Eugene Milne

Report
Healthy Lives, Healthy People
Better Health, Fairer Health
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Thematic similarities and differences
Mechanisms for change
Agreements & conflicts
Opportunities & threats
Credibility
Themes
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Economy, Culture, Environment
Mental health & wellbeing
Tobacco
Alcohol
Obesity, diet, physical activity
Prevention, fair & early treatment
Early life
Mature & working life
Later life
A good death
Papers to come
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Winter 2010/11
– health visitors;
– mental health; and
– tobacco control.
Spring 2011
– Public Health Responsibility Deal;
– obesity;
– physical activity;
– social marketing;
– sexual health and teenage pregnancy; and
– pandemic flu.
Autumn 2011
– health protection, emergency preparedness and response.
Also to come:
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Child Poverty Strategy (HM Government);
Drugs (HM Government);
Public Services Reform White Paper (HM Government);
Alcohol pricing and taxation (Her Majesty’s Government);
Response to the consultation Rebalancing the Licensing Act – on
empowering individuals, families and local communities to shape and
determine local licensing (Home Office);
Crime Strategy (Home Office);
Social Mobility White Paper (Cabinet Office);
Welfare White Paper (Department for Work and Pensions);
Also to come:
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Special Educational Needs and Disability Green Paper (Department for
Education);
Munroe Review of Child Protection (Department for Education);
Graham Allen Early Intervention Review (Department for Education);
Local Transport White Paper (Department for Transport);
Road Safety Strategy (Department for Transport);
Natural Environment White Paper (Department for Environment, Food and
Rural Affairs);
Sentencing and Rehabilitation Green Paper (Ministry of Justice);
Skills Strategy (Department for Business, Innovation and Skills).
Thematic differences
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Includes a focus on:
– Health protection issues
– Drugs
– Sexual health
Does not include:
– Emphasis on regional policies (notably economic)
– Emphasis on environments as shapers of choice – far more
focused on individual choice
– Role of the NHS
Differences relate more strongly to
– the philosophy of strategy
– mechanisms of influence
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
Research
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NIHR will continue to take responsibility for the commissioning of public
health research on behalf of the Department of Health, working with
partners whose actions affect public health. Public Health England will
work closely with the NIHR in identifying research priorities. To further
develop public health research the Department will:
– establish an NIHR School for Public Health Research – conducting
high-quality research to increase the evidence base for effective public
health practice. This school will draw on leading academic centres with
excellence in applied public health research and evaluations and place
emphasis on what works practically and can be applied across the
whole country;
– continue to promote a public health focus within the NIHR and fund,
from within the Department’s Policy Research Programme, a new
Policy Research Unit on Behaviour and Health; and
– ensure that Public Health England provides the necessary resource to
support the cost of public health interventions that are undergoing
research outside of the NHS.
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
Social marketing
• Central government will sequence social marketing for
public health through the life course so that, at each stage in
a person’s life, there is a meaningful and trusted voice. We
will also scale back the number of brands that we support.
We will trial new ways of changing behaviours, using
emerging ideas from behavioural science, such as the use
of social norms, changing defaults and providing incentives.
We will publish a social marketing strategy, setting out our
plans in more detail, in spring 2011.
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity – the BIG SOCIETY?
Governance
Mechanisms
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Policies and planning
Research and development, analysis
Advertising and social marketing
Service redesign & funding
Performance management of services
Lobbying activity
Governance
North East Public Health Board
RDPH / Executive DsPH
Regional Office of Public Health
(& SHA Medical Directorate)
Steering groups
10 Themes
Conference of public
health practitioners
Commissioning and delivery of
public health functions
Regional Public Health Delivery (PCTs, LAAs etc)
Social Marketing Collaborative NE
Lobbying functions
FRESH, OSCA, etc.
Research & Development
Public Health Centre of Research Excellence
PHINE PHO
Teaching & learning, Workforce planning,
Specialist training
Regional Advisory
Groups
Policy
Advisory & scrutiny
Strategy
Effector
Governance
• Existing structures are not fit for purpose since:
– They reflect a system that includes a regional
administrative tier
– Support for RAGs cannot be sustained under existing
arrangements
– RAGs cannot advise an RDPH if there is none
• However:
– Some things will continue to be done better and more
efficiently at a supra-district level
Agreements
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Life course approach
Shift of emphasis away from the NHS
Ring fenced (identifiable) budgets
Focus on evidence
Cross-sectoral and upstream emphasis
Importance of well-being and autonomy
Marmot support
Many specifics (key drivers of ill-health and inequalities)
“Nudge” thinking echoes what we have been doing
Nudge
Compulsion
De-normalisation
Conflicts
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No regional working
Civil service ethos?
Avoidance of regulation
Potentially excessive trust in choice and markets
Much looser on performance
Opportunities
• Genuine upstream opportunities
• Closer positioning should allow greater influence on key
effectors in local policy
• Ring-fenced budgets (double-edged)
• Continued focus on inequality and child poverty
Threats
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Loss of NHS influence
Agenda dominated by NHS change
Loss of population perspective in favour of individualism
Austerity – threat to public and third sectors
Downgrading of public health as a specialty
Loss of staff / lack of skills / damaged morale
Incoherence
Bad decisions
Credibility of policy
Credibility
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Radicalism is essentially structural rather than content-related
Excess winter deaths
– “The Warm Front scheme will also continue until
2012/13, providing grants to improve housing warmth
and sustainability” White Paper Nov 30th 2010
– “Warm Front payments suspended” Daily Telegraph
Dec 15th 2010
“There are also some activities that it makes sense to do once at
national level rather than repeat many times over at local level” –
paragraph 2.26
Inclined to dress political choices (health visitor numbers, Olympic
‘legacy’, convenience store roll-out etc) as responses to evidence
Credibility
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Uses theoretical structures that are not in accepted use
Weak on the role of the NHS
Central management of policy
Equivocation on point of sale advertising
Closeness to industry (e.g. Knighthood for the CE of British
American Tobacco, closeness of some senior ministers to
tobacco and alcohol)
• Cessation of NICE programs / shelving of evaluations:
Removed from the work programme:
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Preventing unintentional road injuries among under 15s: education and
protective equipment
Preventing unintentional road injuries among young people aged 15 to 24
Spatial planning for health: local authorities and primary care trusts
Tobacco - how PCTs and local authorities can combat markets in illicit
products
Tobacco - how retailers can provide information and support when selling
nicotine replacement products over the counter
Tobacco - how commissioners and providers can develop and implement
policies on smoke-free homes, cars and other vehicles
Suspended:
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Social and emotional wellbeing of vulnerable pre-school children - homebased interventions; and:
Social and emotional wellbeing of vulnerable pre-school children - early
education and childcare (To be combined and reviewed once the Prime
Minister's taskforce on early interventions has reported.)
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Contraceptive services for socially disadvantaged young people; and:
Personal, social, health and economic education focusing on sex and
relationships and alcohol education (To be reviewed following the
publication of the White Papers on Public Health and Schools)
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Preventing obesity using a ‘whole-systems' approach at local and
community level (to be reviewed as part of the obesity strategy / work
programme.)
Under review:
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Increasing fruit and vegetable provision for disadvantaged communities
Identification and management of overweight and obese children in primary
care
Preventing domestic violence: guidance for the police, social services and
the NHS
Reducing infant mortality among children born to women aged under 20
and living in disadvantaged circumstances
Developing transport policies that prioritise walking and cycling
Using the media to promote healthy eating: guidance for policy makers,
food retailers and the media
Identification and weight management for overweight and obese children:
community based interventions
Tobacco - smoking cessation services provided by NHS secondary care
providers for patients with long-term and chronic conditions in hospital and
the community
Confirmed:
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Skin cancer prevention: information, resources and environmental changes
Increasing the uptake of HIV testing among black Africans in England
Increasing the uptake of HIV testing among men who have sex with men
Type 2 diabetes - preventing pre-diabetes among adults in high-risk groups
Type 2 diabetes - preventing the progression from pre-diabetes among
adults in high risk groups
Identifying and managing tuberculosis in hard to reach groups
Hepatitis B and C: ways to promote and offer testing to people at risk of
infection
Tobacco - harm reduction approaches to smoking cessation for PCTs and
NHS Stop Smoking Services
Tobacco - commissioning and providing smoking cessation services for
people using smokeless tobacco
Conclusion
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Many overlaps with content of BHFH
Sustaining focus will be difficult
Who will own and support infrastructure?
Financial arrangements
National policy in practice may differ from
what is being anticipated

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