Worcestershire Public Health Directorate Business plan Public Health website: www.worcestershire.nhs.uk/publichealth 1 Worcestershire Public Health Directorate Business Plan
Vision 1. The Public Health directorate will lead and support partnership work to improve and protect health & well-being, and close the gap between the health of the worst-off and best-off in Worcestershire - on behalf of NHS Worcestershire, Worcestershire County Council, GP Commissioning Consortia, District Councils, other partners and the public. Context 2. Nationally, the NHS and Public Health systems will be radically reformed over the next two years. The NHS Commissioning Board, Public Health England (PHE) and GP Commissioning Consortia (GPCC) will be established, and primary responsibility for health improvement will transfer to local authorities. Locally, the County Council will be continuing a programme of transformation and efficiencies, which will include taking on a range of new responsibilities for health and health service strategy. This means that the directorate s current responsibilities will transfer to legacy organisations and the directorate will take on new responsibilities on behalf of Public Health England, GPCC and the County Council - although it is not yet certain what these will be. Responsibilities 3. Broadly, the directorate has three sets of responsibilities: To improve health and reduce health inequalities, adding years to life and life to years - by working in partnership with local organisations and communities to influence the determinants of health such as life-styles, education, employment, housing, transport and the environment. To protect health - by preparing for and responding to outbreaks of infectious diseases, chemical, radiological and other major incidents in order to minimise their health impact. To improve health, social care and related services and enable NHS Worcestershire, the GPCC, Worcestershire County Council and District Councils to optimise use of resources to meet health needs and continuously improve the quality and efficiency of public services. Outcomes and performance management 4. The directorate leads delivery of a number of outcomes on behalf of the local NHS and County Council, and supports delivery of a much wider range of outcomes. The directorate works to a set of national and regional key performance indicators with targets set by the Department of Health and Strategic Health Authority, as well as to a series of local performance indicators. A new Public Health Outcomes Framework is under development as part of the NHS and Public Health reforms and is likely to include many of those indicators shown below among others. 2 Worcestershire Public Health Directorate Business Plan
5. The high level key performance indicators to be used in are all age all cause mortality rates in males and females as shown in Figure 1. Portfolio specific key performance indicators and targets are listed in the relevant sections below. Additional local performance indicators and up to date performance data can be found on the public health website. Figure 1: All age all cause mortality rates Aims and objectives (Direct age standardised rates per 100,000 population) 6. In the context of NHS, Public Health and Council reforms, the directorate s aims for are a combination of continuing a process of substantial change, whilst at the same time discharging its full range of responsibilities. health functions and organisations, and for discharging new responsibilities - in line with national and local reforms. This will include development of a West Mercia Public Health Transitions Plan setting out the direction of travel for public health functions and resources, and how any risks will be managed and mitigated during transition and in the new local public health system. As part of this the directorate will complete the Excellence and Efficiency Programme, with internal reconfiguration consistent with the emerging NHS, Public Health and Council reforms, and agree a Memorandum of Understanding with GPCC. ii. Establish and support the Health & Well-being Board (HWB) and develop effective strategies health & well-being. that good governance is in place through the transition period including to the West Mercia PCT cluster. iv. Support improvement of health, social care and related services and ensure that commissioning of these is carried out to a consistently high standard - including by reviewing and updating the NHS Quality, Improvement, Innovation and Productivity (QIPP) Plan. multi-disciplinary workforce - which can perform highly across all areas of public health competence. 3 Worcestershire Public Health Directorate Business Plan
Resources 7. The directorate staffing and commissioning budget with key areas of investment are shown in Table 1, and an overview of the directorate structure is shown in Figure 2. Table 1: Public Health budget 1. Staffing Health visiting 4,167,112 Public Health 2,376,577 Older people s health & well-being 300,000 Medicines Management 1,082,109 Substance misuse services 6,074,484 2. Health improvement unit 4. Health protection Smoking cessation 600,000 NHS resilience and response 25,000 Adult weight management 200,000 Health Trainers 350,000 5. Population healthcare Alcohol brief interventions 150,000 Health intelligence 50,000 Childhood weight management 150,000 Breast feeding peer support 100,000 6. Screening Chlamydia screening 525,000 Diabetic retinopathy 700,000 Sexual health service development 250,000 Bowel cancer TBC Health Checks 400,000 Abdominal aortic aneurysm TBC Cardiac rehabilitation Stage 4 10,000 Health information 80,000 7. Contingency Local projects 250,000 Reserves 132,524 3. Joint commissioning TOTAL 19,395,984 School nursing 1,423,178 7. Contingency HPV TBC Reserves 132,524 TOTAL 19,395,984 4 Worcestershire Public Health Directorate Business Plan
Figure 2: Overview of Directorate structure Director of Public Health Dr Richard Harling Health improvement Assistant Director PH: Dr Frances Howie Service improvement Assistant Director PH: Stuart Bourne Health protection PH Consultant lead: Dr Ash Banerjee Medicines Management Head of MM: Jane Freeguard Dental public health PH Consultant lead: Alan McMichael Partnership, strategy & leadership PH Consultant leads: Liz Altay & Karen Wright Healthy communities team Community pharmacy commissioning and primary care support Practice pharmacy team Health intelligence team PH Consultant lead: Peter Fryers Screening team Health information and training team Health improvement commissioning team GPCC commissioning support Joint commissioning support WCC commissioning support Health improvement Key performance indicators Reference Indicator Target Latest performance SQU18 Number of smoking quitters 3236 3,000 (FOt) SHA 2010/11 SHA Alcohol related hospital admissions 1670 1615 (Rate per 100,000 population) 2009/10 SQU19 Breastfeeding prevalence at 6-8 wks after birth 43.9% 41.1% SHA 2010/11 SHA Childhood obesity prevalence year 6 15.5% 18.9% 2009/10 SHA Teenage pregnancy rate 17.6 33.6 (Conceptions per 1,000 girls aged 15-17) 2010 2009 SHA Chlamydia screening coverage in young people 35.0% 23.4% aged 16-24 2010/11 SHA Access to GUM services 100% 99.9% (Appointments offered within 48 hours) 2010/11 SQU27 Health Checks coverage in men & women aged 8.1% 2.9% 40-74 2010/11 5 Worcestershire Public Health Directorate Business Plan
Aims organisations, and for discharging new responsibilities. health & well-being. iv. Support improvement of health, social care and related services and ensure that commissioning of these is carried out to a consistently high standard. Establish a Healthy Lifestyles Hub. Establish the Health Improvement Unit. Complete transfer of health improvement staff to provider organisations under Transforming Community Services. Develop options and plans for phased transfer of health improvement functions and organisations and for addressing any associated risks - under the Public Health Transitions Plan. This should include development of a S75 for transfer of functions and budgets from the PCT to the County Council in 2012/13 Refresh the health improvement and health inequalities strategies in line with the Joint Strategic Needs Assessment and Joint Health & Well-being Strategy, and lead the development and implementation of action plans to deliver these. Review and revise partnership health and well-being structures and processes under the HWB, ensuring appropriate multi-agency representation and community involvement. Work at locality level to improve health and well-being for local communities, in partnership with service providers and residents. Strengthen networks of health promotion champions throughout the statutory, business and VCS sectors. Increase the numbers of providers of healthy lifestyle services. Evaluate current services and projects to build the local evidence of what works. Continue to develop health information resources and social marketing campaigns to promote health, extending the reach into non-health settings. Develop a set of metrics and a governance framework to enable performance management of progress against health improvement aspects of the NHS QIPP programme. Achieve financial balance for the health improvement budget. Ensure that contracts are in place and effectively performance managed for all health improvement services. Provide professional public health advice and support to the Adults and Children s Joint Commissioning Units and the DAAT. Produce and implement a commissioning development programme for Joint Commissioning staff. Develop and run a CPD programme for West Mercia public health staff. Support Master s level study, practitioner registration in public health and specialist public health training. Increase the numbers of front line health and social care staff in all sectors who are trained to offer healthy lifestyles brief interventions. 6 Worcestershire Public Health Directorate Business Plan
Health protection Key performance indicators Reference Indicator Target Latest performance SHA DTaP/IPV/HiB vaccination coverage at 12 months 95.0% SHA MMR vaccination first dose coverage at 24 95.0% months SHA MMR vaccination two doses coverage at 5 95.0% years SHA Meningitis C vaccination coverage at 5 years 95.0% SHA Flu vaccination coverage in adults >65 yrs 75.0% 95.5% 91.3% 82.7% 95.6% 75.0% 2010/11 Q3 2010/11 Q3 2010/11 2010/11 2010/11 Aims organisations, and for discharging new responsibilities. health & well-being. iv. Support improvement of health, social care and related services and ensure that commissioning of these is carried out to a consistently high standard. Implement and evaluate the West Mercia Public Health on-call rota. Develop options and plans for transfer of health protection functions and organisations and for addressing any associated risks - under the Public Health Transitions Plan. Ensure that health protection issues are adequately reflected in the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy. Contribute to development of a governance framework to enable assurance of NHS resilience arrangements by the PCT Board and West Mercia PCT cluster. Test, review and update emergency plans including the Major Incident and Pandemic Flu Plans. Ensure that all NHS funded providers are compliant with business continuity requirements. Extend coverage of childhood and adult immunisation programmes. Develop a set of metrics and a governance framework to enable performance management of immunisation programmes by West Mercia PCT cluster. Ensure that contracts are in place and effectively performance managed for TB services, BBV and community infection control services. Ensure that public health and other key staff, including in GPCC, are familiar with emergency plans. Ensure that public health staff are appropriately trained for on-call duties. 7 Worcestershire Public Health Directorate Business Plan
Service improvement and screening Key performance indicators Reference Indicator Target Latest performance SHA Breast cancer screening coverage in last 3 years 70-80% 81.1% in women aged 53-70 Q1 2010/11 SQU20 Extend breast cancer screening to include 8% invited 31.9% women aged 47-49 and 71-73. Q4 2010/11 SQU22 Proportion of women receiving cervical cancer 98-100% 98.9% screening test results within 2 weeks Q2 2010/11 SHA Cervical cancer screening coverage in last 3½ 75-80% 70.8% years in women aged 25-49 Q2 2010/11 SHA Cervical cancer screening coverage in last 5 75-80% 77.6% years in women aged 50-64 Q2 2010/11 SHA Bowel cancer screening coverage in last 2 years 50-60% 59.2% in men and women aged 60-69 Q1 2010/11 SQU21 Extend bowel cancer screening coverage to Due Q3 men & women aged 70-75 SQU23 Diabetics invited for diabetic retinopathy 95-100% 96.7 screening in last year Q3 2010/11 Aims organisations, and for discharging new responsibilities. health & well-being. iv. Support improvement of health, social care and related services and ensure that commissioning of these is carried out to a consistently high standard. Lead the commissioning theme of the Council s transformation programme. Develop options and plans for transfer of service improvement and screening functions and organisations and for addressing any associated risks - under the Public Health Transitions Plan. Develop a process for Joint Strategic Needs Assessment. Complete a second iteration of the Joint Strategic Needs Assessment including a local profiling tool, deep-dive analyses specific areas and an Annual Public Health Report. Begin development of the Joint Health and Wellbeing Strategy Continue to roll out and develop screening programmes in line with national requirements including: breast screening digital mammography; age extension to bowel cancer screening; AAA screening; antenatal and postnatal screening. Develop a set of metrics and a governance framework to enable performance management of screening programmes by West Mercia PCT cluster. Achieve financial balance for screening budgets. Ensure that contracts are in place and effectively performance managed for all screening services. Ensure an appropriate response to QA requirements including implementation of any action required. Review and update the Worcestershire QIPP Plan Provide professional public health advice and support to GPCC. Produce and implement a skills and knowledge development module for the HWB. Produce a needs assessment toolkit for health and social care commissioners. 8 Worcestershire Public Health Directorate Business Plan
Dental public health Aims organisations, and for discharging new responsibilities. health & well-being. iv. Support improvement of health, social care and related services and ensure that commissioning of these is carried out to a consistently high standard. Develop options and plans for transfer of dental public health functions and organisations and for addressing any associated risks - under the Public Health Transitions Plan. Ensure that dental public health issues are adequately reflected in the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy. Co-ordinate local implementation of the dental epidemiological survey. Provide professional public health advice and support to the ongoing procurement of additional general dental capacity. Produce and implement a dental commissioning development programme for West Mercia primary care commissioning staff. Support the GDP Performance Review Process and Performer s List as required. Medicines management Aims organisations health & well-being iv. Support health and social care commissioning and ensure it is carried out to a consistently high standard Develop options and plans for transfer of medicines management functions and organisations and for addressing any associated risks - under the Public Health Transitions Plan. Establish procedures to ensure the pharmaceutical needs assessment is kept up to date. Ensure effective operation and governance of the Controlled Drug Local Intelligence Network. Ensure that contracts are in place and effectively performance managed for all community pharmacy services. Ensure that medicines management requirements are in place and effectively performance managed for all NHS funded providers. Ensure reporting of NHS QIPP prescribing metrics through the appropriate governance mechanisms. Horizon scan for new drugs and technologies and ensure appropriate prioritisation of in year developments and policies for their use. Provide expert advice and support to GPCC in relation to individual funding requests. Ensure that systems are in place to identify and address any performance concerns among community pharmacists. 9 Worcestershire Public Health Directorate Business Plan