholders at engagement events
100+ stakeholders respond to online surveys and polls
450 staff respond to surveys
Over a dozen commissioned works and projects

15. Public Health Scotland’s Values
Collaboration
Respect
Innovation
Integrity
Excellence

16. Public Health Scotland’s Desired Culture
Innovative
Collaborative
Inclusive

17. Public Health Scotland – Target Operating Model
The role of Public Health Scotland is to support and enable the wider public health system
Public Health Scotland will provide more local support than the existing national organisations
Public Health Scotland will be organised based on outcomes for how the organisation will help the whole public health system

18. Public Health Scotland’s Draft Outcomes
Public Health Scotland’s Supports and Enables the Wider Public Health System
National policy is well informed and takes every chance to improve and protect Scotland’s health and reduce health inequalities
The whole system collaborates on Once For Scotland strategies and networks
Local policies and planning improve population health
The public health community is competent and works together
The public health system is supported to respond to public health challenges
Public Health Scotland’s data is appropriately managed and local areas are supported to build their data linkages and capability
Public Health Scotland meets and exceeds the needs and expectations of its stakeholders

19. Public Health Scotland – TOM Questions for discussion
Does the offer to the wider system from Public Health Scotland match what you understand is needed?
How do you see Public Health Scotland’s work needing to change to better enable and support the wider system than it does now?
Have we got the outcomes for organising the organisation right?
What responsibilities do you see as essential in Public Health Scotland?

20. Public Health Scotland – Legislative Consultation
Describes our proposals for the new national body and how we expect it will interact with other organisations and frameworks.
Primarily asks for views on the expected functions, structure and wider role of Public Health Scotland.
Some of the new arrangements will require legislative change and will be subject to parliamentary scrutiny.
Consultation live from 20th February 2019

21. Public Health Scotland – Legislative Consultation
Key themes of the consultation are:
Governance and accountability for the new model;
Outcomes, performance and improvement;
Functions of Public Health Scotland;
Structure of Public Health Scotland;
Composition of the Board.

22. Core and Specialist Public Health Workforce

23. Core and Specialist Public Health Workforce - What is Public Health
What we as a society do, collectively, to assure the conditions in which people can be healthy.
Institute of Medicine

24. Core and Specialist Public Health Workforce -– What is Public Health
Individual
Family
Community
Local
Regional
National
Global
Health protection
Healthcare service
improvement
Health improvement
Health intelligence and surveillance; leadership; partnership working; strategy, policy development and implementation; research

25. Core and Specialist Public Health Workforce Commission - Remit
Identify the range of possible options for organisation of the specialist public health workforce
Review models of specialist public health workforce arrangements implemented and operating elsewhere
Assess the options against which would deliver the most effective, efficient and resilient specialist public health function
Consider the specific role of the Director of Public Health and how that that can be most effectively delivered
Provide the Public Health Reform Programme Board with options for how the specialist public health workforce (including environmental health) should be organised.

26. Core and Specialist Public Health Workforce – Specialist Expert Advisory Group
Draw on expertise and insights to co-produce options for the reform programme board to consider.
Participation and engagement from across the whole system including:
Professional bodies
Health Protection
Health Improvement
Healthcare Public Health
NHS Boards
Community Planning
Environmental Health
Community and Voluntary Sector
Local Government
Academia
Scottish Government

27. Core and Specialist Public Health Workforce
Core Public Health Workforce
Wider Workforce that contributes to health & wellbeing
Core Public Health Workforce - All staff engaged in public health activities that identify public health as being the primary part of their role
Specialist Public Health Workforce – Specialist Public Health workforce registered with the General Medical Council (GMC), General Dental Council (GDC) UK Public Health Register (UKPHR) or the Royal Environmental Health Institute Scotland REHIS
Wider Public Health Workforce – Workforce in wider public, private. voluntary and community sectors who contribute to improving health and wellbeing

28. Core and Specialist Public Health Workforce – in scope:
Staff in public health departments
Environmental health staff in local authorities
Staff in health promotion/ improvement departments
Staff in new public health body - Public Health Scotland
Staff working in surveillance and health intelligence

29. Core and Specialist Public Health Workforce - Timeline

30. Core and Specialist Public Health Workforce – shared assumptions
The status quo has not been successful in delivering the level of improvements that we want - therefore some form of change is inevitable
There is a need to strengthen partnership working across the public and third sectors - therefore this needs to be a priority within any option developed
The need for increased public health leadership stated clearly by the Scottish Government - all options need to consider how this can be strengthened
Organisational change is disruptive - therefore significant organisational change will only take place where there are clear gains to public health in Scotland

31. Core and Specialist Public Health Workforce – Options
Option 1 - Move staff in public health departments to local authorities
Option 2 - Move staff to health and social care partnerships (HSCPs)
Option 3 – Enhanced current model: staff remain in NHS Boards (+ Public Health Scotland)
Option 4 - All staff from Public Health Departments move to Public Health Scotland and deployed from there
Option 5 - Regional public health hubs
Option 6 – Hybrid model bringing together local, regional and national elements

32. Core and Specialist Public Health Workforce – Option 1
Move staff in public health departments to local authorities (other than PHS staff, screening and health protection)
Strengths: influence in LAs and CPPs; local accountability & connections; visibly new opportunities; stronger population health focus
Weaknesses: loss of important connections with NHS; budget pressures on LAs; resource potentially too thinly spread; negative perception of experience in England; dilution of PH workforce

33. Core and Specialist Public Health Workforce – Option 2
Move staff in public health departments to HSCPs (other than PHS staff, health protection and possibly screening)
Strengths: influence on health and social care; accountability through two partners; visibly new opportunities; links to HB and LA data; potentially stronger population health focus
Weaknesses: complexity of accountability; budget pressures (although less than on LAs alone); resource potentially too thinly spread; separation of health protection from rest of PH

34. Core and Specialist Public Health Workforce – Option 3
Staff stay in NHS Boards and participate in obligate networks Strengths: less structural change; retains strong links with the NHS; potential for more collaboration & less duplication Weaknesses: potentially insufficient change to achieve reform ambitions; unclear how this would strengthen influence in LAs and CPPs; unclear how this would strengthen population and prevention focus; potential tensions between local and obligate network priorities

35. Core and Specialist Public Health Workforce – Option 4
Move all public health staff to PHS and deploy locally from there Strengths: ability to deploy in response to need; flexibility; stronger identity for public health; visibly new opportunities; potential to reduce variation & duplication; stronger training and career path opportunities for staff Weaknesses: complexity in ensuring governance and accountability for local delivery; potential conflict between PHS and local systems view of needs; potential for negative impact on remote & rural areas

36. Core and Specialist Public Health Workforce – Option 5
Move staff in public health departments and PHS to three regional hubs Strengths: consolidate expertise; economies of scale; potential to reduce variation & duplication; stronger training and career path opportunities for staff Weaknesses: lack of good alignment with other structures across the system; unclear how this would strengthen influence in LAs and CPPs; unclear how this would strengthen population and prevention focus

37. Core and Specialist Public Health Workforce – Option 6
Hybrid model contracting public health staff jointly to Health Boards, PHS and LAs
Strengths: potential to facilitate co-ordination, de-duplication & deployment according to need; facilitation of greater action locally and whole system working; visibly new opportunities for change
Weaknesses: challenge of co-ordination of staff across Scotland; potential conflict between the different partners’ views of needs; complexity of governance & accountability arrangements

38. Core and Specialist Public Health Workforce – some further reflections
Recognition of the complexity of public health delivery
Experience tell us that being located in an NHS setting does not always maximise impact, limits the focus on prevention and can make engaging communities challenging
Overall there is an opportunity to strengthen elements of local delivery  
Some elements of public health need local engagement and support but do not suit local delivery
The relationship with the health system is vital for elements of public health

39. Core and Specialist Public Health Workforce - Questions
Is there anything you think the process so far has not considered/ captured? What would need to be considered further to explore the other options? Other questions and feedback?

40.
Website: publichealthreform.scot

41. Public health reform
A Scotland where everybody thrives