I am pleased to be writing my first article as National Director after stepping into the role previously held by John Wilderspin. During the next few months, I hope to build on his strong legacy and ensure support continues for health and wellbeing boards from 1 April. In particular, I will want to ensure that the new health system with local government can effectively support boards to deliver better outcomes for their communities.

An enormous amount of work has taken place at all levels to set up the boards, but it is clear that the hard work will really begin as boards move from shadow to live form. The Department is working hard with its partners to ensure that health and wellbeing boards continue to receive support and guidance as they begin supporting their local communities as statutory bodies from 1 April.

In many ways, this partnership working between DH, local government and other partners (e.g. the LGA, NHS Confederation and Healthwatch England), throughout the implementation programme mirrors the partnerships that will need to flourish at a local level if boards are to succeed.

I have seen first-hand how building strong partnerships eases the challenge of distilling local priorities and translating strategies to implementation. I recently observed a board debating short-term goals and more complex longer-term objectives. It was impressive to see this direction-setting in action and the collaboration of a broad range of people who have the same goal: to make a real difference for their community.

As well as looking forward to 1 April, it is useful to reflect on what resources are already available for supporting boards as they navigate this crucial period. The Department has collaborated with partners at a national level to deliver a comprehensive set of resources, many of which you will find on our Knowledge Hub group (details below).

A common concern for boards is that of involving local providers in decision-making. The recent NHS Confederation report, ‘Stronger together: how health and wellbeing boards can work effectively with local providers’, suggests that boards should adapt their engagement to suit local priorities to ensure the best outcomes for communities.

One practical challenge will be overcome with the publication of the secondary legislation. These technical regulations enable boards to establish themselves formally and the intention is to give as much flexibility to local areas as possible and to build on how shadow boards are already running. In addition to the regulations, the Local Government Association (LGA) and Association of Democratic Services Officers (ADSO) are jointly publishing a practical guide to support local authorities in interpreting and implementing constitutional and governance aspects of the legislation. This will be published on their respective websites shortly.

The Department is also producing a suite of resources for supporting health and wellbeing boards and wider stakeholders in understanding what ‘good’ looks like in relation to Joint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs). The resources will include new material as well as signposts to existing documents that align with the new role of JSNAs and JHWSs and we anticipate that these will be published over the coming months. In the meantime, draft guidance on undertaking JSNAs and JHWSs can be found on the consultations page of the DH website.

Over the past 15 months, my colleagues in the HWB team have used a number of tools and channels to drive conversation between health and wellbeing board members, both online (through Twitter, the Knowledge Hub and online publications such as the Local Government Chronicle), and offline through conferences and workshops, including our national learning and sharing events. One way we have brought health and wellbeing boards together has been through a programme of webinars, or web-based seminars, which have generated inspiring and rich learning opportunities. Webinars have allowed board members from across the country to meet virtually and discuss issues such as including loneliness and social isolation in JSNAs and JHWSs and addressing issues of dementia and health inequalities. Recently, we ran a webinar with the Districts’ Council Network on how districts will contribute to the new public health system. Each webinar has been recorded and can be listened back to at https://webarchive.nationalarchives.gov.uk/20130804124318/http://healthandcare.dh.gov.uk/hwb-webinars.

My colleague Janine, who is Communications Lead for the Health and Wellbeing Board Implementation programme, has recently produced a Storify highlighting the digital work she’s been leading on for the health and wellbeing board and Healthwatch implementation programme. You can read about Janine’s digital journey at https://webarchive.nationalarchives.gov.uk/20130804124318/http://storify.com/JanineComms/my-last-15-months-in-social-media.

As you can see, the Department has worked closely with its partners to provide a comprehensive package of support for health and wellbeing boards as they move towards 1 April. However, giving boards the flexibility and space to decide what’s best for them may be the most important part of this package in their first year of statutory running. I will seek to ensure this happens and look forward to working with boards to help us get this right.

Stay in touch

Join the National Learning Network for health and wellbeing boards group on the Knowledge Hub. The Knowledge Hub is an online platform which provides tools to help people connect, share and learn from each other. All of the outputs from the National Learning Network for health and wellbeing boards can be found on the Knowledge Hub and the site provides a central online resource for any board members seeking clarity on a specific issue.

Follow the team on Twitter: @JanineatDH @davidatDH @Edwards1Ginny @FreyaLockatDH

Joyce takes over from John Wilderspin who stepped down in December 2012 to become Managing Director at the Central South Commissioning Support Unit.

Joyce’s primary task will be to ensure that the right support arrangements for 2013/14 are in place when health and wellbeing boards go live in April 2013. She will provide visible leadership to the programme until April 2013 and will continue to build and maintain the strong partnership working currently in place.

Joyce said:

“I am delighted to be joining the team during this exciting period. It is vital that we maintain the strong shared leadership arrangements as I am convinced this is the best way of delivering better health outcomes for patients and local people.

“Health and wellbeing boards have an important and central role to play in promoting collaborative leadership and I am pleased to support and develop the good work being done locally.”

Joyce will oversee the final three months of the health and wellbeing boards programme and brings to the role a wealth of experience. Previously, she has worked in  Wigan where in her final 15 months she was in a shared Chief Executive post with the Ashton Leigh and Wigan PCT.  Prior to that, she helped to reintroduce the Chief Executive role to Gloucestershire County Council and took it from a poor to a good Authority.  She has been working in partnership with DH since May 2012 through her role as a consultant on health and wellbeing boards at the Local Government Association.

Joyce recently spoke at a national sharing event on 8 November on the progress being made by health and wellbeing boards. The video can be viewed at https://webarchive.nationalarchives.gov.uk/20130804124318/http://www.youtube.com/watch?v=cxqTJ99BykA

To find out more about the ‘story’ of the event on 8 November and health and wellbeing boards, visit the Storify page at sfy.co/jDNL

I am very pleased to announce the first tranche of appointments to PHE’s 15 centres. So far the centre directors appointed are: Dr Qutub Syed, Cheshire and Merseyside; Dr Martyn Regan, Greater Manchester; Dr Roberta Marshall, North East; Dr Graham Bickler, Surrey, Sussex and Kent; Dr Sue Ibbotson, West Midlands; and Dr Stephen Morton, Yorkshire and the Humber.

The remaining centre director posts will be going out to open advert at the end of next week and we expect to confirm regional director appointments next week too. These, taken together with our national appointments, mean that PHE is bringing together a formidably talented and experienced group of leaders to establish and deliver a world class public health service.

We wish to co-produce, with our partners and staff, how we want our centres and regions to work in practice and the style and behaviours that are most likely to succeed. Richard Gleave, Paul Johnstone and Yvonne Doyle will be leading this and we are calling the work ‘Going Live’. Sue Ibbotson and Ann Hoskins are also helping and we expect to have an initial description to inform a wider set of internal and external discussions by the end of January.

The link between unemployment and ill health as well as the negative impact that long term sickness often has on future health are well known. The evidence suggests that if you are off work for 6 months your chances of successfully returning are reduced by 50% and at 1 year by a further 25%. Early intervention when an employee becomes ill is proving very successful in preventing further health problems developing and getting people back to work quickly and this is being clearly demonstrated by a pilot programme operating across the three boroughs of Kensington and Chelsea, Hammersmith and Fulham and the City of Westminster.

Their ‘Fit for Work‘ programme, one of seven in the country, takes referrals at no cost from GPs, employers and self referrals, for patients who have been signed off work for more than 4 weeks. The service works in partnership with the patient, their employer and GP and looks at the barriers to their returning to work, which include common health conditions such as muscular and joint pain, and moderate mental health problems, as well as non-health barriers such as worries about family, money or work itself. The results are remarkable with three quarters of those referred returning to work, on average within 6 weeks. This pilot is being evaluated nationally by the Department of Work and Pensions and should inform decisions about rolling out this intuitively sensible investment by employers and commissioners.

Finally, as we look forward to the coming seasonal festivities, the voluntary sector is preparing ahead to help us help ourselves be fit and well come the New Year. For example, Alcohol Concern has launched a campaign inviting people to give up alcohol for the month of January.  Have a look at their website at www.dryjanuary.org.uk.

I am very pleased to be today publishing the final stage of our People Transition Policy, which sets out the terms and conditions for staff transferring into PHE (either by direct slot in, matching, or redeployment). Staff will move on their existing terms and conditions. In addition, everyone in a civil service or NHS scheme will retain the right to remain in their current pension scheme until 2015, after which they will move to the new civil service career average scheme in line with the reforms, which affect staff across the public sector.

Although all our staff will be civil servants, and new appointments will be on PHE terms and conditions, we will have the flexibility to offer NHS terms, including pensions, for posts in a clearly defined “clinical ring fence.” This will enable PHE to continue to recruit the specialists it needs, where the market is principally the NHS, and will facilitate mobility across the whole system.

Also today, another major step forward is that confirmation of those staff who will lift and shift into PHE is being sent out to those sender organisations not included in the first phase of notifications. Individual letters communicating the decisions on lift and shift and matches should be with staff in the next week. Those remaining staff subject to competitive matching can get the advice and guidance they need from their HR teams. As I have said before, we are committed to doing everything we can to secure the futures of all staff whose work is moving to PHE – and soon.

I am also very glad to say that the Secretary of State yesterday confirmed that the chair of PHE’s advisory board will be Professor David Heymann, who is currently chair of the Health Protection Agency and acting chair of PHE. He brings a wealth of invaluable experience to this role as a public health scientist and doctor at both national and international levels.

Last week I talked about the development of a shared culture with a common language, and a further essential element of this is establishing a core public health literature base – public health literature is very broad, ranging from philosophy and ethics to genetics, and we should identify those books, articles and reports that inform this. Muir Gray and Richard Gleave, who are leading the work on developing a shared culture, are also starting a debate on the top 100 public health documents that form the core of our intellectual heritage and will be seeking contributions to this.

Finally, I have been aware of uncertainty in the field about the financing for community infection prevention and control. This responsibility rests with the embedded public health teams within local government and we have decided that 50% of the £25 million set aside for this function, which was due to be retained by PHE, should be handed in its entirety to local government. This will be reflected in the allocations, which are expected before Christmas.

The consultations cover fair and transparent pricing for NHS services, and ensuring continuity of NHS services.

Fair and transparent pricing for NHS services sets out proposals for which providers can formally object to Monitor’s way of calculating prices and the level of objections from commissioners and/or providers that would require Monitor to reconsider its way of calculating prices or refer to the Competition Commission.

Protecting patients’ interests – ensuring continuity of NHS services sets out how safeguards to protect the services that patients need will be extended to NHS services provided by social enterprises and other companies.

If you can’t join the webchat on the day, you can send questions in advance by using the ‘reply’ box at the end of this page. Questions sent in this way will also be published on this page.

On Wednesday, Professor Dame Sally Davies published her first annual report as Chief Medical Officer which is a unique resource for Public Health England, local government and the NHS. It draws on data from a wide range of sources and shines a bright light on the nation’s health and at a local level. Importantly, it comes at a timely moment as local government assume their new responsibilities for improving health and PHE begins its work.

Public health specialists come from a diverse range of professional backgrounds and this is set to extend further as they become embedded in local government. One of these is the nursing profession. Viv Bennett, our lead nurse, is on the PHE national executive board helping to ensure that multidisciplinary professional voices are heard and valued. She and her team have considerable experience in operating professional networks across large geographies and they will be contacting our nurses very shortly so that they will have the opportunity to help shape these as they are strengthened over the coming months.

The language of public health is understandably complex, its variations can be subtle and on my travels I hear people using even common terms in very different ways. One of the steps in creating a shared culture is to ensure we have a common language, using the same terms in the same way. The first stage of that process will be to seek your views on the most important terms for which we need a consistent meaning. Richard Gleave and Muir Gray are leading on creating a shared culture and you should be hearing from them soon about how to get involved.

Last week I visited Turning Point Complex Needs Service in Stevenage, commissioned by Hertfordshire County Council jointly with the local NHS. This is public health improvement at the cutting edge. The service has been designed around the needs of the people it serves, recognising that few ever present with only a single problem.

From my own past, whenever a complex problem was under discussion I assumed this was for the statutory sector to sort out. This is sometimes but not always the case. The voluntary sector can reach and support people that the statutory sector cannot and often at less cost. The key to securing lasting improvement is in getting the statutory and voluntary sectors to work together, recognising the strengths and differences that each bring. The complex needs service in Hertfordshire is an example of how to do this and is what is meant by truly integrated commissioning.

Southampton’s Two Saints Day Centre for the homeless is another good example of the public and voluntary sectors working together. The City Council, with its public health team led by Dr Andrew Mortimore, Director of Public Health, is honest about the tough service and financial decisions before them and clear that the safety and security of the most vulnerable must be prioritised over ‘nice to have’ which is no longer affordable. We need to see this integration replicated across England.

Finally, this week saw the publication of the refreshed Public Health Outcomes Framework, together with the first set of baseline data for more than half the indicators. This will be a critical tool for local government who, with the support of PHE, will be reviewing their strengths and challenges in order to shape their work plans.

I was delighted to join 150 senior public health professionals from across the country – consultants and specialists, trainees, directors of public health, commissioning managers, intelligence specialists – at the first PHE healthcare public health conference on Friday. As everyone knows, the NHS has not really focussed on population health nor perhaps fully appreciated just how much public health professionals can contribute to improving the overall health of the population and addressing specific inequalities through their influence on the NHS.

Healthcare public health is firmly on our agenda and the QIPP Right Care programme is handing over to us a considerable range of their responsibilities, the atlases and the development of population based systems of care. The conference was an invaluable opportunity to share learning and to begin our work in building capability in this most important domain.

We have assets of international standing in our microbiology and epidemiology centres at Colindale and Porton and for some time now there has been a proposition to bring these, together with our colleagues at the National Institute for Biological Standards and Control, onto a single campus at Harlow in Essex. I recently asked Professor George Griffin, Chair of Infectious Diseases at St George’s Hospital, to carry out a due diligence review of the process and scientific arguments for this. Professor Griffin has completed his review and I am satisfied that the scientific premise for the proposed move to Harlow is sound.

This is, though, not the last milestone and there is more work to be done in making the business case which will take a further year to complete, after which the government will carry out a full value for money assessment of the case, and crucially to agree how we can best handle this for the staff most directly affected. In my visits to Colindale and Porton I hope everyone has heard the importance I place on their work and contribution to science and service and that our ambition is to see this fully embedded and extended in PHE.

Across the country, all 152 local authorities taking on the statutory duty to improve health have completed a Local Government Association (LGA) led self-assessment of their readiness. The main message is that implementation is well under way with councils seizing the opportunity to embed health across everything they do and to become public health organisations. There are a small number of areas where locality specific difficulties remain and, again, this is being led by the LGA with our support. We have in return received a clear message of the urgency local government place on knowing their budget allocations and this is being addressed.

Finally, I am very glad to say that we have appointed Dr Kevin Fenton as our Director of Health Improvement and Population Healthcare. Dr Fenton will be joining us from the US Centers for Disease Control and Prevention in Atlanta in early January.

The people transition for Public Health England is now really getting into gear. This week we told over 70 organisations, who have staff joining PHE, the results of the matching exercise for most groups of staff. In the next few days, we will be able to confirm the names of those who will move to PHE in “lift and shift” teams. By the following week we expect the great majority of public health staff whose work is moving to PHE to hear from their managers that they have a confirmed role in PHE. For those who may not have certainty after this we will be continuing to expend every effort to settle their futures too.

I contributed to the National Learning Network’s conference for health and wellbeing boards this week. I was encouraged to learn that great progress is being made in most areas of the country, with clear priorities agreed between local government and their partner clinical commissioning groups. The health and wellbeing boards are the frontline in bringing the whole system together as they are best placed to shape local priorities and act on them. Improving health and reducing health inequalities goes so much wider than the NHS and no one organisation can address these on their own.  We are in effect, all in this together.

Partnership working is tough, and we have not always succeeded, but local government does have a strong track record in this and can lead the way. Health and wellbeing boards must be bold in their prioritising and mature in their choices and this will involve moving resource to where it can have the most impact. Our responsibility will be to distribute knowledge about what works, offer practical “know-how” and make this truly accessible to everyone.

Our Extreme Events team, in partnership with the Met Office and the Department of Health, has led the development of the Cold Weather Plan for this winter. The Plan, which is supported by Age UK and many other voluntary sector partners as well as local government, is genuinely excellent and aims to help raise awareness of the dangers of severe cold weather with the general public and health professionals. It spells out the steps individuals and organisations can take to reduce risk and particularly for the most vulnerable. The average number of excess winter deaths over the last decade in England has been just over 25,000 a year. Other countries such as Finland experience lower numbers despite lower temperatures, suggesting that we could do better by making the right preparations.

And finally, I was privileged to speak at a conference to celebrate 25 years of the work of the Medical Foundation for HIV and Sexual Health (MEDFASH ), the independent charity dedicated to supporting health professionals and policy makers working in HIV and sexual healthcare. I remember like yesterday the apocalyptic fear felt back in 1987 and I lost a number of friends to AIDs at that time. When you think how far we have come, to the point where HIV is now managed as a long term condition rather than an automatic death sentence, there is much to be celebrated and MEDFASH is to be thanked and congratulated on its massive contribution.

The products, which launched at the Network’s national summit on 8 November, cover themes including integration, criminal justice, improving population health and patient and public engagement. They add to the extensive range of resources for health and wellbeing boards (HWBs) published earlier this year.

Sharing learning

In collaboration with the Department of Health, Local Government Association and NHS Institute for Innovation and Improvement, the NHS Confederation has been working with HWB learning sets to produce these resources, which are informed by key learning from shadow HWBs from across the country.

The new resources summarised below provide practical guidance and principles for these new bodies to consult and consider as they assume their critical role within the reformed health and care system:

Operating principles for Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies: Enabling joint decision-making for improved health and wellbeing. This co-produced report complements the Department of Health’s guidance and is designed to support areas to develop successful Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies. It provides operating principles to guide key processes and practical examples of how these have been put into practice.

Encouraging integrated working for adults and older people: a practical guide for health and wellbeing boards. Provides HWBs with some practical approaches to consider and use in promoting closer joint working.

Health and wellbeing boards: developing a local outcomes framework for adults and older people. Provides a visual map of each of the national outcomes frameworks for adult social care, the NHS and public health. It aims to help HWBs to develop local outcomes frameworks linked to priorities set out in Joint Health and Wellbeing Strategies.

Health and wellbeing boards and criminal justice agencies: building effective engagement. This briefing details practical information and learning on building effective engagement between health and wellbeing boards and local criminal justice system agencies.

Improving population health: action learning for health and wellbeing boards. Demonstrates valuable learning of how others have addressed some of the difficult strategic and policy issues involved.

Patient and public engagement: a practical guide for health and wellbeing boards. Designed to help HWB members think through, plan and deliver their responsibilities in relation to patient and public engagement. It provides practical learning on ‘how’ and ‘when’ to engage, and ways this can work alongside the responsibilities of partner organisations, in particular local Healthwatch.

Support and resources for health and wellbeing boards. Provides information on organisations that deliver support and produce resources to enable health and wellbeing boards develop and operate effectively. It aims to spread networking and learning opportunities for health and wellbeing board members.

Download the learning set products from the NHS Confederation publications library or the LGA’s Knowledge Hub.

Golden opportunity

NHS Confederation chief executive, Mike Farrar, who spoke at the event on 8 November, said these new local bodies have a “golden opportunity”  to bring together health and care leaders to jointly improve health and wellbeing, adding that the summit provides an invaluable occasion to share learning, test new thinking, and uncover practical solutions.

About the network

The National Learning Network for health and wellbeing boards  is supported by the NHS Confederation, Department of Health, Local Government Association and NHS Institute for Innovation and Improvement, and was set up to support the development and establishment of health and wellbeing boards.

 Find out more about the network.

HWB publications A5 flyer final for website

I had a very positive experience on Monday in being introduced to the voluntary sector strategic partners and listening to how we can best work with them as a profoundly important partner from the outset. The voluntary sector across the country is made up of more than 900,000 organisations, has a workforce of over 1.6 million and combined assets of some £244 billion.

Local government will have statutory responsibility from next April for addressing what determines good health such as having a job or something meaningful to do during the day; a home that is decent, warm and in a safe neighbourhood and someone who cares about you such as a friend or neighbour. The voluntary sector will help them achieve this. It would take the statutory public health system 10 years to have a fraction of their impact and reach.

We will work alongside the voluntary sector and do all we can to help get them “into the room” to co-design services that are integrated as well as, of course, delivering them. One without the other rather misses the point. That is exactly what I saw in action when I spent last Friday in Gloucestershire where the local authority, clinical commissioners, police and voluntary organisations have got together to provide a range of community services for the poorest and the excluded.

The community has set up a friendship café where young people are particularly encouraged to develop interests and hobbies. These include a city farm run by volunteers, which is free to local residents and involves them in the natural world on their own doorstep; activity sessions being provided 7 days a week at Kingfisher Church, led by their inspirational Pastor Jan Burn, where volunteers work with young adults with learning disabilities amongst many others and SkillZONE, a purpose-built educational facility, which gives children and adults opportunities to learn about street, fire and personal safety. What is being done here brings people and communities together. Focusing on the poorest and most poorly is the only way we can truly address health inequalities and give everyone, especially the youngest, the chance to be the best they can be.

Public Health England will be working closely with our colleagues in Scotland, Wales and Northern Ireland, with whom we share many similar responsibilities and provide advice and support on an agreed basis. These relationships are of great value to England and we hope to strengthen our work together. On Tuesday, I spent the day with the Welsh government and Public Health Wales and had the opportunity to hear about their focus on health improvement and addressing inequalities as well as their strengths in academia. We know from our health protection work how artificial physical borders are to the public’s health. Good practice, of course, knows no borders and we can learn from each other in creating a healthier and safer UK.

Finally, I want to mention the right care conference, Health and healthcare public health: shaping the new system, on Friday 9 November and to encourage people to attend. Population healthcare will be a core contribution to effective commissioning of NHS services and is a key responsibility to the public health teams being embedded in local government. We must get this right if we are to make the paradigm shift from treatment to prevention and from late to early intervention. An ounce of prevention is worth a pound of treatment. Public health specialists are the professionals who know how to do this.