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/20130804124227/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/20130804124227/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.

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I am glad to say that the Secretary of State has given the green light to begin work on implementing the commitment to bring non-medical public health consultants into the same statutory professional framework as their medical colleagues.  This addresses a long-standing concern that the statutory regulation of public health consultants should reflect the wide diversity of those now entering the profession.  More on this in the months to come.

This week we have completed our regional ‘Going Live’ events, co-produced with a group of partners including the LGA, NHS CB, and Association of Directors of Public Health, in Leicester for the Midlands and East of England and in London.  As was the case in the South and the North, they were again very well attended by our partners in local government, Health and Wellbeing Boards, Clinical Commissioning Groups, the NHS Commissioning Board, the voluntary and community sector, the local NHS and other public services such as the police.  Each has been notable for the genuine enthusiasm and commitment of all the participants and their absolute determination to work together to improve the public’s health and ensure the new public health system delivers on its future promise.  We were particularly encouraged by feedback from a number of local government colleagues who commented on how refreshing it was that we were undertaking this development in the ‘open’ and that it signaled how we were going to work together going forward.

On Tuesday evening we clubbed together to have a party with the Public Health England Transition Team to say thank you and recognise their tireless work over more than two years in bringing Public Health England to fruition.  I want to pay profound tribute to this team and especially to Janice Shersby, their leader, who has quietly and tenaciously made all this happen.  We have established a style of co-production with our partners, and especially in local government, which will absolutely inform how we work as PHE.  Transparency, earned trust and co-production will be the essential underpinning for a locally organised and delivered public health service in England.  We are as well prepared as we could possibly have hoped to take our first steps next month.

And finally, World TB Day is this Sunday and a great opportunity for raising awareness as this is very far from being an issue of the past.  In the UK we have regrettably seen no fall in the number of new cases each year over the past five years and they are today significantly above the lowest point that was achieved in the 1980s.  This is, however, a preventable and treatable disease, so we must do everything in our power to bring together the NHS and public health system in controlling it better.  TB Alert has prepared really useful free resources for raising awareness of TB among GPs and they are inviting local government Directors of Public Health to request packs through primarycare@tbalert.org so they can be widely disseminated.

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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

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This series of frequently asked questions has been developed to support module 2 of the Public Health England People Transition Policy.

Module 1 of the People Transition Policy was published in July 2012 and the first set of frequently asked questions was published in August 2012.

As promised, this additional set of frequently asked questions provides an update to section 5 of the original set published in August.

If you have any queries about any aspects of the topics covered in this document, then please contact us at phe_hr@dh.gsi.gov.uk

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On Monday the CMO, Professor Dame Sally Davies, published volume two of her annual report focusing on infectious diseases and particularly the threats of antimicrobial resistance. This sits at the very heart of our responsibility for communicable diseases and you will see this reflected in various chapters.

We are refreshing our vision for the Chrysalis programme, designed to bring together our national assets in microbiology and epidemiology in Porton and Colindale, and those of the National Institute for Biological Standards and Control, onto a single integrated campus, most probably in Harlow, Essex. This is about planning for the next 30 years but brings with it natural concerns for those staff most directly affected. Please be assured that should we go ahead the greatest care will be taken to get this right. Richard Gleave, Chief Operating Officer, and Paul Cosford, Director for Health Protection and Medical Director, will be hosting listening events for staff at Porton on 17 April and Colindale on 25 April.

This week we held the first two of our regional ‘Going Live’ events in the North (Leeds) and South (Swindon). We have really appreciated that such a wide range of our partners have been able to join us. Everyone from local councillors, CCG commissioners, the NHS Commissioning Board and directors of public health, to PHE centre teams have said they found these really helpful opportunities to meet colleagues and talk through the practical issues as the new public health system goes live in 17 days. Our aim is to understand what people most want of us and provide it, rather than say this is what we have and we would like you to want it. We are also running a series of internal ‘Going Live’ events, the latest being in London and the West Midlands and I continue to have the singular pleasure of meeting with senior political leaders and senior management teams in local government, most recently in Kent and Essex.

Notwithstanding the wind and rain the plane landed safely in Edinburgh on Friday last, allowing me to affirm our unbreakable commitment to our professional relationship with Scotland, and completing my introduction to the three devolved administrations. Sir Harry Burns, Scotland’s CMO, described their journey and ambition and we have much to learn from their work on addressing inequalities. Communicating a compelling narrative for England and recreating a similar sense of family and shared ambition for our public health community, wherever people work in the system or whoever their employer, seems to me two early themes for us to concentrate on.

And finally, on Monday Professor Kevin Fenton and I introduced PHE to the Industry Key Partners Forum chaired by Minister for Health Anna Soubry. We listened hard to the perspective of 20 plus major corporates including supermarkets, convenience stores, high street pharmacists and many others and hopefully got across our absolute intention to work with them in making further and faster improvements to the public’s health. They in turn have much to teach us about health and wellbeing in the workplace.

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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.

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These regulations revoke the regulations laid on 13 February 2013.

See revised regulations.

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Tuesday saw the publication in the Lancet of a special analysis of the UK data from the Global Burden of Disease Study 2010. This was co-authored by Professor Kevin Fenton, our Director of Health and Wellbeing and Professor John Newton our Chief Knowledge Officer, among others. The analysis looked at how the health of the UK has changed since 1990 and how it compares with 14 other EU countries, Australia, Canada, Norway and the United States. The findings were both surprising and disturbing. Notwithstanding six decades of universal access to healthcare, some significant public health achievements and a decade of massive investment in health services, the UK has slipped back in the various GBD rankings when compared with these other countries. People in the UK are living a good deal longer now, but death rates in some age groups have hardly changed in two decades, some causes of death such as alcohol have shot up, and levels of disability (living with chronic conditions) have not shifted much in any age group. The NHS has made a difference but it has not delivered on prevention and early intervention, and the data on attributable risk are remarkably powerful support for health improvement moving to local government. Mental health problems including depression and anxiety remain a major cause of chronic disability while the top risk factor for death and disability is still smoking, followed closely by hypertension, obesity, physical inactivity and alcohol in that order. The study has coincided with the launch of the Secretary of State’s Call to Action on reducing avoidable early death and the publication of the Cardiovascular Disease Outcomes Strategy for England. We will be finalising our priorities over the next few weeks and the Lancet study is of seminal importance in getting us focused on the right things.

In partnership with the recently launched Early Intervention Foundation, conceived and chaired by Graham Allen MP, we are organising a seminar in the House of Commons for Directors of Public Health to debate what more can be done on prevention and early intervention and the Secretary of State will be joining us. This is to be held on the afternoon of Wednesday 15 May and places will be allocated on a first come first served basis through marie-claire.platt@parliament.uk.

And finally, last week I mentioned the presentation from Ben Page of MORI and his emphasis on the importance of social marketing and behavioural science and on Tuesday this week the National Executive spent time with Dr David Halpern who heads up the Behavioural Insight Team in Number 10 and his colleague David Albury. Their research based approach to influencing behaviour has been astonishingly successful in other areas of public life and they and we are keen to bring this to bear on the public’s health. We will be working in partnership with them, the NHS and local government to design, implement and evaluate a number of pilot projects across England.

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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.

Public Health England Press Office
Tel: 0208 327 7901
Out of hours telephone 0208 200 4400

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The Department received 48 responses from various parties to the consultation to help ensure fair and transparent pricing for NHS services.

The proposals summarised in this document will be implemented through a set of regulations which will be laid before parliament.

The consultation included proposals on:

• which providers can formally object to Monitor’s way of calculating prices
• what level of objections from commissioners and/or providers would require Monitor to: reconsider how it calculates prices, or refer its way of calculating prices to the Competition Commission, who will then decide whether or not it is appropriate.

Organisations who responded to the consultation.

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