Healthcare Features
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Local authorities will be “in the driving seat” when it comes to securing improvements in public health, Health Secretary Andrew Lansley claimed today on the publication of the government’s keenly-anticipated White Paper.
Town hall chiefs said the proposals represent a great opportunity for local authorities, but warned that they do not go far enough and there was a risk of a swing towards central control.
Key proposals in Healthy Lives, Healthy People, which was published today and only applies to England, include:
- The creation of Public Health England – located within the Department of Health – as a service to give “more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics”. It will take on full responsibilities from 2012. Public Health England will combine experts from bodies such as the Health Protection Agency and the National Treatment Agency. It will also be a “knowledge bank” for evidence on behaviour change techniques and monitoring data
- Ring-fencing of public health funding from the overall NHS budget. Government estimates suggest that Public Health England will have responsibility for £4bn.
- Local health improvement functions will be transferred to local government, with the ring-fenced funding allocated to upper-tier and unitary authorities from April 2013. Local authorities will have a duty to take steps to improve the health of their population
- Local government will also be given new functions to “increase local accountability and support integration and partnership working across social care, the NHS and public health”
- The majority of public health services will be commissioned by local authorities from their ring-fenced budgets or by the NHS through Public Health England’s new public health budget
- Directors of Public Health will be employed by the relevant upper-tier or unitary local authority “and be the ambassadors of health issues for the local population”. This means in practice that they will lead discussion about how the ring-fenced money is spent and also influence investment decisions right across the local authority. The White Paper says directors will be able to “make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions”. The role can be shared with other local councils if agreed locally
- The government will take forward detailed proposals for the establishment of health and wellbeing boards in every upper-tier local authority. “They will also have the flexibility to bring in the local expertise of district councils”. There will be a proposed minimum membership of elected representatives, GP consortia, Directors of Public Health, Directors of Adult Social Services, Directors of Children’s Services, local HealthWatch, and, where appropriate, the participation of the NHS Commissioning Board
- The new general power of competence will provide local authorities “with much greater freedom and flexibility to act in the interests of their communities”
- A health premium will take into account health inequalities and reward progress on specific public health outcomes. The Department of Health will consult on the detail of how the outcomes framework and the funding will work, but disadvantaged areas will receive a larger premium if they make progress
- The Department of Health will publish documents on mental health, tobacco control, obesity, sexual health, pandemic flu preparedness, health protection and emergency preparedness in 2011. The government wants to see a more coherent approach to mental health in particular, and will shortly publish a new mental health strategy
- A new “Public Health Responsibility Deal” will be driven forward by the Health Secretary with a view to making it easier for people to make healthy choices. This is likely to include “better food labelling, more information about alcohol harms, and much bigger contribution from industry around campaigns like Change4Life”.
The White Paper said: “There is huge potential to meet people’s needs more effectively and promote the best use of public resources through close working relationships between local authorities and the NHS, to further integrate health with adult social care, children’s services (including education) and wider services, including disability services, housing, and criminal justice agencies. There will be sufficient flexibility in the legislative framework for health and wellbeing boards to go beyond their minimum statutory duties to promote joining-up of a much broader range of local services for the benefit of their local populations’ health and wellbeing.”
The core elements of the new system will be set out in the forthcoming Health and Social Care Bill.
The Department of Health has also published a review of the regulation of public health professionals. It said the government’s preferred approach was to ensure “effective and independently assured voluntary regulation for unregulated public health specialists”. This will be overseen by the Council for Healthcare Regulatory Excellence, as provided for in legislation currently before Parliament.
Lansley said: “Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health.
“People’s health and wellbeing will be at the heart of everything local councils do. It’s nonsense to think that health can be tackled on its own. Directors of Public Health will be able to champion local cooperation so that health issues are considered alongside housing, transport, and education.”
The Health Secretary argued that people should have services tailored for them, “at the right times in their life from the professionals closest to them”.
He added: “With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation’s health.”
Responding to the White Paper, Cllr David Rogers, chairman of the Local Government Association’s community wellbeing board, said: “Public health has been the core business of local government since its foundation. Many councils already put a lot of effort, resources and imagination into improving the health and happiness of their communities.
“We believe public health should be at the heart of all we do, so the government’s decision to give town halls a wider role presents us with a great opportunity to build on the good work which already exists across the country.”
He added: “This White Paper states it is time to free up local government and local communities to decide how best to improve the health and wellbeing of their citizens, but it doesn’t go far enough and leaves many questions unanswered. Behind the language of greater freedom lies a swing to central control which risks hampering town hall efforts to boost health.
“With Public Health England employing the majority of the public health workforce, how can we make sure local and national needs work hand in hand? How can we answer to government when the people leading on public health don’t answer to us? Public Health Directors must be accountable to councils.”
Cllr Rogers praised the government for recognising that councils will need more money to perform the extra public health duties contained in the White Paper. However, he added: “Not only should we make sure they're given enough to do the job, they also need the financial freedom to effectively take on the challenges of improving their residents’ health. How the public health ring-fence will work must be made clear.”
The Chief Medical Officer (Interim), Professor Dame Sally Davies, said: “We need a strong and protected public health system to tackle our public health problems, and protect the public. So I welcome this Public Health White Paper which sets out how a new core public health service, Public Health England, will integrate public health expertise, providing national support and advice, for local delivery.
“By joining up the local work done by the NHS, social care, housing, environmental health, transport and leisure services and focusing on public health at a local level, this paper lays out a strategy to improve the health and wellbeing of the nation, and addresses the issues of health inequalities.”
A copy of the White Paper can be downloaded here. The deadline for responses is 8 March 2011.
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The proportion of reported data loss incidents that involve the healthcare sector doubled in the first six months of 2010, according to research by professional services firm KPMG.
The sector accounted for 25% of all incidents, KPMG’s 2010 Data Loss Barometer found. The Information Commissioner’s Office has already warned that the NHS has seen the highest number of serious breaches since 2007.
Healthcare was closely followed by government – both central and local – which was involved in a fifth of all incidents.
KPMG’s research also showed that one in five reported data loss incidents in the first half of 2010 came from malicious attacks inside the affected organisation. The percentage of incidents from malicious attacks has been growing rapidly – such incidents accounted for only 4% of the total in 2007. Hacking nevertheless remains the biggest threat, the Data Loss Barometer suggested.
On a positive note, there was a decrease in the number of publicly disclosed incidents for the second year in a row.
On malicious attacks, Malcolm Marshall, head of the information security practice at KPMG in the UK, suggested that the recession may have played its part in driving up the increase, as data becomes an increasingly valuable commodity.
“But the alternative is that as organisations get wiser to the tactics of hackers, then criminals may be tempting staff to pass on valuable information – hence the massive growth in the insider threat,” he warned.
Publication of the research results comes just days after the ICO fined Hertfordshire County Council £100,000 for accidental data breaches in its childcare litigation unit.
Employment services company A4e was also handed a £60,000 penalty for failing to use encryption on a laptop containing information on customers of two law centres. The laptop was then stolen from an employee’s home.
KPMG’s Marshall said: "The fear of tougher sanctions, regulatory developments and negative publicity appears to have increased the awareness of the need to protect vital information. But as 'cyber wars' begin to take hold as a threat, and criminals constantly seek new ways of infiltrating systems, businesses and individuals alike need to ensure the security of their data is given utmost priority.”
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A private health company has been appointed as recommended bidder for an NHS hospital in Huntingdonshire, but senior NHS officials have insisted that the move does not represent privatisation.
The deal, which will see Circle run Hinchingbrooke Hospital, is the first time an operation franchise has been offered for an NHS acute hospital in England. “Uniquely it was achieved via an open and competitive process,” NHS East of England said in a statement.
Key elements of the deal are:
- Circle will be appointed for a 10-year franchise term, taking over from 1 June 2011
- Within that period it is planning to repay all the hospital’s £38.8m historic debt
- There is no subsidy
- Staff and assets remain part of the NHS
- Clinical and non-clinical services will be provided via the operating franchise agreement
- A full range of acute hospital services – including accident and emergency and maternity services – will be provided. However. services provided by other organisations such as Cambridgeshire Community Services NHS Trust, through contractual arrangements with NHS Cambridgeshire, are unaffected.
The Department of Health will now consider whether to approve Circle’s appointment. The unsuccessful bidder was Serco.
More details of the deal will be made public once it is approved by the Department and other regulators.
“Until that time they remain commercial and in confidence, in accordance with UK and international purchasing law,” NHS East of England said.
Dr Stephen Dunn, Director of Strategy at NHS East of England, said Hinchingbrooke was heavily indebted and might have had to close or receive a large subsidy from the taxpayer.
“Thanks to this process this is not the case,” he added. “This is not privatisation. Staff and assets will be protected, and the taxpayer will not be forced into bailing out Hinchingbrooke. This could be a model for hospitals that face similar challenges.”
Ali Parsa, Circle’s managing partner, said its co-operative model offered a “Big Society” solution for the hospital. Circle is an employee-owned social enterprise with more than 2000 clinicians. It already has day surgery hospitals in Nottingham and Burton that provide NHS services to 130,000 NHS patients a year.
“This is a great opportunity for a social enterprise and local clinicians to come together to lead the next chapter in the long and successful history of the NHS,” Parsa claimed.
Dr Paul Zollinger-Read, chief executive of NHS Cambridgeshire, which commissions services at Hinchingbrooke, said the appointment was a good solution. “The thorough and robust tender process has secured a sound foundation from which we can continue to commission services at the hospital,” he suggested.
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Local authorities managed to sustain recent improvements in the provision of adult social care in 2009/10, the Care Quality Commission has reported in its final annual performance assessment under the existing framework.
The CQC’s report found that joint commissioning and monitoring of services were more widespread. “This was a key strength in half of all councils,” the watchdog said. However, it was also an area for improvement in a third of local authorities.
Other key findings from the report include:
- Some 95% of all 152 councils were assessed as performing well or excellently
- Just seven were assessed as performing adequately, “and must improve”
- For the seventh year running, no councils were rated poor
- Areas such as dignity and respect, choice and control, and emotional health and well-being continued to improve.
Significantly, the report also revealed that the number of concerns reported to councils under the adult safeguarding system increased by nearly a third, to 103,000 referrals. The watchdog put this down to a growing awareness of safeguarding through public information campaigns and closer working between councils and health agencies.
CQC chief executive Cynthia Bower said: “The large majority of councils provide good standards of care, whether they run the services themselves or commission them from the private or voluntary sectors. But a few need to improve considerably before they can say they are providing good services for local people.
“Our experience is that good performance is the result of strong leadership and commitment by elected councillors and service managers, working together with a skilled and dedicated workforce. They encourage people to be actively involved in shaping their own care packages, and they develop and commission the services that meet people’s individual needs.”
Bower added that the best-performing councils worked closely with health agencies to deliver joined-up care.
The arrangements for performance assessment, in operation since 2002, are to change for 2010/11, with the emphasis on councils taking more responsibility for driving and monitoring improvement locally.
The CQC is currently working with a range of organisations – including the Local Government Group and the Association of Directors of Adult Social Services – to design this new system of performance assessment.
Cllr David Rogers, chairman of the Local Government Association’s community wellbeing board, hailed the fact that 95% of councils performed well or excellently as a great achievement.
He said: “Councils across the country work tirelessly to provide the best possible level of social care so people in need can enjoy the respect and dignity they deserve. It’s testament to this dedication that the vast majority of town halls continually improve their services every year, giving more elderly and vulnerable people control of their own lives and independence.”
However, Rogers also warned that would be “very hard times in the years ahead” as local government faces up to a multi-billion pound shortfall in its adult social care budget.
“Tough decisions will have to be made and councils will have to work harder than ever to keep building on this good record,” he argued.