Agenda item

Further to Minute No. 62 of December, 2010, the Policy and Scrutiny Officer submitted the key proposals and consultation questions which the Government were seeking views on by 31^st March, 2011.

 

The proposals included:-

 

-        Establishing a new body – Public Health England – within the Department of Health to protect and improve the public’s health

-        Responsibility for Public Health would transfer to local Councils from 2013  Directors of Public Health would be jointly appointed by the local authority

-        Public Health England and work within the local authority

-        Establishing Health and Wellbeing Boards to decide upon local public health priorities

-        Using a ‘ladder of interventions’ to determine what action needed to be taken to address different public health needs

-        Funding for public health work would be ringfenced and areas with the poorest health would receive extra funding

-        Commissioning of public health activity would be the responsibility of Public Health England through directly commissioning certain services directly, asking the NHS Commissioning Board to commission Public Health Services and the provision of the ringfenced budgets for public health to local authorities

-        GPs, community pharmacies and dentists would be expected to play a bigger role in preventing ill health

-        A new Outcomes Framework would be produced against which progress on key public health issues would be measured

 

A powerpoint presentation was given to help the Panel in their deliberations as follows:-

 

·        Government was consulting on the Public Health White Paper

·        Deadline for which was 31st March, 2011

·        Follows consultation which has already taken place on the NHS White Paper – which RMBC responded to

 

·        3 parts to consultation:

• Consultation questions referring to main white paper
• 2 supporting documents:

–        Commissioning and Funding for Public Health

–        New Public Health Outcomes Framework

 

·        Consultation Questions

§         The Department. of Health would work to strengthen the Public Health role of GPs by:

–        Public Health England (PHE) and NHSCB to work together to encourage GPs in their Public Health role

–        Incentives and drivers for GP-led activity concerning Public Health

–        PHE to strengthen the focus of Public Health issues in the education and training of GPs

 

Question a:  Are there additional ways in which we can ensure that GPs and GP practices will continue to play a key role in areas for which Public Health England will take responsibility?

 

§         PHE will promote information-led PH interventions

§         PHE will draw together existing complex information and intelligence performed by multiple organisations into a coherent form for ease of access

§         The National Institute of Health Research will continue to take responsibility for PH research on behalf of DH

 

Question b: What are the best opportunities to develop and enhance the availability, accessibility and utility of Public Health information and intelligence?

Question c: How can Public Health England address current gaps such as using the insights of behavioural science, tackling wider determinants of health, achieving cost effectiveness and tackling inequalities?

Question d: What can wider partners nationally and locally contribute to improving the use of evidence in public health?

 

§         A detailed workforce strategy will be developed late 2011

§         The DH will encourage PCTs and local government to discuss future shape of PH locally

§         DH also publishing review of the regulation of PH professionals – they believe statutory regulation should be a last resort, preferred approach is to ensure effective voluntary regulation for any unregulated PH professionals

 

Question e: We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary regulation for public health specialists?

 

·        Funding & Commissioning

16 questions relating to how PH is to be funded and services commissioned, key points to consider:

 

§         Ring-fenced PH budgets allocated to LAs by PHE

§         Will include Health Premium for authorities with greatest deprivation and inequalities

§         PH budget will not include functions which are already carried out by LAs such as housing, leisure, social care

§         HWB can pool other budgets as required

§         Shadow PH allocated to be provided April 2012

§         Local authorities and GP consortia will have equal obligation to prepare the JSNA through the HWB

§         HWB to develop local HW Strategy, based on the JSNA

§         Commissioners to have regard to the JSNA and HW Strategy

§         Ring-fenced budget to give opportunities for local government to involve new partners when contracting for services

 

·        Outcomes Framework

12 questions relating to the proposed new Outcomes Framework, key points to consider:

 

§         The framework will be co-produced and nationally applicable without the Government dictating what is contained in the data set

§         There will be  a need to reflect the breadth of contributions from all partners

§         Public Health, NHS and Adult Social Care frameworks will all align with key areas of overlap where services share an interest

§         The framework will:

–        Use indicators which are meaningful to communities

–        Focus on major causes and impacts of health inequality

–        Take on a life-course approach

–        Use data collected and analysed nationally to reduce burden on LAs

 

• Will include 5 domains:

–        Health protection and resilience

–        Tackling wider determinants of health

–        Health improvement

–        Prevention of ill health

–        Healthy life expectancy and preventable mortality

 

Discussion ensued on the report with the following issues raised/clarified by the Policy and Scrutiny Officer and Director of Public Health:-

 

-        It was essential that the GP Consortia recognised that it was responsible for health services as well as commissioning.  Part of the proposals in both White Papers were that part of the payments to GPs in terms of the Quality Outcomes Framework would be based on the basis of some of the services they provided.  Previously 20% of the payments were based on Public Health initiatives such as prevention of heart disease, screening for diabetes etc. at GP practice level

 

-        The Government had stated its intention to market health so there would be an onus on those bodies commissioning services to comply with European Legislation and competition from the private sector

 

-        With regard to voluntary registration, there were a large number of people working in Public Health that had a Public Health qualification as currently recognised.  It was how those working in other aspects of Public Health were brought together under the “Public Health family” in terms of qualifications and standards in relation to practice.  An example was Environmental Health Officers who were qualified in their own right and within their field may have specialism in Food Standards.  They would come under Public Health.  There were also Town Planners etc., professionals who took into account the health impact when submitting proposals for Council decision

 

-        The Outcomes Framework would be a number of Indicators like Teenage Pregnancy rates, death rates etc. that the local authority’s performance would be judged against.  The Government was not stating that an authority had to reach a set target but that it had to make progress against the Framework and if it did it would get a reward in the form of “Health Premium”

 

-        In terms of the competition, it did not necessarily mean the cheapest option.  The specification around service had to be right so that it provided both quality and value for money in terms of the service commissioned on behalf of the people of Rotherham

 

-        If a contract went wrong and it was part of Public Health it would fall to the Council; if it was health services it would be the GP Consortia

 

-        The basis for the public health science at a local level was to understand the pattern of disease locally and then apply the measures to prevent those illnesses and diseases.  Together with the information from the census it would be essential to understand which communities suffered most, what the problems were and how,  under the new system, the Health and Wellbeing Board designed those services to meet those needs

 

-        The financial impact of the new regime on councils was not known as yet.  There would be a small amount of funding for Public Health divided out between the local authorities although the basis for the division had not been decided as yet.  The bulk of the funding would be with the GPs so there was a need to work with the GPs to promote Public Health and secure the best deal possible

 

Victoria Farnsworth read out the following statement:-  “Speak Up has developed the training package “My Health”.  I hope the GPs Consortia will continue to commission it.  We train over 500 health workers last year across Rotherham and Sheffield to train health carers and workers to communicate better with people with learning disabilities and remind them that people with learning disabilities and other vulnerable people should be treated with dignity and respect.  This training is also assisting professionals fulfil their obligations under the Equality Act.”

 

Resolved:-  (1)  That a copy of the questions be circulated to Panel Members for consideration.

 

(2)  That Panel Member feed any comments they wish to be incorporated into the response to the Scrutiny Office by 18^th February, 2011.

 

(3)  That the report and Panel comments be submitted to the 25^th February, 2011, meeting of the Performance and Scrutiny Overview Committee.