HC 1048-III Health CommitteeWritten evidence from Blackburn with Darwen (PH 136)

We welcome the opportunity to respond to the Health Select Committee inquiry into public health. Our response is in two sections—the first covering specific issues identified by the Committee and the second covering an additional issue which we feel needs to be highlighted.

1. Background

NHS Blackburn with Darwen Teaching Care Trust Plus, only the second of its kind in the country, was established on 1 April 2010 and has ensured the integration of health and social care commissioning across the local health economy. The health service and local authority have a history of strong and vibrant partnership working in Blackburn with Darwen (BwD) and our latest radical initiative places us at the leading edge of the national health and local government integration agenda,

The Care Trust Plus arrangement now formally allows us to come together to ensure that first class services are delivered in a more efficient manner that will support improved health outcomes for local people.

We have a very strong public/private/third sector and Blackburn with Darwen’s Local Strategic Partnership (LSP) was established in the late 1990s to work co-operatively for the common good of the borough, recognising that more could be achieved by a partnership approach than by agencies operating on their own.

2. Executive Summary

NHS Commissioning and GP commissioning consortia requires public health intelligence, advice and specialist input to implement the population approach and to bring about real change and commitment.

Public health budgets in the most deprived and poor health outcome areas of the country must be protected and enhanced.

We would like to see a more structured approach to Marmot’s evidence.

We are concerned with the proposals for a nationwide communications and engagement service.

Opportunity for local solutions need to be given the time to develop.

3. Specific issues identified by the Committee

3.1 The future role of local government in public health

The Borough is significantly challenged in terms of poor health determinants particularly in relation to housing, educational attainment, worklessness and adult skills levels. Effective action against these long term health outcome challenges requires BwD to develop an integrated public sector response and for this reason the Borough is a Community Budget Pilot.

We need to ensure regular interactions, joint working and enhanced accountability for the H&WB Board since this has been very powerful locally in BwD in terms of shared ownership of priorities, eg cancer, alcohol

Merger of public health and the Council will bring considerable benefits and this will create an opportunity for Public health to be a strong guiding/challenging force for improving health and wellbeing outcomes within Local Authorities

The Joint Strategic Needs Assessment (JSNA)/Integrated Strategic Needs Assessment (ISNA) remains a vital tool in service planning across all agencies and enabling planning to happen in a joined-up way. The role of the Joint Intelligence Unit (JIU) is key in delivering this as are other integrated working agendas through the Health and Wellbeing Strategy.

3.2 Arrangements for public health involvement in the commissioning of NHS services

It is vital that the strong links that have been forged between NHS and public health are not lost in the changes and we are concerned that there will be fragmentation of commissioning public health prevention/interventions services, eg screening, vaccination and immunisation. This leads to a further concern of where/how public health influences such decisions, i.e. if the NHS NCB commissions such services.

BwD recommendation—Wider health and social care professionals involvement will benefit the GPCC eg pharmacists, dentists, social care professionals, nurses, hospital consultants, public health representative.

BwD Recommendation—That all existing community children’s health services are integrated into the local public health service.

3.3 Arrangements for commissioning public health services

Adequate capacity is needed to meet Public Health functions. For example PCTs Prevention spend that will transfer to Local Authorities should be sufficient to meet the challenges proposed by the Public Health Outcomes Framework (they are not likely to be on current proposals).

3.4 The structure and purpose of the Public Health Outcomes Framework

The PH Outcomes Framework fits well alongside the frameworks for NHS and Adult Social care; the issue now will be ensuring that all three. frameworks are considered alongside each other and that this is incorporated into local performance reporting frameworks.

3.5 Arrangements for funding public health services (including the Health Premium)

There is a need to ensure that already challenged boroughs are not penalised further and that deprivation is taken into account for health premiums allocation.

The national funding formula should be based on need rather than an average of all areas, especially where areas are investing higher than average currently for future improved health outcomes.

3.6 The creation of Public Health England within the Department of Health

We feel that independence of Public Health England is crucial and PHE needs to be outside of DH.

3.7 How the Government is responding to the Marmot Review on health inequalities

The current policy rhetoric supporting Marmot Review is completely at odds with what is actually happening eg areas and groups with the greatest health inequalities are being hit hardest by funding cuts.

3.8 The abolition of the Health Protection Agency and the National Treatment Agency for Substance Misuse

There is a need to ensure that there is local innovation in addition to nationally driven objectives.

Again independence for these agencies should be outside of DH—as per PHE.

3.9 The future of the public health workforce (including the regulation of public health professionals)

Public Health England should employ Public Health Professionals.

Public Health Directors should be senior posts accountable to the LA Chief Executive if they are going to sufficiently influence anything meaningful in terms of resource allocation to health improvement.

(BwD PH Director is already accountable to LA Chief Executive).

4. Additional Issue

National Communications shared service

We have a well-established shared communications and engagement service in Blackburn with Darwen between the Care Trust Plus and Borough Council that builds on the partnership and single management of both organisations.

We are concerned that while the proposals for a nationwide communications and engagement service are not policy based and are not specifically included in the published NHS reform, they are being rapidly driven forward.

BwD recommendation

In addition to this the DH Social Marketing Strategy outlines “more will be done at a local level; the centre will do only those things which it alone is best placed to do” therefore if local health economies wish to locally target/innovate/engage with social media messages then DH cannot and will not do this.

Therefore locally owned communications is actually best practice.

June 2011

Prepared 28th November 2011