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Healthy Lives, Healthy People Consultation - closes 8th March 2011

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kevin
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Dr Gabriel Scally, Regional Director of Public Health for the South West, has prepared a report on the issue of professional regulation within public health on behalf of the Chief Medical Officers in England, Scotland, Wales and Northern Ireland.

The White Paper Healthy lives, healthy people invites views on the report, and asks a specific consultation question on this report.

 

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publicati...<

http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm<

http://consultations.dh.gov.uk/healthy-people/healthy-people/consult_view<

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Local authorities are to be given freedom to spend public health budgets transferred from the NHS, under the government's public health White Paper<, published today.

The document promised that local authorities would be able to set their own priorities for public health spending, when they take over responsibility for this area from primary care trusts from April 2013.

The White Paper said councils were best placed to tackle the health challenges their areas faced in areas such as drugs, alcohol, sexual health and obesity. It added: "We will keep to a minimum the constraints as to how local government decides to fulfil its public health role and spend its new budget."

However, the scope to divert public health budgets into other areas such as preventative social care will be limited by a requirement for councils to fund some services such as open access sexual health provision and immunisations.

Councils will also be paid for their results in improving health outcomes against a new performance framework, through a health premium. This will form part of their budget and will be initially distributed purely on the basis of health need, in order to tackle health inequalities, before a payment by outcomes element is introduced.

The money for public health is expected to total over £4bn nationally, but some of this will be retained by a new national agency, Public Health England, within the Department of Health, which will commission and provide some services directly.

Public Health England will also jointly appoint local directors of public health, who will lead local strategies to improve health outcomes.

It will also take over the functions of the National Treatment Agency for Substance Misuse and the Health Protection Agency, which will both be abolished.

Health secretary Andrew Lansley said: "With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation's health."

The NHS Confederation welcomed the transfer of public health responsibility to local authorities from PCTs, which will be abolished in 2013 with their health commissioning functions transferred to new GP consortia.

"Moving public health to local authorities should have many benefits as councils have greater potential to impact on the causes of ill health," said acting chief executive Nigel Edwards.

However, he said that the implementation would need to be got right "otherwise a good idea can do more harm than good".

Others also raised concerns. Deborah Jack, chief executive of the National Aids Trust, said: "A ring-fenced budget could protect funds for HIV prevention, but we need local authorities to be up-skilled quickly and effectively in their new responsibilities. This is especially important given the proposal they also commission open-access sexual health services, which will be a completely new role for them."

Related articles

Demise of primary care trusts stalls personal health budgets<

Council cuts will damage social care, warn doctors' leaders<

http://www.communitycare.co.uk/Articles/2010/11/30/115922/councils-promi...<

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White Paper brings welcome focus on public health - success on HIV will be a key test

 

On the day before World AIDS Day, the Government has published its Public Health White Paper 'Healthy Lives, Healthy People'.

The latest figures on HIV from the Health Protection Agency (HPA)< have shown what a long way there is to go in diagnosing HIV early and reducing the number of new HIV infections in the UK.  A new focus from the Government on public health is therefore welcome and could mean a step in the right direction in addressing HIV in the UK. 

NAT< welcomes the ring-fenced protection for public health funding and we are pleased to see an acknowledgment within the White Paper that increasing rates of STI transmission and the level of late diagnosed HIV are matters for serious concern.

A more detailed paper on sexual health will be published by the Government in spring 2011.

Deborah Jack, Chief Executive of NAT (National AIDS Trust)<, comments:

'Significant changes are proposed to public health in this White Paper.  A ring-fenced budget could protect funds for HIV prevention, but we need local authorities to be up-skilled quickly and effectively in their new responsibilities.  This is especially important given the proposal they also commission open-access sexual health services, which will be a completely new role for them.

NAT< is concerned that there are still unanswered questions about who will be responsible for commissioning HIV prevention and testing outside sexual health clinics - an essential element in an effective response. A national public health outcomes framework will be important to ensure consistency of standards across the country and it is essential some of these outcomes specifically relate to HIV.

‘The White Paper should be seen as an exciting opportunity to do more public health and to do it better – and for all of society to be involved.  Over the next year, as we debate the details of implementation, we need commitment to these changes delivering measurable improvements.  And crucially, this includes reducing late HIV diagnoses and new HIV infections.'

- Ends -

Notes to the editor:

 

The full report ‘Healthy lives, healthy people’ can be found here:
http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm<
  

The full report from the HPA can be found here:
http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1287145264558<

http://www.nat.org.uk/News-and-Media/Press-Releases/2010/November/Public%20Health%20White%20Paper%20response.aspx<

kevin
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Council leaders have slammed yesterday's public health White Paper< for centralising control, despite it purporting to empower councils.

The White Paper transfers responsibility for local provision from primary care trusts to local authorities, along with a budget that the government insists councils will have freedom to use as they like, even though it is ring-fenced for public health.

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However, the Local Government Association warned that the White Paper represented a "swing to central control" of public health through the creation of Public Health England.

The new agency will jointly appoint directors of public health with councils, fund local authorities and provide or commission some public health services.

"This White Paper states it is time to free up local government and local communities to decide how best to improve the health and well-being of their citizens, but it doesn't go far enough and leaves many questions unanswered," said an LGA spokesperson. "Behind the language of greater freedom lies a swing to central control which risks hampering town hall efforts to boost health.

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"With Public Health England employing the majority of the public health workforce, how can we make sure local and national needs work hand in hand? How can we answer to government when the people leading on public health don't answer to us? Public Health Directors must be accountable to councils."

But the Association of Directors of Adult Social Services was more positive. President Richard Jones said it "begins to make a reality of the idea of localism".

However, he called for more clarity over how much of the estimated £4bn annual public health budget would be retained by Public Health England and how much devolved to councils.

"We'd like to see as much as possible devolved locally," he said.

Trade union Unite raised concerns that councils would not be able to cope with their new responsibilities.

"How are local authorities, facing cuts of 28% over the next four years, meant to cope with this added massive layer of responsibility? They are already creaking at the seams," said Karen Reay, Unite's national officer for health.

http://www.communitycare.co.uk/Articles/2010/12/01/115923/LGA-slams-publ...<

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kevin
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Secretary of State for Health, Andrew Lansley, made a statement to the House of Commons on Tuesday 30 November on the publication of the Government's White Paper on public health.

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Oral statements

Oral statements are made after Question Time (or at 11am on a Friday). Statements usually relate to matters of policy or government actions.

At the end of a statement, MPs can respond or question the government minister on its contents.

http://www.parliament.uk/business/news/2010/December/statement-on-public...<

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'Healthy Lives, Healthy People: Our strategy for public health in England' (NHS Chief Executives)

The Secretary of State for Health has written to NHS Chief Executives following today's publication of the Government White Paper on public health - 'Healthy Lives, Healthy People: Our strategy for public health in England

Healthy lives, healthy people: our strategy for public health in England

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http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/De...<

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kevin
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Mental health services in England can enhance care and save hundreds of millions of pounds a year through measures including cutting unnecessary hospital bed use and out-of-area placements, research has found.

However, such productivity improvements could be put at risk by the government's reforms to the NHS and a lack of joint working, the report by think-tank the King's Fund and charity the Centre for Mental Health said.

The study examined how mental health, which accounts for about 10% of the NHS's £100bn annual budget in England, could contribute to the government's target of making £20bn in annual efficiency savings by 2015.

Report author Chris Naylor, senior researcher at the King's Fund, said it would be "challenging" for mental health to achieve a £2bn a year productivity gain, in line with its share of the budget, but said it could get a "substantial way there" by taking the measures outlined in the report.

The report estimated up to £200m a year could be saved by cutting unnecessary use of acute psychiatric beds given the current variations in admission rates and average lengths of stay on inpatient wards between mental health trusts with similar populations. This would require improvements to crisis resolution and home treatment (CRHT) teams, which have been set up to support people who are in crisis at home, but have been found to be under-performing in some areas.

Up to half of the 10,000 out-of-area placements in psychiatric hospitals could be avoided, saving £65m a year, through investment in local residential services and supported acommodation, the research found.

The report also suggested that more than £300m a year could be saved for the NHS by improving mental health support for older people with dementia in general hospitals, facilitating earlier discharge, through mental health liaison teams in hospitals and specialist older people's CRHT teams.

Other areas set out for savings include reforming secure services - the biggest slice of mental health expenditure at almost £1bn a year - by reducing unnecessary admissions, increasing workforce productivity by reducing sickness absence and providing effective employment support to clients.

However, the report warned that the abolition of PCTs by 2013 and their replacement as health commissioners by new GP consortia could detract from efforts to improve mental health productivity. It also highlighted a survey by the charity Rethink that found most GPs did not feel equipped to commission mental health services<.

Naylor said consortia would need support to commission mental health, including from councils and regional officials from the new national NHS commissioning board, adding: "GP consortia on their own will really struggle to meet these challenges." Other issues raised by the report included the fact that in some of its examples of improved productivity, spending by one body would result in savings in other organisations' budgets. Naylor said tackling this would require pooled budgets, but warned: "Pooling budgets can be a fiendishly complicated process on the ground."

Related articles

Council risks rift with mental health trust over cuts<

http://www.communitycare.co.uk/Articles/2010/12/02/115927/nhs-reforms-co...<

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Health organisations – and the Labour party – have given the government's white paper 'Healthy Lives, Healthy People' a mixed reaction, as could be expected.

When launching the white paper, Lansley said: "Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health. People's health and wellbeing will be at the heart of everything local councils do. It's nonsense to think that health can be tackled on its own. Directors of Public Health will be able to champion local cooperation so that health issues are considered alongside housing, transport, and education."

The NHS Alliance welcomed the paper and said it was looking forward to working with the Department of Health on developing the proposals that it contained.

Chair Dr Michael Dixon said: "This thought-provoking document rightly states that the determinants of health are far wider then healthcare, and include housing, transport and the local economy. It rightly outlines the significant public health challenges we must meet if the NHS is to remain affordable and free at the point of use."

He went on: "The move to put local government into a driving seat on public health directly employing directors of public health could prove very effective, as many determinants of health are within their remit. [But] it will be crucial to develop clear and effective two-way means of communication between local authorities, GP commissioning consortia and the local knowledge of the whole primary care team."

Dixon concluded: "The idea of a meaningfully integrated approach to health at national level, policy-wise, is really quite novel, and one that we regard very positively."

The Work Foundation called for more detail on how the government plans to work "in partnership" with so many different agencies, not least employers.

Associate director-policy Stephen Overell said: "Public health is not just a health service problem so the emphasis on sharing responsibility and making local government the key players in the system should help to de-medicalise the issue. But local government is facing deep budget cuts and undergoing considerable organisational turmoil so introducing this reform by 2013 is ambitious.

"The government has rightly highlighted the value of having work and the high costs attached to mental ill-health and stress in terms of absence: these are big moves forward in terms of enhancing public health. Beyond initiatives such as Fit for Work, it would be good to see more emphasis on how work and work organisation can support public wellbeing policy and how occupational health can be enhanced."

Responding to reports that Oliver Letwin had been given the role of scrutinising Andrew Lansley's plans for NHS reorganisation, the shadow Health Secretary John Healey said this revealed "just how isolated the Health Secretary has become".

He added: "The Tories trusted Andrew Lansley to be their 'Mr NHS' and stop health policy becoming a toxic issue. Instead, he's led the government into a barrage of concern from patients, doctors and health experts and broken the Prime Minister's pledge on no more top down reorganisations.

"The Prime Minister needs answers from the Health Secretary. How can he justify spending £3bn reorganising the NHS at a time of financial pressure? What safeguards are there against the changes leading to a two-tier NHS? Why have these plans failed to bring front-line professionals with them? How will proper control and public accountability be exercised with £80bn of taxpayers' money a year in the hands of GPs?"

http://www.publicservice.co.uk/news_story.asp?id=14910<

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kevin
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Responding to the Public Health White Paper published today by the Department of Health, Sir Richard Thompson, president of the Royal College of Physicians said:

‘The white paper gives a clear overview of how this government plans to improve public health, and is to be welcomed for attempting to bring to the field a much needed strategic focus and coherence. However, the RCP is disappointed by the lack of detail, especially around how to deal with the threats posed by alcohol misuse, obesity and smoking. We wait keenly to see if the promised subsequent strategies will fill in the gaps.’

On the new public health service (PHS)

‘The RCP welcomes the government’s proposals to put public health on a more secure footing. Long term, the future of the NHS can only be guaranteed if we become more effective at preventing ill health. A ring fenced budget, robust workforce development plans and a challenging outcomes framework will do much to change perceptions of public health, and greatly increase the capacity of its workforce to make a difference. However public health is highly contingent on external factors. A difficult economy and less money for public services will make it a more challenging environment both in terms of managing the inevitably greater demand for public health programmes, and then in leveraging whatever community resources remain to meet them.

On minimal interventions where appropriate:

‘We agree that if they achieve good results it makes sense to adopt less burdensome regulations where possible. However, on a whole raft of issues it has been clearly demonstrated that a laissez faire attitude does not work, either in terms of promoting responsible behaviour among the manufacturers and retailers of potentially harmful products or in creating an environment that would allow individuals to make healthier choices.

It took the last government at least six years to recognise this and then gather the political courage to start tackling some of the deeper seated problems with robust, population wide, policies.  It would be a great shame if the new government were to take just as long to reach similar conclusions, whilst in the interim more people become ill.’

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Notes:

For a comprehensive overview of the RCP’s policy priorities, see Leading for Quality.

http://pressrelease.rcplondon.ac.uk/Archive/2010/RCP-responds-to-public-...

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kevin
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London Councils briefing on 'Healthy Lives, Healthy People' - public health strategy.

'Healthy Lives, Healthy People: Our Strategy for Public Health in England' was published on 30 November 2010 by the Department of Health.

This consultation paper sets out a new approach to the way public health is to be tackled in the future to improve health outcomes. The government aims to give responsibility to individuals to make their own choices and encourage local communities to get involved to improve health and well being in their areas. Local government is placed at the heart of these proposals along with dedicated funding to support this work. The government will take forward these proposals as part of a Health and Social Care Bill to be introduced next year. This paper contains a summary of the key points.

London Councils welcomes many of the proposed changes, including the transfer of overall responsibility for public health improvement from the NHS back to local authorities. London boroughs are already working to improve public health across the capital, and believes that local authorities are ideally placed to provide the oversight and strategic direction needed to drive different areas of health improvement.

The full briefing and related pages including the London Councils press release are available here<.:

https://www.londoncareplacements.gov.uk/?q=node/1606<

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Equity and Excellence: Liberating the NHS - Managing the Transition

NHS Chief Executive Sir David Nicholson has written to the chief executive community giving an update on transition arrangements with a particular focus on the new commissioning system and providing answers to some frequently asked questions on the Health and Social Care Bill.

Letter from Sir David Nicholson, NHS Chief Executive.

 

http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/De...<

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kevin
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It would be "appallingly unethical" if NHS reforms meant that GPs could get bonuses for delaying patients treatment, said British Medical Association head Dr Laurence Buckman.

Referring to proposals that would reward doctors for shunting expensive procedures into the next financial year to keep expenditure down, and penalise them if they don't appear to be managing their budgets effectively, Buckman said it would be wrong for GPs to deny patients treatment then get a bonus under the 'quality premium' scheme.

He reckoned that the bonus scheme would mean that the only way GPs could continue to be paid at their current level would be to show how much money they had saved the NHS and the only way to do that would be to cut back on spending on treatments.

Buckman told the BBC: "We don't understand what the 'quality premium' means. We don't understand where it will come from. We rather fear it will come out of our pay and be paid back to us if we do certain things. It appears that what we might actually be asked to do is to save money and if we save a certain amount of money we will receive some of our pay given back to us. That is something that is appallingly unethical.

"I don't believe that I should be saying to a patient 'you can't have treatment because that way I'll get paid'. I don't think any patient would sit down with me and have in their head the thought that I would only be being paid by withdrawing treatment from them. I'm not prepared to do that ... I'm not prepared to ... receive pay … on the basis that I withdraw treatment from a patient. That is disgracefully unethical and most GPs will have nothing to do with that."

However, health minister Paul Burstow said Buckman's comments were "a caricature, a gross distortion of what we are trying to do".

Burstow added: "What GP commissioning consortia will be rewarded for is improving survival rates, improving quality of care given to their patients. If the BMA haven't understood that at this stage then we clearly need to talk to them further."

http://www.publicservice.co.uk/news_story.asp?id=15634<

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