| Saving Lives: Our Healthier Nation | |||||||||
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10 Making it work: progress and partnerships 10.1 The goals of this health strategy will be achieved only by a joint effort. That means individuals taking steps to improve their own health, and on new directions and new more effective partnerships formed at local community level between the NHS, local authorities and other agencies. 10.2 Our new approach to better health comprises:
REORIENTING AND EMPOWERING HEALTH SERVICES 10.3 Our determination to modernise the NHS, including ending the wasteful internal market, placing new duties on health authorities, and the creation of primary care groups which are close to patients, is not simply an agenda for improving the reliability and effectiveness of health care services. It is an agenda which will help to improve health overall and to tackle inequality. Health authorities have overall responsibility for improving health locally. Within the health authority the director of public health generally leads this work, accounting for it to the chief executive. In the past public health staff, including the director, had to spend too much time servicing the demands of the internal market. As a result a valuable public health resource was dissipated. The importance of the role of public health was not always clearly reflected through local priorities and too often public health was seen as something which someone else did. 'Health authorities
have overall responsibility 10.4 We are modernising the NHS, and have abolished the internal market. In its place we have introduced a new structure based on partnership working linked to a new duty of co-operation between NHS bodies and local authorities. 10.5 As part of the modernisation process, we have placed a duty on health authorities to draw up health improvement programmes which tackle the health and health care needs of their area. This gives them a key role in improving the health of the local people they serve and we are encouraging them to develop public health expertise throughout their workforce and to apply it across the range of their activities. They must ensure that health problems are tackled and health inequality is addressed. This is reflected in the National Priorities Guidance we issued last autumn to health and local authorities, and again in the guidance we have issued for developing local health improvement programmes. NHS Trusts, too, will have a major part to play in the delivery of our health strategy, for example through their contribution to the National Service Frameworks, and in their role as large employers. 10.6 In particular health authorities will:
New primary care organisations 10.7 We have placed primary care at the heart of our programme to modernise the health service. We are strengthening these services by introducing new primary care groups and the prospect of primary care trusts. These new organisations consist of broadly-based, multi-professional teams including family doctors, nurses, public health professionals, other practitioners and therapists. 10.8 Primary care groups began work in April 1999. Over time we expect them and, when established, primary care trusts, to play a leading role in improving health and cutting inequality, working closely with their local communities. They have strong links with local people and are well placed to do this. In some areas the best primary care teams have already taken on this wider public health role. 10.9 Primary care groups and primary care trusts will take on a range of important new responsibilities which were set out in guidance last December:
10.10 Primary care groups and primary care trusts must continue to ensure that preventive services - some cancer screening, immunisation and vaccination - are available as necessary. They will also continue, for example, to provide help to those wishing to give up smoking or to lose weight. 'we expect primary
care groups to forge powerful local 10.11 However we expect primary care groups and primary care trusts to go beyond simply the provision of existing preventive services. Over time they too will forge powerful local partnerships with local bodies - schools, employers, housing departments - to deliver shared health goals. They will help shape the health improvement programme and draw up their own plans for implementing it and for hitting the targets in it. Key features of core roles of health authorities and primary care
LOCAL PARTNERSHIPS: Leading health improvement 10.12 Tackling poor health and health inequality needs the NHS and local government to take joint responsibility. There are several parts of the country where NHS bodies, local authorities and others already work well together. But there are others where they work less well. 'a culture in which learning and good practice are shared' 10.13 Successful partnership working is built on organisations moving together to address common goals; on developing in their staff the skills necessary to work in an entirely new way - across boundaries, in multi-disciplinary teams, and in a culture in which learning and good practice are shared. It also means:
10.14 Through the Health Act 1999 we have extended the existing duty of partnership between health authorities and local authorities to NHS Trusts and primary care trusts (when established), reflecting the need for partnership in service commissioning and delivery as well as strategic planning. All this is underpinned by new financial flexibilities, including powers to operate pooled budgets. This will create the opportunity for the new style of partnership we want to promote. Effective planning for health 10.15 Local health improvement programmes will reflect these new partnerships. They will be genuinely joint enterprises with local authorities and others. The role of local authorities in improving health locally will be clearly defined and reflected in their priorities and any community plans. Health improvement programmes will also show how the National Service Frameworks will be implemented at local level. So they will be effective vehicles for making a major and sustained impact on the health problems of every locality in the country. As well as looking at the overall health of the local population, they will also focus action on people who are socially excluded and need the most support. 10.16 The main responsibility for developing health improvement programmes rests with the health authority, drawing on the contributions of other NHS bodies, local authorities and others including local businesses, voluntary bodies, community groups and individuals. Universities and those responsible for the education and training of professional staff will also play a part. 'Local authorities
will be key contributors 10.17 Local authorities are at the centre of local public service provision. They will be key contributors to the health improvement programme through the best value initiative and any community plans which they develop in partnership with other local bodies to promote the economic, social and environmental well-being of their communities.
Health improvement programmes 10.18 Health improvement programmes will:
10.19 Health improvement programmes are so central to achieving our aims that we want to recognise the success of those health authority areas which, working through NHS and local authority partners, are making a real difference in improving health and tackling health inequality locally. So we are setting up a Health Improvement Programme Performance Scheme. The Scheme will reward health authorities which have made the best progress in meeting their targets and objectives. In particular, it will recognise those health communities making progress from a low base, tackling entrenched problems of ill-health, deprivation and poor or fragmented services. In the first year we are investing at least an additional £10 million to drive forward implementation of the National Service Framework on Coronary Heart Disease. 'a Health Improvement
Programme Performance Scheme
Building local capability: regenerating health in communities 10.21 There is increasing evidence, including from the World Health Organisation, that having strong social networks benefits health. When people are involved in making the decisions which affect their lives their self-esteem and self-confidence rise, in turn improving their health and well-being. And, of course, many local people, including local workers such as health visitors, have a good understanding of the community's main health problems and of priorities for action. 'Real change can
come only from the local community 10.22 For most people these issues come together at the neighbourhood level. We will encourage local people to make their neighbourhoods healthier, for example by identifying and sharing good practice. Real change can come only from the local community itself by harnessing the energy, skills and commitment of local people in setting clear objectives for change and forming new partnerships for action. Sometimes certain individuals - "social entrepreneurs" - are particularly effective in focusing community action to secure change. Health action zones 10.23 Health action zones are leading the way in breaking down organisational barriers. They are using imaginative new ways of providing services which cross boundaries between organisations. We established eleven health action zones from April 1998, and a further 15 started in April this year in some of the most deprived parts of the country. They cover both urban and rural areas. Healthy living centres 10.24 The development of healthy living centres will help people struggling with health problems which may not need medical treatment. Healthy living centres will provide a way in which they can find help and support within their local community. Healthy living centres:
10.25 They will be funded throughout the UK with £300 million of Lottery money. The first Lottery applications for healthy living centre funding are likely to be agreed this autumn. 'there is a great
deal of expertise within local communities, a 10.26 We recognise that there is a great deal of expertise within local communities, and in non-Governmental organisations. At local level we will encourage health authorities, local communities, primary care groups and primary care trusts to make use of non-Governmental organisations in delivering programmes. At a national level we will establish a National Forum of Non-Governmental Public Health Organisations to offer expertise and advice.
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