School of Medicine & Health Update on Emerging Policy Changes: what they mean for health and wellbeing David Hunter.

School of Medicine & Health

Update on Emerging Policy Update on Emerging Policy Changes: what they mean Changes: what they mean for health and wellbeingfor health and wellbeing

David HunterDavid Hunter


Continuing Policy ChurnContinuing Policy Churn

Policy and organisational landscape is Policy and organisational landscape is unstable, unclear and complicatedunstable, unclear and complicated

Fate of Health and Social Care Bill still Fate of Health and Social Care Bill still unknownunknown

Bill has survived House of Commons but risks Bill has survived House of Commons but risks being rejected by House of Lordsbeing rejected by House of Lords

Public health changes - little progress, great Public health changes - little progress, great uncertainty stilluncertainty still


Recent Key DevelopmentsRecent Key Developments22ndnd white paper – white paper – Health lives, Healthy People: Update and way forwardHealth lives, Healthy People: Update and way forward (July 2011)(July 2011)

Roger Boyle’s departure from DH (July 2011)Roger Boyle’s departure from DH (July 2011)

22ndnd phase of NHS Future Forum (August 2011) phase of NHS Future Forum (August 2011)

38 Degrees – independent legal assessment of Health and Social Care 38 Degrees – independent legal assessment of Health and Social Care Bill (August 2011) Bill (August 2011)

Growing opposition from BMA, RCGP, RCN and members of House of Growing opposition from BMA, RCGP, RCN and members of House of Lords (August/September 2011)Lords (August/September 2011)

Report stage of amended Health and Social Care Bill (September 2011)Report stage of amended Health and Social Care Bill (September 2011)

Health and Social Care Bill passed by House of Commons (September Health and Social Care Bill passed by House of Commons (September 2011) with a majority of 65; enters Lords in October2011) with a majority of 65; enters Lords in October


The Second White Paper: The Second White Paper: Highlights (1)Highlights (1)

Bold, exciting vision for local authoritiesBold, exciting vision for local authorities

LA role across 3 domains: health protection, LA role across 3 domains: health protection, health improvement, health service health improvement, health service improvementimprovement

PHE to be established as an Executive PHE to be established as an Executive Agency of DH Agency of DH

PHE to support local action, including ‘having PHE to support local action, including ‘having a local presence’a local presence’


The Second White Paper: The Second White Paper: Highlights (2)Highlights (2)

DsPH employed by LAs but joint DsPH employed by LAs but joint appointment with PHEappointment with PHE

Expectation that DPH will be directly Expectation that DPH will be directly accountable to local authority CEOaccountable to local authority CEO

‘‘Core public health’ offer from LAs to NHSCore public health’ offer from LAs to NHS

Reaffirmation of clear line of sight from Reaffirmation of clear line of sight from SoS down to frontline re health protectionSoS down to frontline re health protection


Work in Progress: Unresolved Work in Progress: Unresolved IssuesIssues

Relationship between LAs and PHE: the Relationship between LAs and PHE: the makings of central-local tension?makings of central-local tension?

Public health funding: little progress so farPublic health funding: little progress so far

Health premium: not generally welcomed Health premium: not generally welcomed

Public health outcomes frameworkPublic health outcomes framework

Workforce – risk of becoming Workforce – risk of becoming fractured and ending single fractured and ending single multidisciplinary composition; uncertainty multidisciplinary composition; uncertainty about registration of specialistsabout registration of specialists


NHS Future Forum: Second NHS Future Forum: Second PhasePhase

Four workstreamsFour workstreams

Public health (focus on NHS involvement)Public health (focus on NHS involvement)

InformationInformation

Education and trainingEducation and training

IntegrationIntegration


Coming Soon…Coming Soon…Party conferences season - more criticism Party conferences season - more criticism of health changes (September)of health changes (September)

Fate of Health and Social Care Bill in Fate of Health and Social Care Bill in Lords (October)Lords (October)

Report on Public Health Inquiry by House Report on Public Health Inquiry by House of Commons Health Committee of Commons Health Committee (October/November)(October/November)

Responses to consultation on public Responses to consultation on public health white paper published in November health white paper published in November 2010 (anytime)2010 (anytime)


Known Unknowns (1)Known Unknowns (1)Will the Bill be passed by Lords or be Will the Bill be passed by Lords or be delayed?delayed?

Does the fate of the Bill matter - is it Does the fate of the Bill matter - is it necessary for what the government seeks necessary for what the government seeks to do?to do?

Ring-fenced funding for public health - Ring-fenced funding for public health - what is it to be?what is it to be?

Accountability of DsPH - to LA CEOs or Accountability of DsPH - to LA CEOs or others? Who decides?others? Who decides?


Known Unknowns (2)Known Unknowns (2)

Will Health & Wellbeing Boards be different from Will Health & Wellbeing Boards be different from previous partnerships? previous partnerships?

What is to be the future of public health in the What is to be the future of public health in the NHS?NHS?

Will the public health workforce remain unified?Will the public health workforce remain unified?

Will the changes work?Will the changes work?

Do they increase bureaucracy and transaction Do they increase bureaucracy and transaction costs?costs?

How ready are local authorities to take on public How ready are local authorities to take on public health?health?


Public Health Leadership in Public Health Leadership in England is FailingEngland is Failing

There was a time when public health in England was driven by passionately articulated values and compelling research, a time when its leaders were concerned about social reform and political change....Yet today's leaders in public health prefer to collude with a mendacious government and preside over the decimation of public health in the NHS.

Richard Horton, editor, The Lancet, 378: 1060, 17 September 2011-09-23


Why?Why?

Public health has become 'unconsciously Public health has become 'unconsciously anti-science’anti-science’

Public health leaders are taking part in ‘an Public health leaders are taking part in ‘an utterly corrupt' responsibility dealutterly corrupt' responsibility deal

Public health leaders spend too much time Public health leaders spend too much time looking inwards ignoring future challengeslooking inwards ignoring future challenges

School of Medicine & Health Update on Emerging Policy Changes: what they mean for health and wellbeing David Hunter.

Documents

health protection

health improvement

health premium

future of public health

public health workforce

public health funding

public health inquiry

school of medicine health