SUBMISSION OF EVIDENCE

SUBMISSION OF EVIDENCE Commons Health Select Committee: Inquiry on Public Health Response by the Wellcome Trust June 2011 Summary 1. Our key messages are: research plays a vital role in informing the evidence base for public health interventions. It is essential that research, evaluation and the use of evidence are embedded in the public health system; Public Health England (PHE) must be established in a form that enables it to provide independent advice to ministers, the Department of Health and the National Health Service (NHS). The proposed loss of independence of key functions currently undertaken by the Health Protection Agency (HPA) will seriously compromise the provision and use of scientific evidence for policy and practice; the fragmentation of public health services across local authorities may make it more difficult to deliver evidence-based services. A coordinated national approach to public health is required; reforms to the public health system need to be considered within the context of the proposed reforms in health and social care services, including the reorganisation of the NHS. The public health functions of the Department of Health, the NHS and the National Institute of Health Research need to be clarified and must be coordinated with PHE and local authorities; and we support the proposal that PHE will act as a central repository for public health data in England. In order to maximise the use of this resource it will be important that this is supported by appropriate mechanisms to facilitate access to these data for research. Introduction 2. Reform of the public health system in England provides an important opportunity to establish a new vision for public health, fit to respond to the challenges of the 21st century, including: an ageing population; the increasing burden of non-communicable diseases; and the threat posed by global infectious diseases. Realisation of this long-term vision for the provision of public health in England needs to be reflected in the structural reform of public health services. 3. Given the Trust s remit, our comments focus primarily on research and the use of evidence in informing public health policy and practice. We are pleased to have the opportunity to submit evidence to the Health Committee s inquiry and we welcome scrutiny of the Government s proposals to reform public health service provision, as part of the wider reforms outlined in the Health and Social Care Bill. We look forward to the publication of the Government s response to the consultation on the strategy for public health in England and note that this is likely to lead to significant changes to the Health and Social Care Bill. 4. The Wellcome Trust, the Medical Research Council and the Economic and Social Research Council held a joint workshop on 1 March 2011 that brought together public health practitioners and researchers. The aims of the workshop were to discuss the implications of the White Paper Healthy Lives, Healthy People and to discuss how evidence can be effectively translated into policy and practice in the new system. The discussions at the workshop and the report summarising the day s discussions have informed our response and is attached as an Wellcome Trust response to the inquiry on Public Health June 2011 Page 1 of 3

Annex to this paper. Our vision is that a reformed public health service for England must be able to: commission, undertake and adopt the results of high quality research; provide independent advice to Ministers; take a nationally co-ordinated view, with clear lines of accountability; draw on suitably trained professionals; make effective use of data from surveillance, patient records and research; and have the capacity to utilise a range of technologies. Research and evidence in public health 5. Although the White Paper Healthy Lives, Healthy People emphasised the importance of an evidence-based approach to public health policy and practice, both the White Paper and the Health and Social Care Bill fail to set out mechanisms to achieve this. 6. A public health research framework is needed to ensure that the full range of research that could inform public health policy is supported. This will include epidemiological research; natural experiments; social science research; health service research; bioethics research; and environmental health research. In turn, mechanisms must be in place to facilitate uptake of these findings into practice and to ensure that information is made available for all stakeholders in public health service provision to inform their policy and practice. Implementation of this approach can be promoted through improvements in education and training, and the development of incentives that reward adoption and ongoing evaluation of practice. 7. Robust methods to evaluate the success of public health interventions are required. The proposed Public Health Outcomes Framework and Health Premium, outlined in the White Paper, must be underpinned by the best available evidence and should be refined as evidence is gathered over time. 8. Research and evidence-based evaluation of public health policy and practice should be embedded in the new system for public health. One possible mechanism would be to create public health research networks, based on clinical research networks, that can coordinate research and act as the interface between researchers and health practitioners. A culture of research and the use of evidence must be fostered in all components of the public health system, notably PHE and the local authorities. This should be supported by legislative duties on these bodies to promote research and the use of evidence in public health services. Independence of public health functions 9. The HPA undertakes research and is responsible for providing independent advice on health protection issues. However, the Health and Social Care Bill would abolish the HPA and transfer its key functions to PHE within the Department of Health. This will undermine the actual or perceived independence of the advice provided. Public trust in Government advice was undermined during the BSE crisis due to a perception that Government scientists lacked independence, and this contributed to the establishment of an independent HPA in 2003. 10. Another potentially damaging consequence of moving the functions of the HPA to within the Department of Health is that it may compromise the ability to obtain external funding and carry out independent research, which is important in retaining expertise. The eligibility criteria of external funders, including the Wellcome Trust, will often not be met if the work is to be carried out within a Government department, and this would therefore limit the availability of resources to carry out research. The retention of expertise is fundamental to the role of providing advice; for example, the experts leading the UK response to the recent Fukushima nuclear accident were supported by external research funding. 11. It is essential that the public health system can provide Government with independent advice on health protection issues. We therefore propose that the functions of the HPA are retained at arm s-length from the Department of Health, for example within a Special Health Authority or Executive Agency. Wellcome Trust response to Public Health June 2011 Page 2 of 3

Coordination and national oversight are critical to avoid fragmentation 12. We are concerned that commissioning of public health services by local authorities will lead to fragmentation in public health service provision and increase social inequalities. Devolution to a local level is likely to make it more difficult to communicate and implement successful evidence-based initiatives consistently. Local authorities do not have experience of managing public health services or commissioning research at a local level and it is vital that some level of national oversight and coordination is maintained to ensure public health policy and practice can be refined over time. The White Paper proposes to abolish Public Health Observatories, removing a regional tier that could have provided advice to local authorities if they became responsible for public health commissioning. 13. Reform of public health must be considered alongside, and be compatible with, reform of the NHS and social care systems. The health reforms attempt to draw a distinction between prevention and treatment, as responsibilities of PHE and the NHS, respectively. However, this distinction is somewhat arbitrary. Prevention and treatment lie along a continuum with overlap between the two spheres; for example, public health practice spans health promotion, health protection and improvement of health services. The reforms should take a holistic view of public health within health and social care and the Government should outline how the responsibilities of the National Institute of Health Research, the Department of Health, the NHS, local authorities and PHE will be coordinated. 14. The commissioning arrangements outlined in the Health and Social Care Bill are confusing and lack detail. As outlined in paragraph 12, it will be necessary to coordinate public health services commissioned through the NHS, PHE and local authorities, as well as commissioning social care and research. We welcome the Health Committee s proposals that local Directors of Public Health should be represented on the proposed commissioning consortia; and that coterminosity of these consortia with social care structures should be encouraged to facilitate integration 1. 15. We believe that the local commissioning consortia, alongside local authorities and PHE, should support and foster public health research. We welcome the creation of the NIHR School for Public Health Research and the Policy Research Unit of Behaviour and Health to promote the role of research and its adoption into practice, as outlined in the White Paper. However, we would welcome further clarification on the roles of these organisations. 16. The Government should clarify the functions of organisations involved in public health research and the mechanisms for their coordination. Embracing new technology and the use of patient data 17. It is essential that the public health system is responsive, and can adapt to emerging technologies, such as genomics and informatics, and it is therefore critical that research is embedded in the public health and healthcare systems. It is essential that the single repository for population health data, research and surveillance, as outlined in the White Paper, is created. This will require a specialist workforce for analysis and development of the webbased system, as well as training at a local level in public health and primary healthcare settings to maximise its potential. Concurrently, mechanisms must be developed to ensure that this valuable resource is available for public health research while safeguarding individuals data. 2 These issues must be taken into account in the upcoming Information Revolution strategy. 3 The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. We support the brightest minds in biomedical research and the medical humanities. Our breadth of support includes public engagement, education and the application of research to improve health. We are independent of both political and commercial interests. 1 http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/796/79612.htm 2 http://www.wellcome.ac.uk/stellent/groups/corporatesite/@policy_communications/documents/web_document/wtvm049559.pdf 3 http://www.dh.gov.uk/en/consultations/liveconsultations/dh_120080 Wellcome Trust response to Public Health June 2011 Page 3 of 3

PUBLIC HEALTH WORKSHOP REPORT Department of Health White Paper: Healthy Lives, Healthy People March 28 2011 Workshop hosted by the Wellcome Trust in partnership with the Medical Research Council and the Economic and Social Research Council

- 2-1. Aims The aims of this workshop were: To bring together key stakeholders to discuss the implications of the White Paper: Healthy Lives, Healthy People. To develop a plan for how the key stakeholders will work together to ensure that research and evaluation are fully integrated into the new structures so that research evidence is effectively translated into policy and practice. 2. Introduction The Government published its White Paper on Public Health, Healthy Lives, Healthy People: Our Strategy for Public Health in England on 30 November 2010. The White Paper describes key areas for Public Health improvements and a new system to deliver these improvements and other Public Health functions, including health protection and emergency planning and response. The legislative changes required to implement these proposals are currently before Parliament in the Health and Social Care Bill. The White Paper emphasises the importance of evidence and research in informing Public Health interventions and calls for the development of a culture of using evidence to prioritise what we do. This is not the first White Paper on Public Health published by the Government, but it aims to go further in addressing health inequalities in the UK through high-level structural changes, ring-fencing of the Public Health budget, and moving back to Local Authority control. Proposals for research include the formation of an NIHR School for Public Health. The Government is consulting on specific questions set out in the White Paper, the Public Health outcomes framework, and the funding and commissioning of Public Health, up to 31 March 2011. The meeting involved 42 participants, including Public Health practitioners, researchers, funders, and policy-makers. Sir Mark Walport gave an opening address, followed by Tim Baxter from the Department of Health who described the key elements of the White Paper and the Government s strategy for Public Health in England (see Annex 1). There were then a series of short presentations outlining the perspectives of other stakeholders. During the afternoon session, panel and general discussions were held on issues raised in the White Paper. Please see Annex 2 for the programme and speakers. 3. The Challenge The White Paper states that the mission of the new public health service - Public Health England - is to protect and improve the public s health, improving the health of the poorest, fastest. Central to this is evidence-based policy, and this implies that research and evaluation must be fully integrated into the new structures: Fig. 1: The relationships between research and evidence in public health Evaluation Research Evidence base Policy Implementation

- 3 - Sir Mark challenged the participants to develop a vision for UK Public Health in the 21st century, using the opportunity of the consultation on the White Paper to input into the development of the new structure. 4. Summary of Discussion Research Evidence and Evaluation are an integral part of Public Health Strategy Issues: The White Paper stresses the need to use evidence to inform policy but currently the different communities researchers, practitioners and policy-makers are relatively separate and do not communicate effectively. Public Health research is about more than Randomised Controlled Trials and the field must make greater use of natural experiments and other evaluation techniques, addressing the second gap in translation and demonstrating with appropriate evaluation what works in practice. Recommendations: Appropriate incentives and requirements should be put in place to ensure that researchers, practitioners, and policy-makers work together and use a collaborative problem-solving approach from the beginning of any research project or implementation of new policies. The gap between research and service must be bridged, and as part of this, the utility of surveillance data as a research tool should be harnessed. Transdisciplinary Action Research (Stokols, 2006) engages policy, practice and public partners through a cycle of problem identification, development, research, and implementation. It should be employed as a process to engage researchers, policymakers, and practitioners in Public Health research. The value of Social Science research, Health Systems research, and research into methodological issues should be recognised as integral parts of furthering the Public Health research agenda. Independence and accountability Issues: If the proposed changes are implemented, Public Health England will be part of the Department of Health and therefore not independent of Government, leading to a potential loss of public confidence in its advice and accountability. Bringing the functions of the Health Protection Agency into Public Health England (PHE) within the Department of Health is likely to jeopardise the conduct of research currently carried out by the HPA because potential sources of funding will be severely limited; this may result in the loss of valued expertise. Recommendations: PHE should be separated from Government Departments in order to be able to offer independent advice to national and local government, the NHS and the public. It could be constituted as a Special Health Authority or, if that is not acceptable, as an executive agency of the Department of Health. It is essential that researchers employed by PHE are at arm s-length from government, in order that they can access funding from a wide variety of sources. Balance between localism versus centralism

- 4 - Issues: There are some potential benefits of localism and in particular this might allow for better coordination of the delivery of Public Health services with other services that have an impact on health, for example, education, housing and transport. There are potential risks posed by delivering Public Health services through Local Authorities and in particular this fragmentation may make it even more difficult than at present to connect research and practice. The regional tier of Public Health functions, which currently includes the Public Health Observatories (PHOs), supports many local activities where specialist expertise is required which cannot be provided efficiently at a local level. Loss of this tier could be detrimental: PHOs, have an important knowledge-sharing function, for example, in producing local inequalities profiles for all Local Authorities in England. Local Authorities and GP Consortia are not experienced or sufficiently aware of issues involved in commissioning and managing health services and related public health research, and will need support in order to contribute to this. Recommendations: Roles, responsibilities and accountability in the new system should be clearly defined. There should be an appropriate balance between localism and centralism. Delivery of Effective Services Issues: The White Paper is focused on health promotion and protection and overlooks key issues in health services provision and research. While health services are the main focus of the current Health and Social Care Bill, it is important to remember that assessing the effectiveness and efficiency of health service delivery is a key Public Health function. The proposed restructuring of the health service will create a system that is driven by market forces and there are risks associated with the fragmentation of health service commissioning and delivery. Local Authorities do not have expertise in the commissioning of Public Health services and therefore there is a danger that these may be commissioned on the basis of market choice rather than need. Recommendations: A plan for implementation of the delivery of health services is required, with clarity on a number of issues relating to Health Service Provision, for example, on what is meant by any willing provider. The relationship between data, surveillance, and evidence Issues There will be benefit from providing a single repository in PHE for data on the population s health. Robust data from surveillance and health intelligence will be vital to inform the evidence base and future practice. There is a tension between the needs for generalisable data and data that contains enough granularity to be of use for the Local Authorities when implementing interventions in the local context. There is a danger that national data collection and surveillance networks could be undermined/disrupted by fragmentation of the PH function at Local Authority level.

- 5 - Recommendations: The collection timeliness and quality of data produced by Local Authorities to inform Public Health outcomes and policy should be overseen by PHE. Data sharing should be encouraged in order to make maximum use of data from population cohorts and demographic studies, and relevant databases should be linked where possible. New technological advances, for example, in the fields of infection, genomics and the information management should be embraced and applied in the Public Health field. Training and workforce capacity Issues: It is essential that a critical mass of Public Health skills, and expertise in monitoring and evaluation is maintained. This will be particularly important in the proposed environment where Public Health functions will be fragmented. Masters programs could be a key bridge between academic and service practice in Public Health, but the current cuts to education will threaten access to these programs. Recommendations: Avenues for facilitating Public Health training and research which could be explored include allowing greater specialisation within the accreditation process, allowing greater flexibility to actively encourage academic careers, considering non-research doctorates, and joint appointments spanning research and practice. Continuing Professional Education is key to ensuring relevant training among non-academics. Clarity is needed on the contractual framework for staff whose functions are transferring from the NHS or arm s-length bodies to Local Authorities or the civil service. In particular, there is concern about Public Health specialists losing NHS terms and conditions of service which will discourage future entry into the specialty. 5. Summary To fulfil the mission of PHE, the following elements are essential: People The workforce (spanning researchers, practitioners and policy makers) must be equipped with the right training and skills to be able to take advantage of technological innovation. Research Environment The new structure must be set up so as to promote Transdisciplinary Action Research and ensure the integration of research, evaluation, policy and practice. Partnerships, roles and responsibilities To ensure Public Health policy is evidence-based, there must be mechanisms and incentives to enable researchers, practitioners, and policy-makers to work together in partnership. To this end, roles, responsibilities, and accountabilities of all parties in the new structure must be clarified. In Table 1, we have suggested roles for key stakeholders. It is the responsibility of all stakeholders to communicate effectively with each other and with the public, commentators, think tanks, media, and other relevant stakeholders. Independence and Accountability

- 6 - To ensure independence, accountability, and public confidence in Public Health England, it must be clearly separated from the government; this could be achieved if it is set up either as a Special Health Authority or, if it must be part of the Department of Health, an Executive Agency. Table 1: Proposed Role and Responsibilities of key stakeholders in the new system Stakeholder Department of Health Public Health England Faculty of Public Health Directors of Public Health of Local Authorities GP Commissioners Role Ensure the new public health system enables and encourages close working relationships between public health researchers, practitioners and policy makers Ensure that the new system does not disrupt existing access to information and data needed for public health research and practice Ensure that public health training is organised alongside training for other medical specialties, with similar routes of access, standard setting and quality assurance. Offer independent advice to national and local government, the NHS, and the public, throughout the UK; Provide effective, expert, and adequatelyresourced local teams, supporting and working closely with local services, including the DPH. Employ, on NHS terms and conditions, public health specialists and consultants to support all three domains of public sector public health activity, seconding them to other agencies (including local authorities) as necessary and deploying scarce expertise effectively. Set standards for all Public Health practice in the UK. Enable and encourage practitioners to access the evidence to inform their decisions and advice. Ensure public health specialists have the skills needed to access, use and provide evidence on health needs and public health interventions Provide strategic leadership. Produce an independent, public annual report on the health and needs of the population. Have direct access to the Local Authorities cabinet and councillors. Be directly accountable to the Local Authority CEO. Have responsibility for managing the ringfenced Public Health budget and public health staff. Work with and through the Directors of Public Health to ensure that commissioners decisionmaking is underpinned by expert, professional Public Health advice.

- 7 - Research Funders Researchers / Academics Policy-makers Ensure researchers are engaging and communicating effectively with practitioners and policy-makers from the beginning of a project. Provide leadership and be involved in agendasetting and funding of priority areas in the research of methodologies, the application of new technologies, health systems research, evaluation, cohort studies, quality of data, datasharing, etc. Engage in high quality Public Health teaching and research at all the undergraduate, postgraduate, and continuing professional education levels. Be closely engaged with policy-makers as well as all levels of Public Health service. Work with researchers and practitioners from the onset of a project to ensure that evidence is gathered from evaluations and other sources to feed into policy-making. 6. Next Steps This report will be fed back to the participants of the Public Health Workshop and will inform the funders consultation responses to the White Paper.

- 8 - ANNEX 1 Healthy Lives, Healthy People Our strategy for public health in England Another White Paper on public health... This is not the first ever White Paper on public health: Health of the Nation: a strategy for health in England (1992) Saving lives: our healthier nation (1999) Choosing Health: making healthier choices easier (2004) Healthy lives, healthy people: our strategy for public health in England (2010) What makes this one different and more likely to succeed?

- 9 - Healthy lives, healthy people Healthy lives, healthy people sets out a framework for tackling some of the most intractable social issues The White Paper: starts from the evidence base (Chapter 1) Articulates a radical new approach to public health, including the concept of a ladder of interventions (Chapter 2) Takes a life course approach, rather than focusing on specific policy areas such as smoking or obesity (Chapter3) Sets out a new organisation for public health, including a critical role for local government and a new clarity to central government s role I expand on these points below Our Health and Wellbeing Today We are living longer than ever before with dramatic changes in the nature of health over the last 150 years infectious diseases now account for only 2% of deaths 4 in every 5 deaths occur after the age of 65 clean air, water, and environmental protection BUT: success brings new challenges circulatory diseases account for 34% of deaths cancers 27% and respiratory diseases 14% rising prevalence of mental ill-health persistence of long-term conditions Lifestyles and behaviours influence our outcomes and inequalities 21% of the adult population still smoke 61% of adults are overweight or obese Fewer than 40% of adults meet physical activity guidelines 2.4 million adults regularly drink more than recommended

- 10 - A radical new approach The mission is to protect and improve the public s health, improving the health of the poorest, fastest Reach out and reach across addressing the route causes of poor health and wellbeing, reaching out to those who need the most support Representative owned by communities and shaped by their needs Resourced with ring-fenced funding and incentives to improve Rigorous professionally-led, focused on evidence, efficient and effective Resilient strengthening protection against current and future threats to health Health and wellbeing throughout life Starting well: enabling good health in mothers before, during and after pregnancy and good parenting Developing well: encouraging healthy habits and avoiding harmful behaviours Growing up well: identifying, treating and preventing mental health problems and creating resilience and self-esteem Living and working well: choosing lifestyles and behaviours that influence health and productivity Ageing well: supporting resilience through social networks and activity and providing protection from preventable ill-health

- 11 - A new public health system Public Health England a national public health service A return of public health leadership to Local Government Professional leadership nationally and locally Dedicated resources for public health at national and local levels Focus on outcomes and evidence based practice supported by a strong information & intelligence system Maintaining a strong relationship with the NHS, social care and civil society Set out in the Health and Social Care Bill A new public health service - Public Health England New public health service directly accountable to the Secretary of State for Health with a clear mission to; 1. Achieve measurable improvements in public health outcomes; and 2. Provide effective protection from public health threats It will do this by; 1. Protecting people from infectious disease and biological, chemical and radiological threats; 2. Helping people and families to be able to take care of their own health and wellbeing; and 3. Inspiring challenging and commissioning partners from all sectors.

- 12 - The Director of Public Health, a proposed role Will be jointly appointed by the relevant local authority and Public Health England and employed the local authority with accountability to locally elected members and through them to the public Will be the principal adviser on all health matters to the local authority, its elected members and officers, on the full range of local authority functions and their impact on the health of the local population Will play a key role in the proposed new functions of local authorities in promoting integrated working Jointly lead the development of the local Joint Strategic Needs Assessment (JSNA) and the joint health and wellbeing strategy (with Directors of Adult Social Services and Directors of Children s Services) Will continue to be an advocate for the public s health within the community Will produce an authoritative independent annual report on the health of their local population Public health funding and commissioning Local communities Local Authorities GP Consortia Providers Department of Health including Public Health England NHS Commissioning Board Key Route for funding Route for accountability

- 13 - Public health funding and commissioning -examples Proposed activity to be funded from the new public health budget (provided across all sectors) Proposed commissioning route/s for activity (including any direct provision) Examples of proposed associated activity to be funded by the NHS budget (including from all providers) Infectious disease Current functions of the Health Protection Activity in this area, and public health oversight of prevention and control, including co-ordination of outbreak management PHE with supported role by local authorities Treatment of infectious disease; co-operation with PHE on outbreak control and related activity All screening PHE will design, and provide the quality assurance and monitoring for all screening programmes NHS Commissioning Board (cervical screening is included in GP contract) - Obesity programmes Local programmes to prevent and address obesity, e.g. delivering the National Child Measurement Programme and commissioning of weight management services Local authority NHS treatment of overweight and obese patients, e.g. provision of brief advice during a primary care consultation, dietary advice in a healthcare setting, or bariatric surgery Public health funding and commissioning - public health and the NHS The NHS will commission some public health services, with funding passed from Public Health England. In addition, the NHS will have an ongoing role in certain services with public health aspects - the Department expects that public health continues to be an integral part of primary care services. Public health expertise will inform the commissioning of NHS funded services, facilitating integrated pathways of care for patients. This will be underpinned: locally by ensuring DsPH are able to advise the GP consortia; and nationally via the relationship between the Secretary of State/ Public Health England and the NHS Commissioning Board. We are consulting on public health commissioning in the funding and commissioning consultation document

- 14 - Public health funding and commissioning - allocations and the health premium Allocations From April 2013, Public Health England will allocate ring-fenced budgets, weighted for inequalities, to upper-tier and unitary authorities in local government. Shadow allocations will be issued to LAs in 2012/13, providing an opportunity for planning. We propose to move to actual allocations from current spend towards the target allocations over a period of time. We will take independent advice on how the allocations are made. Health premium Building on the baseline allocation, LAs will receive an incentive payment, or health premium, that will depend on the progress made in improving the health of the local population and reducing health inequalities, based on elements of the Public Health Outcomes Framework. The premium will be simple and driven by a formula developed with key partners, representatives of local government, public health experts and academics. We are consulting on public health allocations and the health premium in the funding and commissioning consultation document Public health funding and commissioning - accountability Secretary of State is accountable for: resources allocated to the health and social care system as a whole strategy and for the legislative and policy framework progress against national outcomes PHE (within DH) accountable to the Secretary of State Local government accountable to local populations in improving outcomes in health and wellbeing accountable to PHE for spending public health grant according to conditions Health and Wellbeing Boards charged with assessing and agreeing local priorities Data published in one place by Public Health England enabling national and local democratic accountability for performance against outcomes, enabling: easy comparison by local areas with others/peers across the country Incentivising of improvements tracking progress at a national level towards health improvements across the country

- 15 - Public Health Outcomes Framework -the vision The mission: to improve and protect the nation s health and to improve the health of the poorest, fastest Domain 1 - Health Protection and Resilience: Protecting the population s health from major emergencies and remain resilient to harm Domain 2 - Tackling the wider determinants of health: Tackling factors which affect health and wellbeing and health inequalities Domain 3 - Health Improvement: Helping people to live healthy lifestyles, make healthy choices and reduce health inequalities Domain 4 - Prevention of ill health: Reducing the number of people living with preventable ill health and reduce health inequalities Domain 5 - Healthy life expectancy and preventable mortality: Preventing people from dying prematurely and reduce health inequalities We are consulting on public health outcomes in the outcomes framework consultation document Public Health Outcomes Framework -the indicators Criteria for how we developed proposed indicators Are there evidence-based interventions to support this indicator? Does this indicator reflect a major cause of premature mortality or avoidable ill health? By improving on this indicator, can you help to reduce inequalities in health? Will this indicator be meaningful to the broader public health workforce and to the wider public? Is this indicator likely to have a negative / adverse impact on defined groups (groups sharing a characteristic protected by equalities legislation)? (If yes, can this be mitigated against?) Is it possible to set measures, SMART objectives against the indicator to monitor progress in both the short and medium term? Are there existing systems to collect the data required to monitor this indicator; and Is it available at the appropriate spatial level (e.g. Local Authority)? Is the time lag for data short, preferably less than one year Can data be reported quarterly in order to report progress?

- 16 - Public Health Outcomes Framework alignment with the NHS AND Adult Social Care Adult Social Care and Public Health: Maintaining good health and wellbeing. Preventing avoidable ill health or injury, including through reablement or intermediate care services and early intervention. Adult Social Care Public Health NHS ASC, NHS and Public Health: The focus of Joint Strategic Needs Assessment: shared local health and wellbeing issues for joint approaches. NHS and Public Health: Preventing ill health and lifestyle diseases and tackling their determinants. Awareness and early detection of major conditions Adult Social Care and NHS: Supported discharge from NHS to social care. Impact of reablement or intermediate care services on reducing repeat emergency admissions. Supporting carers and involving in care planning. Transition -a timetable Summary timetable (subject to Parliamentary approval of legislation) Consultation on: specific questions set out in the White Paper; the public health outcomes framework; and the funding and commissioning of public health. Set up a shadow-form Public Health England within the Department of Health Start to set up working arrangements with local authorities, including the matching of PCT Directors of Public Health to local authority areas Develop the public health professional workforce strategy Public Health England will take on full responsibilities, including the functions of the HPA and the NTA. Publish shadow public health ring-fenced allocations to local authorities Grant ring-fenced allocations to local authorities Date Dec 2010 March 2011 During 2011 Autumn 2011 April 2012 April 2013

- 17 - Transition - leadership Accountability for delivery in 2011/12 will continue to rest with SHAs and PCTs In addition, SHAs will be responsible for the overall transition process in their regions during 2011/12 with co-ordination and leadership for public health from DH As part of this, Regional Directors of Public Health (RDsPH) will lead the transition for the public health system at the regional and local level Healthy Lives, Healthy People consultation Public Health White Paper - Role of GPs and GP practices in public health - Public health evidence - Professional regulation (independent review) Outcomes Framework for Public Health Funding and Commissioning for Public Health Find consultation documents at: www.consultations.dh.gov.uk/healthy-people Respond to consultations at: publichealthengland@dh.gsi.gov.uk

- 18 - ANNEX 2 - PROGRAMME Public Health Workshop to discuss: Department of Health White Paper Healthy Lives, Healthy People 1 March 2011 Programme 9.30: Registration and coffee Chair: Anne Johnson 10.00 Welcome and opening remarks Anne Johnson (UCL) 10.10 Public Health going forwards..what is the vision? Mark Walport (Wellcome Trust) 10.40 Introduction to the White Paper Tim Baxter (Department of Health) Stakeholder perspectives: 11.00 HPA: Anthony Kessel Researchers: 11.15 The Big Picture - John Frank (Scottish Collaboration for Public Health Research and Policy) 11.30 The Academic-NHS interface - Rosalind Raine (UCL) 11.45 Faculty of Public Health: Lindsey Davies 12.00 Public Health Observatories: Bobbie Jacobson (London Health Observatory) 12.15 General discussion 1.00 Lunch 1:45 Panel and general discussion on issues raised in the White Paper: Research evidence and evaluation as an integral part of Public Health strategy (Laurence Moore - Cardiff Institute of Society and Health) Interactions between researchers, practitioners and policy makers (Dave Buck King s Fund) Training and workforce (Mala Rao - Indian Institute of Public Health) Delivery of effective services (John Nicholl - ScHARR, University of Sheffield)

- 19 - Role of the Faculty of Public Health (Lindsey Davies) 3.00 Tea 3.20 Panel and general discussion. A plan for the future: what can the funders do to make the Public Health reforms work? Perspectives and priorities. Dawn Woodgate (ESRC) Wendy Ewart (MRC) Mark Walport (Wellcome Trust) 3.55 Conclusions and recommendations (Anne Johnson) 4.00 Close