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The Changing National Context for Health and Wellbeing

The Changing National Context for Health and Wellbeing. David Hunter. New Public Health System (1). A tale of two parts Return of public health locally to local government: Natural home or poisoned chalice? Creation of Public Health England at centre:

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The Changing National Context for Health and Wellbeing

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  1. The Changing National Context for Health and Wellbeing David Hunter

  2. New Public Health System (1) A tale of two parts • Return of public health locally to local government: • Natural home or poisoned chalice? • Creation of Public Health England at centre: • Renewed focus on public health or loss of independence?

  3. New Public Health System (2) Key drivers • ‘Centralisation has failed’ • Localism at heart of new system: principle of subsidiarity • Professional ownership and leadership • Central government focus on emergency preparedness and health protection (HPA) • More nudge, less shove • ‘Responsibility deals’: working with business

  4. Making it Happen (1) • Transfer of DsPH to local government (2013) • Health and Wellbeing Boards (early adopters) • Health and wellbeing strategy, including JSNA • Ring-fenced budgets (2013)

  5. Making it Happen (2) • ‘Health premium’ • GP consortia • Creation of Public Health England (from 2012) • NHS Commissioning Board • Public health outcomes framework

  6. Will it Ever Happen? • NHS Future Forum – pause, listen, report (by early June) • ‘cosmetic, phony, ornamental exercise’ • Post local election positioning by political parties • Bill’s fate may lie with the House of Lords

  7. Are the Public Health Changes Unravelling? • Fate of the Health and Social Care Bill hangs in the balance • Secretary of State for Health is being sidelined • Responsibility deals have not been a success to date • BMA call for public health to remain part of the NHS • FPH want PHE to be a special health authority independent from DH

  8. Known Unknowns • Changing nature of DPH role, new culture, working in a politically-led locally based organisation: elected members make decisions • Centre-local balance unclear • Managing dual accountability: to local authority, and to Secretary of State in DH • Ring-fencing: aid or barrier? • Links with GP consortia: GPs not strong on public health • Future of public health in NHS

  9. More Known Unknowns • Health and Wellbeing Boards: how effective will they be? • Balance between tackling SDH and addressing the ‘nudge’ agenda: where does Marmot figure? • Implications for NICE’s public health role: role in local government • Future of Public Health Observatories • Impact of localism and Big Society • Impact of spending cuts

  10. Unknown Unknowns • Performance management: hands-on DH (PHE) versus hands-off DCLG and DfE • Balance between must-dos and may-dos in conditions for public health grant • Local public health budget equal to or greater than the public health grant? • Resourcing of public health team beyond the DPH • New breed of DsPH - new titles, skills

  11. More Unknown Unknowns ?

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