Physical activity in the changing political landscape

							   Physical activity in the
changing political landscape
       Alan Maryon-Davis
• Known knowns
• Known unknowns
• Unknown unknowns
    What are the known knowns?

•   Underlying principles
•   Key policies
•   Proposed structures
•   Roadmap and timetable
        Underlying principles
• Encourage and support people and
  communities to take greater responsibility
  for their health and wellbeing
• Partnership working across different
  sectors – statutory, business, voluntary,
  community. Encourage ‘Big Society’
• Focus on prevention and evidence-based
  interventions
• Encourage innovation
• Seek best value for money
            Key policies

• Shift balance of power to primary care
• GP consortia to commission 80% of NHS
  services
• New NHS quality standards and outcomes
  framework
• Open up the market by encouraging more
  private sector input
       Proposed structures
• Stripped down Department of Health
• National Commissioning Board to oversee
  health and social care
• PCTs and SHAs to disappear
• About 500 local GP commissioning
  consortia
• New national Public Health Service
• Local Health & Wellbeing Boards
  NHS
 current
structure
  NHS
proposed
structure
   GP commissioning consortia
• Most NHS commissioning decisions made by
  consortia of GP practices, based around
  sufficient geographical focus to interlock and
  cover a whole local authority upper tier area

• Responsibility for GP consortia to collaborate in
  Joint Strategic Needs Assessment (JSNA)

• Consortia to work in partnership with local
  authority-led health and wellbeing boards
Green light for
public health?
  Health Secretary
says ‘Yes absolutely’
          • Set clear goals for
            improving public health
            and wellbeing
          • Lead and drive a cross-
            government approach
          • Establish a new Public
            Health Service to protect
            and promote the nation’s
            health and wellbeing
          • Develop Responsibility
            Deals with industry
Radical re-design for public health

• New national Public Health Service (PHS)
  focusing on health protection and health
  improvement, an extension of the
  Department of Health
• Directors of Public Health to be jointly
  appointed by PHS and local authority,
  based with the latter
• Ring-fenced budget for health
  improvement held by DPH
       Public Health Service
• Extension of Department of Health
• Directly accountable to SoS
• Dual role: to protect and improve health
  and wellbeing
• Operating at national and local level
• Working jointly with local authorities, GP
  consortia, third sector and private sector
     Director of Public Health
• Appointed jointly by the PHS and local
  authority (or authorities)
• Employed by the local authority
• Responsible for driving health
  improvement locally
• Accountable jointly to LA and PHS
• Ring-fenced health improvement budget
  allocated by the PHS, held by DPH
 Local health & wellbeing board
• Lead the JSNA, which will inform the
  commissioning of health and care services
• Promote integration and partnership across the
  area, including joined-up commissioning plans
  for the NHS, social care, and public health
• Support local ‘voice’ and the exercise of patient
  choice
• Undertake a scrutiny role in relation to major
  service redesign, giving local authority influence
  over NHS commissioning, and vice versa.
        Responsibility Deals
• Strategic partnerships (called ‘Networks’)
  with a range of stakeholders including
  commercial players
• Covering:
  – Nutrition
  – Physical activity
  – Alcohol
  – Health at work
  – Behaviour change
    Public Health White Paper
• By mid-December
• More detailed plans for:
  – the Public Health Service role
  – the DPH role
  – local Health & Wellbeing Boards
  – commissioning for health and wellbeing
  – Responsibility Deals with industry
  – cross-government working
• Further consultation
      Reasons to be cheerful
• Prevention and health improvement are
  key national policy drivers for the NHS
• Primary care will be in ‘the driving seat’
• Role of DPH being strengthened, ring-
  fenced budget
• Joined-up strategy through the local HWB
      Reasons to be cheerful
• Links between primary care, local
  government and the fitness/leisure
  industry will be strengthened
• Open market approach, ‘any willing
  provider’
• Responsibility Deal with Physical Activity
  Network
     Physical Activity Network

• The PAN will oversee the creation of a five year
  strategy to enhance cooperation between
  Government, industry and the third sector to get
  more people, more active, more often

• Link to other networks looking at nutrition,
  alcohol, workplace health and behaviour change
  to ensure synergy
    Some action areas for PAN
• Optimise the use of physical activity and sport to
  improve health and wellbeing across society
• Use physical activity and sport to deliver health
  outcomes and NHS priorities
• Deliver a health legacy from 2012 Olympics
• Link physical activity to the green agenda
• Promote physical activity and sport through the
  workplace
• Encourage and empower young people to
  maintain an active lifestyle
• Work with commercial partners to extend social
  marketing of active living
         ‘Any willing provider’
• White Paper Liberating the NHS introduces an
  ‘Any Willing Provider’ (AWP) model that will
  create energetic innovation in community
  services. This includes independent, voluntary
  and community sector providers

• AWP for simpler, episodic community services in
  2011, eg. individual therapy treatment for
  musculoskeletal problems, post-acute
  rehabilitation & re-ablement, etc

• Later extending to more complex community
  services, eg. long term conditions management
            Private sector role

•   Providers of weight management programmes
•   Providers of rehab services
•   Providers of fitness and leisure services
•   Partners in Physical Activity Network
•   Social marketing expertise
•   Support for motivational campaigns
•   Funding of programmes, projects and events
•   Input into commissioning
            Known unknowns
• Ring-fenced PH budget:
  – How big?
  – What’s included?
  – Ring-fenced for how long?
• Local Health & Wellbeing Boards
  –   Membership?
  –   Chair?
  –   Teeth?
  –   Governance?
• What will be the links between GP commissioning,
  the PHS and LA health improvement?
Unknown
unknowns
            Impact of cuts
• NHS budget hit by £20b efficiency savings
  over next four years
• CSR allocation 0.1% increase
• LA budgets unprotected, taking major cuts
• Voluntary sector budgets threatened
• Many DH grants withdrawn
• Regional structures axed
• NHS ‘re-disorganisation’
A challenge for physical activity
Bad news I’m afraid. You’ve got acute
  public sector funding deficiency
How can we
  ensure
 physical
 activity is
kept on the
  health
 agenda?
       Public Health can help
          commissioners
By providing advice and expertise on:
• What works?
• Who to target?
• In what settings?
• How to incentivise?
• How to measure progress?
• How to sustain?

By highlighting issues in public health reports
Lets Get Moving

 Commissioning
   guidance
     2009
NHS
Health
Check

40-74
year-olds

•   BP
•   BMI
•   Cholesterol
•   Blood sugar
    (selected cases)
  How should the physical activity
    community position itself?
• Work closely with public health and primary care
  colleagues
• Win over GP commissioners, especially around
  exercise prescription
• Emphasise synergistic strategies: eg. obesity
  prevention, falls prevention, CV risk control (BP,
  diabetes, etc), green spaces, carbon reduction
• Play the mental health and wellbeing card
• Pitch for contracts
• Demonstrate value for money
      Links to parallel strategies
•   Schools and youth
•   Community safety and wellbeing
•   Sport and leisure
•   Environment, parks and open spaces
•   Employment
•   Transport
•   Regeneration
•   Sustainability and carbon-reduction
We need to work smarter