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Public Health Reform & the Voluntary Community & Faith sector. Dominic Harrison @BWDDPH. Impact of the NHS on Life Expectancy and Infant Mortality 1900-2021?. Source: House of Commons Research Paper, 1999. 99/111 A Century of Change: Trends in UK Statistics since 1900. NHS Reform Context.

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Impact of the NHS on Life Expectancy and Infant Mortality 1900-2021?

Source: House of Commons Research Paper, 1999. 99/111

A Century of Change: Trends in UK Statistics since 1900.

nhs reform context
NHS Reform Context
  • From 1/4/13 NHS will become ‘a system not an organisation’.
  • Current Government policy is for NHS to be a commissioned ‘brand’ of health services provided to specific standards delivered by ‘plurality of providers’ who will be allowed into the ‘market’ by accreditation.
  • Specialist Public Health Services, Statutory (DPH) functions and NHS prevention spend programmes transfer to Local Government from 1/4/13.
  • Local Government will lead the Public Health transition from October ‘12– March ’13.
  • The new public health system in England will be 50% local government and 50% Public Health England.
  • Local Government Specialist PH Services must allocate 40% of its capacity to providing NHS advice (principally to CCG – detailed in MOU)

NHS(CCG, Local Government Health , Wellbeing & SC System)

(for policy, performance, commissioning, scrutiny ,accountability, governance, engagement)




Secretary of State

Is in charge of all


Public Health England (EA)

Department of Health

Sets policy for all


National Commissioning Board/PHE

Health Care Strategy & System Management


SHA Cluster (4 NCB)

Performance manages all

Spends about 20% of Local NHS Budget


PCT Cluster (50 NCB)


Health and Wellbeing Board

Holds all to account for health improvement/outcome delivery


Local Authority

Social Care Commissioning (£50m) & Public Health Commissioning (£15m from 2015)

Clinical Commissioning Group

Commissions Local NHS services Spends 75% of Local Budget

Local Authority Public Health Service

Advises all on prevention & outcome delivery – spends about 5% (current) local NHS Budget

Clinical Senate

Advises CCG

Childrens and Health Scrutiny Committee/Healthwatch/HWB

New local ‘web of Scrutiny’


Represents community to all /CQC

Regional/Lancashire & Cumbria

Commissioning Support Unit

Supports the CCG to commission


Delivering Public Sector Outcomes

Alcohol, obesity, healthy eating, physical activity, tobacco control, road traffic collisions, etc


NHS Public Health/Prevention Spend Transfer to LAs

  • tobacco control;
  • alcohol and drug misuse services;
  • obesity and community nutrition initiatives
  • increasing levels of physical activity in the local population
  • assessment and lifestyle interventions as part of the NHS Health Check Programme;
  • public mental health services;
  • dental public health services;
  • accidental injury prevention;
  • population level interventions to reduce and prevent birth defects;
  • behavioural and lifestyle campaigns to prevent cancer and long term conditions;
  • local initiatives on workplace health;
  • supporting, reviewing and challenging delivery of key public health funded and NHS delivered services such as immunisation programmes;
  • comprehensive sexual health services (this includes testing and treatment for sexually transmitted infections, contraception outside of the GP contract, termination of pregnancy, and sexual health promotion and prevention
  • local initiatives to reduce excess deaths as a result of seasonal mortality;
  • role in dealing with health protection incidents and emergencies (Annex B)
  • promotion of community safety, violence prevention and response; and
  • local initiatives to tackle social exclusion.

1:This is 11/12 budget inflation uplifted from 10/11 data. Actual 13/14 will depend on ARCA ‘formula’

2: Commissioning budget (5% current PCT commissioning spend) = £230K & SPHS =£900K


Health Outcomes Frameworks Public Health, NHS and Adult Social Care

Public Health

Adult Social Care and Public Health:

Maintaining good health

and wellbeing.

Preventing avoidable ill

health or injury, including

through reablement or

intermediate care services

and early intervention.

NHS and Public Health:

Preventing ill health

and lifestyle diseases

and tackling their


Awareness and early detection of major conditions

Adult Social Care and NHS:

Supported discharge from

NHS to social care.

Impact of reablement or

intermediate care services

on reducing repeat

emergency admissions.

Supporting carers and

involving in care planning.

Adult Social Care


ASC, NHS and Public Health:

The focus of Joint Strategic Needs Assessment: shared local

health and wellbeing issues for joint approaches.





what outcomes are the ph function delivering on post 2013
What outcomes are the PH Function: delivering on : Post 2013

Strategic Priorities (whole system) Health Improvement (CCG,BWD BC, Third Sector, Community) e.g. COPC /CCG Care Strategy

DPH Statutory duties (NHS, BwD BC, PHE) e.g. HWB Board

BWD Borough Council Corporate Plan Health Targets

£10.5m PH Prevention Service delivery targets (contributing to NHS outcome targets) e.g. sexual health

Integrated Commissioning Network Service Priority targets e.g. wellbeing /LTC Service

Public Health Outcomes Framework Targets e.g. TB control (integrated PH/Childrens/Social Care Outcome Priorities)

Health and Wellbeing Board Priority Targets e.g. child death rate

CCG MOU outcome delivery (service targets /analysis etc)

Shared BC Directorate (HIAP) targets e.g.20mph, Housing, domestic violence etc

Shared PCC targets e.g. Violence prevention


CCG / PH / Local Government Commissioning


Shared services

Local Government / Others e.g.PCC?

Local Government



integrated commissioning network joint decision making and accountability
Integrated Commissioning Network- Joint decision making and accountability

Corporate Strategy

Single Integrated Plan

Health and wellbeing strategy


Council Executive Board

CCG Board

Health and Wellbeing Board

Decision making at agreed delegated level


Chris Clayton

Harry Catherall

Joe Slater

Cllr Khan


Sally McIvor

Debbie Nixon

Dominic Harrison

Executive Joint Commissioning Group (Exec JCG)



Sally McIvor

Debbie Nixon

Dominic Harrison

Linda Clegg

Joint Commissioning and Recommendation Group (JCRG)

Joint business cases


1.ACRA’s interim recommendations would see councils in the poorest areas receiving less money than is currently spent by the NHS on these services.

2. This reduction in spending on public health services in poor areas would compound the effect of other budget cuts that have disproportionately affected these same areas- further exacerbating health inequalities.

3.The “health premium” component of the public health allocation to local authorities could further shift resources away from deprived areas than is implied by the proposed formula.

4. The use of SMR<75 in the ACRA formula does not sufficiently reflect the differences in the level of poverty between areas that are the main causes of health inequalities.

Public Health Funding Formula Risk:

Unfair, Unjust & avoidable aspects of ACRA Recommendations

Figure 1. Change in funding per head of population that would result from moving from 2010-11 baseline funding to proposed target allocation. Assumes total budget for public health services taken on by Local Authorities is £2.2 as estimated by the Department of Health.