The New Public Health
Landscape, its impact on
Local Authorities and the
obesity agenda
Angela Baker
[email protected]
Purpose of the session
This session will
• Share knowledge of the changes to the public
health system
• Commissioning for Obesity, a new landscape
• Key local figures and organisations and how
to engage with them
But first, who are we….
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Public Health England
Exists to protect and improve the nation's health and
wellbeing, and reduce health inequalities. It does this
through advocacy, partnerships, world-class science,
knowledge and intelligence, and the delivery of specialist
public health services. PHE is an operationally
autonomous executive agency of the Department of
Health.
I am a member of the Thames Valley PHEC. There are
three teams within the centre, Health Protection,
Healthcare Public Health and Health Improvement. We
all work together to achieve the above.
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Old Structure
A History Lesson
Pre 2012 Health and
Social Care Act we
had a structure which
looked like this. It was
hierarchical. PCT’s
were responsible for
commissioning health
services generally
though bundled
contracts
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Dept of
Health
18 Strategic
Health
Authority
151 Primary
Care Trusts
Providers
Current Structure
Dept of
Health
Public Health
Local Authority
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NHS England
Public Health
England
NHS E Regions
(X4)
Public Health
England Regions (4)
NHS E
Local Area Teams
(X24)
Public Health
England Centres (15)
Clinical
Commissioning
Groups
Obesity – what do we know?
Threat of obesity
• Over 2 billion adults, nearly a third of the worlds population and
an estimated 170 million children are overweight or obese
• Social norm in England with 2/3rd of adults either overweight or
obese
• Adults are not judging their weight and that of their children
accurately
• For some adults losing weight is not a priority – most overweight
or obese men are not actively looking to lose weight
• Locally there is a variation in obesity rates
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Obesity and Healthy Weight: An Update
Obesity prevalence by deprivation decile
National Child Measurement Programme 2012/13
25%
Year 6
23.7%
Reception
24.3%
22.2%
20%
20.5%
19.3%
Obesity prevalence
17.9%
15%
15.6%
16.4%
14.2%
10%
5%
11.7%
5.9%
6.9%
7.9%
7.4%
8.5%
9.2%
10.2%
10.4%
11.5%
11.9%
0%
Least
deprived
Index of Multiple Deprivation 2010 decile
Most
deprived
Child obesity: BMI ≥ 95th centile of the UK90 growth reference
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Obesity and Healthy Weight: An Update
Costs of diet, obesity and physical inactivity
9
•
Poor diet and its consequences including overweight/obesity,
cardiovascular disease, diabetes and some cancers make diet one of
the key priorities for public health to tackle.
•
70,000 premature deaths prevented in the UK if nutritional
recommendations on salt, saturated fat and added sugar were matched
•
Economic burden of diet related ill health estimated at £5.8 billion to
the NHS
•
Cost of overweight and obesity to the NHS about £5.1 billion
•
Physical inactivity contributes to almost 1 in 10 premature deaths, equal
to smoking
•
Physical inactivity is estimated to cost the UK £7.5bn annually (incl.
£1bn to NHS)
Obesity and Healthy Weight: An Update
Current shared ambition
• National ambition (Call to Action on Obesity)
By 2020:
• a sustained downward trend in the level of excess
weight in children
• a downward trend in the level of excess weight
averaged across all adults
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Obesity
Obesity
and
and
Healthy
Healthy
Weight:
Weight:
AnAn
Update
Update
Tackling obesity: one of PHE’s seven
priorities
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Obesity and Healthy Weight: An Update
Action at all levels
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Obesity and Healthy Weight: An Update
Obesity work plan: five pillars for action - 2014/15
Where future generations live in an environment, which promotes healthy weight and wellbeing
as the norm and makes it easier for people to choose healthier diets and active lifestyles
1.Systems
Leadership
• Influence local &
national leaders
• raise the national
debate
• influence political
ambition
• maximise
communication
2.Community
Engagement
• enable behaviour
change through
social marketing
• drive social
investment through
local action
• support
communities with
tools on healthy
eating & getting
active to help
reduce health
inequalities
3.Monitoring
& Evidence
Base
• enhance
surveillance, analysis
& signposting of data
• tailor evidence to
meet local needs PHOF
• support effective
commissioning &
evaluation
• develop &
communicate
research to inform
strategy
• promote evidence of
good practice
4.Supporting
Delivery
5.Obesogenic
Environment
• support the obesity
care pathway
• work with DsPH &
CCGs
• support
commissioning
• practical tools to
help deliver
healthier places;
enable active travel
• develop long term,
evidence based
strategy to deliver a
whole system
approach to tackle
the root causes of
obesity and
address health
inequalities
Tackle obesity, address the inequalities associated with obesity and improve wellbeing
13
Obesity and Healthy Weight: An Update
It is about real people
Business &
3rd sector
Communities
& local people
Treatment
Prevention
Awareness/
Recognition
Local authority action –
planning, leisure, social
care & environmental
Obesity and Healthy Weight: An Update
referral
support
services
Schools &
early years
CCG’S & NHS
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•
•
•
Over the next 18 months, PHE will
15
•
work with NHS England to implement the commitments to tackling obesity set
out in the NHS Five Year Forward View
•
produce an independent report for government on sugar and diet, including
evidence
•
reviews on fiscal measures and promotions and advice from the Scientific
Advisory Committee on Nutrition
•
publish the evidence-based Everybody Active, Every Day framework30 and
refresh the eatwell plate and 5 a day approach
•
run the New Year healthy eating campaign and summer physical activity
campaign, and increase the number of families signed up to Change4Life by
500,000
•
support local authorities to deliver whole system approaches to tackle obesity,
including through supporting healthier and more sustainable food procurement
Public Health England: Obesity Update
Whole systems approach
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Obesity and Healthy Weight: An Update
Commissioning of Tier 3 and 4
•
•
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NHS England and PHE convened a Joined Up Commissioning Responsibilities
Working Group following NHS England’s published clinical commissioning policy on
the specialised management of severe and complex obesity in April 2013.
•
A report of the conclusions published, proposed that CCGs would formally take
on the primary commissioning responsibility for tier 3 obesity services.
•
Informal consultation indicated that clarity on responsibility for Tier 3
commissioning was welcomed, and further information on commissioning
responsibility on local implementation was required.
‘Commissioning intentions 2015/16 for Prescribed Specialised Services’ published on
30 September 2014. Recommendations were that the following services currently
commissioned by NHS England should in future be commissioned by CCGs:
• renal dialysis (excluding encapsulating sclerosing peritonitis surgery)
• surgery for morbid obesity
Obesity and Healthy Weight: An Update
Not the only ones in the field?
• Who holds the power in your particular area, for what
you want to do?
• Sports Network, become a member?
• Where can you add value to other partners work?
• Which counsellors can you get involved?
• Is there a clinician you can engage with?
• Make a case about what you can offer and the benfits?
• Assume nothing
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19
Making the Case - ROI
• Seven tools, all do a different thing,
• Briefing Paper can be found at
http://www.noo.org.uk/news.php?nid=2707
• Most important thing is to work out what you need to
know
• NICE Guidance
• Build evaluation of programmes into the planning so that
you collect the right data and information
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Angela Baker, Public Health Consultant in Health Improvement