1. The New PH System, National and Local
The New PH System, National and Local. Maintaining a Focus on Children and Young People Dr Ann Hoskins Interim Regional Director of Public Health / Director of Children, Young People and Maternity Services

2. There Remains a Powerful Case for Change All Cause mortality in Children in European Countries

3. Health Inequalities

4. Consequences of inaction
More than half of 15 – 16 year olds had consumed more than five alcoholic drinks in the previous month
Half of life time mental illness starts by the age of 14
More than 8 out of 10 adults who have ever smoked regularly start before 19
8 out of 10 obese teenagers go on to be obese adults.

5. Strategic shift from healthier habit5 5

6. Healthy Lives, Healthy People: Our Strategy for Public Health in England
The Government aims to:
empower local leadership to strengthen health and wellbeing
support self esteem, increased confidence and personal responsibility
promote healthier behaviour and lifestyles
change the environment to support healthier choices
protect the public from threats to health.
Following extensive consultation, further details published in July 2011’s Update and Way Forward
December 2011: finalising key elements of the design of the new public health system

7. The New Approach to
Public Health
Leadership role for local authorities – so services are shaped by local needs 1
Supported by a new integrated public health service, Public Health England 2
Stronger focus health outcomes supported by the public health Outcomes Framework 3
Public health as a clear priority across government 4
The commitment to reduce health inequalities as a priority across the system 5

8. Local Government Leadership
Local government should lead for public health because of its:
Population focus, as the democratically accountable stewards of local health and wellbeing
Role as the shapers of place
Ability to address many of the wider social determinants of health, and
Experience of, and ability to tackle, inequalities in health.
Factsheet: local government leading for public health

9. Local Government’s New Functions
New duty to improve the health of the population:
Commissioning services from a range of providers
Working with clinical commissioning groups to integrate care pathways
Using health and wellbeing board to integrate commissioning approaches
Providing population healthcare advice to the NHS
Duty to ensure plans in place to protect health.
Local political leadership critical to making this work.
Factsheet: local government’s new public health functions

10. Local Authority Commissioning Responsibilities (1)
Tobacco control & smoking cessation
Alcohol and drug misuse
Services for children 5-19
National Child Measurement Programme*
Obesity and weight management
Local nutrition services
Increasing physical activity
NHS Health Checks*
Public mental health services
Dental public health services
Injury prevention
Birth defect prevention
Behavioural and lifestyle campaigns to prevent LTCs
Local initiatives on workplace health
Support and challenge of NHS services (imms and screening)
Public health advice to NHS*
Sexual health services*
Seasonal mortality initiatives
Local role in health protection incidents*
Community safety
Social exclusion
* Indicates mandated services

11. Local Leadership For Health Protection
Secretary of State responsible for health protection via PHE
Local authority under a duty to ensure plans are in place to protect the local population
Local authority role
How the role will work
Ensuring plans in place for:
outbreaks and emergencies; and preventing them occurring
immunisation and screening
infection control
DPH leadership, rather than managerial role to highlight, advise, challenge and advocate.
Supported by PHE expertise and infrastructure
NHS commissioners duty to cooperate
Lead DPH to co-ordinate local authority public health input to LRF emergency planning and response
DPH challenge and advice to NHS on local screening and immunisation plans
Professional relationship between DsPH and the Chief Medical Officer
Factsheet: commissioning responsibilities

12. Population Health Advice to the NHS
Local authorities will provide population healthcare advice to the NHS
To support healthcare commissioners, including via the JSNA, with strategic population data from many sources
Applying skills to interpret data
Advice at all stages of the commissioning cycle alongside:
advice from new commissioning support organisations, which will focus on processes and clinical systems
PHE role through information and intelligence service to LAs e.g. by providing baseline data
Further work on role for supporting the NHS Commissioning Board and how this advice will meet the needs of CCGs
Factsheet: public health advice to NHS commissioners

13. PHE’s National Office
PHE’s national office will act as the service centre for the organisation and provide leadership, strategic direction and support the overall public health system.
PHE will build the current system’s centres of professional, scientific and analytical expertise with national centres of expertise and excellence.
PHE will distribute a small number of national office functions across four regions that are coterminous with the NHS Commissioning Board’s sectors and DCLG resilience hubs.
Each hub will:
Ensure PHE’s emergency preparedness, resilience and response plans are in place
Quality assure services delivered by centres
Ensure high-quality advice to the NHS commissioning board
Support transparency and accountability across the system
Offer professional support to directors of public health. 13

14. Senior Leadership Team

15. Distributed Evidence and Intelligence Teams

16. Chief Operating Officer

18. PHE centre
Develop and maintain key relationships with local government and provide professional support to enable LAs and other partners maximise health improvement of local population
Provide health protection services
Provide local NHS with public health advice, including supporting DPH in their relationship with NHS
Employment and professional development of immunisation and screening teams
Development of specialist wider PH workforce to support LAs and manage relationship with local health and education boards (LETBs)
Provide specialist PH support specialised commissioning and dental commissioning
Oversee drug and alcohol services

19. Public Health System Updates
The new public health system factsheets are available at
Sign-up to our regular Transforming Public Health bulletin
Contact the DH Public Health England transition team
Contact the DH Public Health Development Unit

21. Department of Health Health and Wellbeing Boards
Public Health England
(National and Regional)
Delivers national health promotion and prevention campaigns
Infectious diseases national overview
Child and Maternal Health Observatory (CHIMAT)
Inform regional strategic commissioning with NHSCB
Commissioning responsibilities for children, young people and maternal health services in 2013, as of 17 July 2012
National Health Service Commissioning Board
Neonatal care and Screening (ante/post natal)
Immunisation and vaccination (incl. school-based programmes)
Healthy Child Programme 0-5 years including Health Visiting and Family Nurse Partnership (transfers to Local Authorities in 2015)
Child health information service
Primary care including GP contraception
HIV/infectious diseases treatment
Health care in secure settings - Youth Offending Institutes, secure children’s homes and training centres
Community healthcare for military families
Sexual assault and referral centres
Specialised commissioning
Clinical Commissioning Groups
Maternity services
Elective hospital treatment/rehabilitative care
Emergency and urgent care
Community health services i.e. speech and language
Mental health including CAMHS, learning disabilities services
Secondary health care accessed by those in secure settings
Continuing healthcare
Wheelchair services
Local Authority (Public Health)
Healthy Child Programme 5-19 years (incl. school nurses)
National child measurement programme
Tackling obesity/increasing physical activity
Sexual health services inc teenage pregnancy
Substance misuse services (incl. alcohol)
Public mental health services
Community safety/violence prevention /accident prevention
Department of Health
Joint Working
Public Health Centres
Support partnerships locally to improve public health outcomes
Health protection services
Employ and develop immunisation and screening teams in LATs
Specialist support to dental and specialised commissioning
Oversee delivery of drug and alcohol services
NHSCB Local Area Teams (LATs)
Core functions include CCG development and assurance, quality and safety, partnerships, system oversight
Commissioning GP services, dental, pharmacy, prison health. Some LATs host specialised commissioning teams
Joint Working
Joint Working
Health and Wellbeing Boards

22. Health And Wellbeing Boards and Children, Young People and Families
Vision
“That Health and Wellbeing Boards make an effective contribution to improving health and wellbeing outcomes for children and young people”

23. Key Success Factors
Governance of HAWB should link into CYP partnership
Holistic Commissioning i.e. commissioning of NHS services for CYP must sit alongside commissioning of all services for CYP
HAWB should prioritise proven interventions
Commissioning of services should be informed by engagement of CYP, parents and families
HAWBs should focus on early intervention, within an overall “life course” approach

24. Key Strategic Questions & Challenges for HAWBs
Are there effective links between HAWB, Children’s Trust, Safeguarding Board & CCGs?
Does HAWB have an agreed process to ensure Children’s issues receive sufficient focus?
Has the HAWB contributed to defining the early help offer (as recommended by Professor Monro)?
Is HAWB really listening to views of CYP, parents and families?
Does JHWS prioritise health needs of children and describe success?
Have views of frontline staff & clinicians been factored into HAWBs planning?
Has HAWB got a clear plan to maximise use of public assets to improve health outcomes for CYP?
Is the HAWB satisfied that the common assessment framework is sufficiently embedded in the local partnership?

25. Questions?