The LGA has been working with the Department to bring together the key national organisations whose members and delivery organisations will be operating in the new locally-led health environment, including Public Health England, the NHS Confederation, the NHS Commissioning Board, the Association of Directors of Public Health and Healthwatch England. Together they will develop an offer of support for the members and organisations involved in local health and wellbeing boards, local government, and local Healthwatch to create an environment within which boards can provide the best possible support for their local communities.

Building on the work of the National Learning Network for health and wellbeing boards, the offer is anticipated to continue supporting boards in 2013-14 by:

• Establishing a single information hub, supported by several organisations, which local health agencies and their partners can tap into for support and learning
• Utilising the existing sector-led improvement tools, such as peer challenge, to help HWBs reflect on their approaches and improve them for the benefit of local people
• Delivering tailored support for clinical commissioning groups
• Producing a revised version of the self-assessment framework for boards to access
• Providing a regionally based support offer including local chairs’ networks and bespoke support
• Delivering a national event to bring together board members to share learning and experiences.

The overall aim of this offer of support is to continue to work with boards and local health agencies and help them identify and make positive and transformational changes to local health services.

Outgoing National Director for Health and Wellbeing Board Implementation, Joyce Redfearn said:

“The LGA’s new role symbolises a strong partnership that’s already in place. We want the support to be responsive to the needs of the 152 boards who will make the real difference to their local areas.

“There’s a huge amount of learning already in the system and we want to make sure that we’re linking people to the right knowledge, understanding and expertise. This involves mirroring at a national level the kind of partnership working that’s going to be essential for health and wellbeing boards to become effective local system leaders”.

For further information about the offer, visit https://webarchive.nationalarchives.gov.uk/20130804124322/http://www.local.gov.uk/web/guest/health/-/journal_content/56/10171/3932121/ARTICLE-TEMPLATE or email Abigail Burridge: abigail.burridge@local.gov.uk

To sign up for regular bulletins about the LGA’s support offer, contact: healthimprovement@local.gov.uk

Find out more about the work of the National Learning Network for health and wellbeing boards – read the online ‘story’ at https://webarchive.nationalarchives.gov.uk/20130804124322/http://storify.com/DHgovuk/reflections-on-health-and-wellbeing-boards-support

Follow the conversation online – search #hwblearn on Twitter for the latest health and wellbeing board news.

Access useful resources, share learning and find out about the latest events at the National Learning Network for health and wellbeing boards group on the Knowledge Hub.

Health and wellbeing boards are vital to that integration – local authorities, clinical commissioning groups (CCGs), local Healthwatch, public health, social care and children’s services leaders joining together to assess what health and care services local people need and agree how they can best work together to make that happen.

To support health and wellbeing boards, the Department of Health has worked with stakeholders on producing statutory guidance, which explains the duties and powers of Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs). The Department of Health undertook a public consultation on a draft version of the guidance which had been developed with significant input from and engagement with stakeholders across the health and social care system. The final guidance is the result of this consultation and engagement.

Read the final statutory guidance, response to the consultation undertaken in 2012, and supporting documents below:

Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies – March 2013

Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies – DH Response to Consultation

Diagram to show the explicit link from evidence to service planning in JSNAs and JHWSs – March 2013

Summary table of the duties and powers introduced by the Health and Social Care Act 2012 relevant to JSNAs and JHWSs – March

The purpose of JSNAs and JHWSs is to improve the health and wellbeing outcomes of the local community and reduce inequalities for all ages. This guidance is especially important as under the Health and Social Care Act 2012, JSNAs and JHWSs will form the basis of CCG, the NHS Commissioning Board and local authority commissioning plans, across all local health, social care, public health and children’s services.

The purpose of the guidance is to support health and wellbeing boards and their partners by:

• laying out duties, which underpin JSNAs and JHWSs to be undertaken by CCGs and local authorities through health and wellbeing boards from April 2013;
• explaining how JSNAs and JHWSs will fit together with commissioning plans in the modernised health and care system; and
• setting out how the JSNA and JHWS process will enable the NHS and local government to make real improvements to the health and wellbeing of local people.

Wider resources

The Department of Health is also working with partners across the health and social care system to develop a suite of wider resources to support health and wellbeing boards and their partners in undertaking JSNAs and JHWSs. This will pull together existing resources which emerging boards have told us they find helpful, and new resources based on what boards have asked for in terms of support in the modernised system. The first wave of these resources will be launched on the LGA Knowledge Hub in April, with further developments to follow over the coming months.

Staying in touch

If you are already a member of the ‘National Learning Network for health and wellbeing boards’ online community, you may wish to visit the Knowledge Hub for related discussions taking place around how shadow boards are developing their draft JSNAs and JHWSs.

Register for the Knowledge Hub to find out more.

Follow the #JSNA and #JHWS conversation on Twitter

Email JSNAandJHWS@dh.gsi.gov.uk

Local Healthwatch Regulations Explained aims to explain and provide clarity in relation to the following issues:

(a)  lay person and volunteer involvement in local Healthwatch and;

(b)  restrictions on activities of a political nature.

Visit the LGA’s website to read Local Healthwatch Regulations Explained.

Healthwatch England has published information on what the regulations mean for local Healthwatch and will shortly publish further resources on other aspects of the legislation.

Visit Healthwatch England’s website to view the document.

These regulations revoke the regulations laid on 13 February 2013.

See revised regulations.

These data are revealed by a special analysis of the high profile Global Burden of Disease Study 2010, published in The Lancet today (Tuesday).

An analysis of the study, which was funded by the Bill & Melinda Gates Foundation, was co-authored by Professor Kevin Fenton, Director of Health and Wellbeing of Public Health England (PHE) and Professor John Newton, Chief Knowledge Officer of PHE, among others. This new body has been established to protect and improve the nation’s health and wellbeing, and to reduce inequalities. PHE will take up its full responsibilities on 1 April, 2013.

The report looked at how the health of the UK compares with 14 other EU countries, Australia, Canada, Norway and the United States. These countries were chosen as comparators with a similar or higher level of health expenditure. Results are presented for 259 diseases and injuries, and 67 risk factors or clusters of risk factors, together with comparable data for years of life lost and disability-adjusted life years between 1990 and 2010.

In the 20 years from 1990 to 2010, life expectancy overall increased by 4.2 years in the UK to 79.9 years. However, improvements in mortality have been very small for some age groups and the UK has performed poorly compared with other countries. Also, some specific causes of death show marked increases, such as Alzheimer’s disease, cirrhosis of the liver, and drug use disorders. The best results are for heart disease mortality where the UK has seen the largest fall in mortality of any of the 19 countries over the period.

Another concern is that levels of disability at specific ages did not improve. This means we are living longer but with an expectation of longer periods of disability. Most other countries share this problem to a greater or lesser degree. The major causes of disability vary by age but include mental and behavioural disorders such as depression, anxiety and schizophrenia, substance abuse including drug and alcohol use, and musculoskeletal disorders, for example lower back pain and osteoarthritis.

The contribution of individual risk factors to the burden of illness and disease in the UK has been quantified. The biggest was for tobacco (12 per cent), followed very closely by high blood pressure and high body-mass (nine per cent each), and then physical inactivity, alcohol and poor diet (five per cent each).

Although the overall picture is one of improvement, there is considerable cause for concern in these figures. Premature mortality has hardly changed in the UK for both men and women in the 20-54 year old age group. The leading causes of death in this group are heart disease and self-harm, but also liver disease, breast cancer and road injury. The number of years of life lost (a measure of the extent of premature mortality) has actually increased in this age group for liver disease (cirrhosis), drug-use disorders and alcohol, cancelling out the benefit of substantial improvements in most cancers and in road deaths.

Across all ages the top eight diseases causing the most years of life lost in the UK remain largely the same as those reported in 1990. In order, these are heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, lower respiratory infections, colorectal cancer, breast cancer and self-harm. Since the last report, years of life lost from drug use disorders have increased nearly six-fold.

Compared with the other 18 countries, the UK does worse for premature mortality (years of life lost) for most conditions and its relative position has worsened since 1990. However, it is not all bad news, the UK’s years of life lost rate is significantly better when compared to the average of all the other countries assessed for road injury, diabetes, liver cancer and chronic kidney disease.

Professor Kevin Fenton, Director of Health and Wellbeing at PHE, said: “This report is both a wake-up call and an opportunity for the UK. While it’s encouraging that overall the health of the UK has improved substantially since the last report the pace of improvement is not enough.

“The creation of PHE and the movement of public health into local authorities are huge transformational opportunities for improving the public’s health, and there could be no better time to do things differently. The results from the study identify where we need to improve and where existing and future resources will need to be realigned to meet the needs of our demographically changing population. To improve public health we need to redress a historic imbalance by focusing more on primary prevention and the promotion of wellbeing in addition to ensuring effective, high quality, and accountable clinical care and rehabilitation services.

“Smoking, high blood pressure, having a high body-mass, physical inactivity and alcohol are five main risk factors for ill-health and many of the major causes of premature death. The finding that poor mental health, substance abuse and musculoskeletal disorders are among the main drivers for disability reinforces the need for the broader health system to intensify efforts in these areas. The reality is that nearly all of these conditions are either preventable or amenable to early intervention, providing opportunities to make a substantial difference in people’s lives, and reduce the tremendous psycho-social and economic burden of poor health on our society.

“Ultimately, in order to really make a difference in improving our nation’s health, concerted action will be required, with individuals, families, local communities, local councils, the NHS and government all taking responsibility and working together towards a healthier population. We already have a range of effective tools for individuals, clinicians, and policymakers to respond to these health challenges. We need to apply and scale-up what we know works. And we need the will to make this happen.”

Professor John Newton, Chief Knowledge Officer at Public Health England, said: “These relatively poor results for mortality and disability in the UK require a response at every level and from all responsible authorities. For example, the data on contribution of different risk factors clearly show the need to redouble our efforts on smoking, high blood pressure and obesity. The NHS must pay more attention to prevention and early intervention but the underlying causes often have little to do with health care.

“This report highlights the potential impact of PHE, an organisation that can take a wide of view of health and its determinants. PHE will continue to report similar data for England on a regular basis, and down to local level, to ensure that national and local resources can be directed towards the areas that need most attention.

“The GBD study only looked at figures for the whole country but within the UK we know we have areas such as the South East and South West that achieve results as good as any of these countries. But there are also areas such as the North West which do as badly as the worst and this is completely unacceptable.

“We should be proud that life expectancy in the UK has increased as much as it has since 1990, but we need to make sure that these extra years are healthy ones. As a society we must look after our vulnerable people better. Poor mental health causes an enormous and increasing burden of disability as does the pain and disability of arthritis, and loss of independence due to poor sight, hearing and incontinence.

“Despite some enviable recent success, for example on smoking, we in the UK need to take a hard look at what can be done to help people in the UK achieve the levels of health already enjoyed by other some countries. Central and Local Government, charities, employers and retail businesses all have a part to play.”

Notes to editors

1. Christopher L J Murray et al. UK health performance: findings of the Global Burden of Disease Study 2010. (2013). The Lancet.
2. Professor John Newton is also honorary Professor of Public Health and Epidemiology at the University of Manchester.
3. PHE would like to thank the Global Burden of Disease (GBD) lead researchers and network for their collaboration on this groundbreaking research. Other UK authors included Professor Sir Mike Richards, National Cancer Director and Professor Adrian Davis, Department of Health Chief Scientific Officer’s Lead Advisor on Physiological Diagnostics, Director of NHS Newborn Hearing and Physical Examination Screening Programmes and Professor of Hearing and Communication at UCL.
4. The GBD 2010 has involved nearly 500 researchers from more than 300 institutions in 50 countries. In total it has looked at 291 diseases and injuries in 21 regions, for 20 age groups, with an estimation of trends from 1990 to 2010. It also includes an assessment of 67 risk factors. The previous project in 1990 assessed the burden of 107 diseases and injuries and ten selected risk factors for the world and eight major regions over one calendar year.
5. The idea for the GBD study was created by a team at Harvard University who developed the ‘Disability Adjusted Life Year’ (DALY) metric that made it possible to combine estimates of mortality and morbidity burden from around the world to enable comparisons to be made.
6. Analyses are presented for trends and relative performance for mortality, causes of death, years of life lost, years lived with disability, disability-adjusted life years and healthy life expectancy.
7. Mental disorders include: major depression, anxiety, drug use, alcohol use, schizophrenia and bipolar disorder.
8. Musculoskeletal disorders include: low back pain, neck pain, other musculoskeletal disorders and osteoarthritis.

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I am very pleased to say that we have made appointments to six of our eight vacant Centre Director posts.  Dr Jane Rossini, currently Joint Director of Public Health for NHS Heywood, Middleton and Rochdale and Rochdale Borough Council, has been appointed Centre Director for Cumbria and Lancashire; Dr Fu-Meng Khaw, currently Joint Director of Public Health for NHS Newcastle and Newcastle City Council, will be Centre Director for Lincolnshire, Leicestershire, Nottinghamshire and Derbyshire; Dr Gina Radford, currently Consultant in Public Health at NHS Cambridgeshire, will be Centre Director for Norfolk, Suffolk, Cambridge and Essex; Dr Shona Arora, Joint Director of Public Health for NHS Gloucestershire and Gloucestershire County Council, will be Centre Director for Avon, Gloucestershire and Wiltshire; Professor Debra Lapthorne, currently Joint Director of Public Health for NHS Plymouth and Plymouth City Council, will be Centre Director for Devon, Cornwall and Somerset; Dr Jim O’Brien, currently Deputy Regional Director of Public Health NHS South-West, will be Centre Director for Hampshire, Isle of Wight and Dorset.  This means our frontline is almost complete and it will be hopefully reassuring for our partners in local government, the voluntary and community sector and the NHS to know who they will be working with.  Most of our new appointees will be in place by the time PHE is up and running in April but where not, contingency arrangements will be confirmed.  The remaining two posts for the Centres in Thames Valley and Bedfordshire, Hertfordshire and Northamptonshire will be advertised next week. 

On Tuesday the Local Government Association held their second annual public health conference, opened by their Chairman Sir Merrick Cockell and addressed by Ben Page, Chief Executive of MORI, amongst many others.  Sir Merrick spoke with passion, knowledge and ambition in taking on their new statutory duties to improve the public’s health and I do wish this could have been broadcast across the nation.  Ben shared the findings from MORI’s recent work around the public’s understanding of their own health and what could be done to improve it.  The essential message, conveyed in a captivating way, is that while people understand what they could do to improve their health they are very often reluctant to act on this and we need to be more savvy in how we listen and respond in ways that are more effective than we have hitherto managed. 

On Monday I had the pleasure of meeting the network of Chairs of the 14 Health and Wellbeing Boards across the West Midlands.  This was a stimulating and practical conversation – and I am keen to have many more in such fora – which emphasised the critical role of Health and Wellbeing Boards and their mission to be bold and ambitious for their communities and to focus unremittingly on health and not solely on illness in tackling the causes of inequalities and poor outcomes. 

And finally, homeless people cost the NHS eight times more than people with homes but still have appalling health outcomes dying, on average, at just over 45.  At an inaugural international conference on homelessness and exclusion in London yesterday I committed PHE to working with all those with an interest to address this as it plays entirely to our mission to improve the health of the poorest and most poorly fastest.

Read the PHE centre director biographies

Alongside the letter we have also published a document including FAQs  to assist staff in understanding how their current pension arrangements will be affected by the transfer to local authorities and a variety of FAQs and information for both employees and employers on other issues such as NHS Pension Direction Orders, Automatic Enrolment and NHS injury benefits.

Pensions letter to HR 28 February 2013

Pension FAQs for staff transferring from PCTs to local authorities

Our ‘Going Live’ work programme has drafted a short description of the roles of our 15 Centres and four Regions and their key relationships. The Centre will be the front door of PHE and responsible for assuring that the services and expertise provided are truly focused on local needs. Its Director will be a full partner in the local public health system, which includes the voluntary and community sector, and their unique role will be to provide a range of services and expert advice that is tailored to the needs, wishes and aspirations of local government, CCGs and the local NHS. Each Centre will provide leadership and support across all three domains of public health – health protection, health improvement and healthcare public health. This will include supporting local government in their leadership of the local public health system; supporting Directors of Public Health across the range of their responsibilities enabling them to access specialised advice and support when required; working with the NHS Commissioning Board to support it in its role as a direct commissioner of key services, including specialist services and national public health programmes; and providing leadership in responding to emergencies where scale is necessary.

Our four Regions are coterminous with those of the NHS CB and other national partners and they also happily map onto the nine regional local government groupings. Each will nurture, assure and support the local public health system and maintain an overview of the whole system’s progress in implementing the Public Health Outcomes Framework. They will have a special responsibility for workforce development and we will be publishing our strategy for this in March. Our regional ‘Going Live’ events, co-produced with a group of organisations including the LGA, NHS CB and Association of Directors of Public Health, will develop this narrative further and work through what this means in practice on the ground. These have now been confirmed in the North of England (Leeds) on 12 March, the South of England (Swindon) on 15 March, Midlands and East of England (Leicester) on 19 March and in London on 22 March.

Health and Wellbeing Boards are the frontline for priority setting at a local level and where the major decisions will be taken that will improve and protect health as well as assuring safe and effective health services. Innovation will increasingly be an essential driver for this. An invitation is shortly to be extended to members of Health and Wellbeing Boards to attend the Healthcare Innovation Expo 2013 at ExCel London on 13 and 14 March. This should prove invaluable and inspiring and I hope as many of you as possible will be able to take up this opportunity.

And finally, PHE is involved in a national collaboration with the NHS CB, LGA, Department of Health and Monitor to encourage integrated care as the preferred local model, particularly for people who have to live with long term conditions. There is a current consultation on this and I would encourage everyone to contribute.

Health and wellbeing boards present new opportunities for effective partnership working at local level to improve commissioning and achieve better health outcomes. The main duties and functions of health and wellbeing boards require them to have strong engagement across their communities.

Following the publication of the paper ‘Stronger Together: How health and wellbeing boards can work effectively with local providers’, this webinar provides the opportunity to gain valuable practical insight directly from health and wellbeing board members and local providers about how boards are working and can work effectively with providers.

During the webinar you will hear from representatives from provider organisations who have had varied levels of engagement with their local health and wellbeing board. There will be the opportunity towards the end of the webinar to ask questions of the panellists.

To register for this webinar, please contact David Harrison at the Department of Health at healthandwellbeingboards@dh.gsi.gov.uk.

Please note that in addition to health and wellbeing board members with a health and local government background, we are also looking for members from the voluntary/community sector.

All you will need for the webinar is a computer and a phone. Alternatively, you can join by smart phone.

For more information on the webinar programme, and to listen back to previous recordings, visit the webinars page.