Healthy Lives, Healthy People: Our Strategy for Public Health
in England
Summary
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From 2013 The Health improvement Function will transfer from the NHS to
Local Authorities
Public Health England (new national public health service) to be the lead
organisation nationally for health protection and health improvement
D’sPH will the leader for public health locally, and a joint appointment
between LA’s and Public Health England.
Introduction
Public Health can be considered as being the three “p’s”:
 Protect: protecting the public from threats and hazards (the current health
protection agency role)
 Prevent – Preventing ill health (advising the NHS on medical bits – evidence
of effectiveness, care pathways etc)
 Promote – Promotion Good Health (the traditional health improvement/wider
determinants of health work).
Since 1974 the public health function has sat within the NHS. The White Paper has
two big ideas:
1) The transfer of the DPH role and the responsibility for health improvement
back to upper tier authorities.
2) The creation of a national public health service (Public Health England).
Policy Driver
The Public Health White Paper has taken on board a lot of the rationale and
recommendations of the Marmot review, recognizing the role that tackling the
broader determinants of health can play in improving health and reducing health
inequalities. There is an emphasis on the life course approach – away from the
disease based approaches of previous white papers.
Intervention is driven by the Nuffield Council on bioethics ‘Ladder of Intervention’.
Essentially, this says seek to intervene the least you can unless you need to step up
a gear, with interventions moving up from ‘do nothing’, to advice and support,
changing defaults, up to state intervention and regulation as a last resort.
This is aligned to ‘nudges’ (think cash point defaults for giving to charity, donor cards,
the ‘swapathon’ and gents toilets in German airports).
Levels of responsibility
Local authorities will have a duty to improve the health of their communities from
April 2013 and they will be expected to take on a leading role under the proposals to
influence factors which affect health and wellbeing, including encouraging joint
commissioning with NHS organisations, social care, public health and other
partners.
The White Paper sets out how the powers and the role of local government will be
enhanced, including providing dedicated, ring-fenced funding to reward local
progress. Local councils will continue to carry out their statutory duties under the
Public Health (Control of Disease) Act 1984, including appointing ‘proper officers’ to
manage the Act locally.
Directors of Public Health will be jointly appointed to upper tier and unitary authorities
with the new Public Health Service. They will be employed by local authorities and
professionally accountable to the Chief Medical Officer. They will be expected to be
the strategic leaders for public health and health improvement in local communities,
working with NHS organisations and the public, private and voluntary sectors. They
will be given control over the health improvement funds allocated according to
relative population health needs within the ring-fenced public health budget and they
will be required to prepare an annual report on local health.
GP consortia will have responsibility for communities as NHS commissioners and
they will have a central role in promoting public health. They will be encouraged to
work with local authorities and other organisations to deliver services and address
public health issues.
The government proposes a new ‘Public Health Responsibility Deal’ to encourage
collaboration between business, voluntary groups and other organisations.
Local health and wellbeing boards will be established to bring together elected
representatives, GP consortia, Directors of Public Health, Directors of Adult Social
Service, Directors of Children’s Services and other partners where appropriate.
GP consortia and Directors of Public Health will have an obligation to jointly prepare
the local JSNA. Joint health and wellbeing strategies will emerge from the JSNA,
setting out how commissioners can work together to achieve the aims set out.
A new dedicated national public health service, Public Health England, will provide
disease control and protection, together with information on public health innovations
from elsewhere. Public Health England will have a protected budget and it will
support local action through funding, professional support and evidence. Public
Health England will also ensure that the country remains resilient to health threats.
Funding
Funding for the proposals will be ring-fenced from within the existing NHS budget.
Funding for local authorities will be allocated to upper tier and unitary authorities by
Public Health England, weighted for inequalities. A new health premium will reward
councils for progress against a new public health outcomes framework.
A shadow in 2012-13 will enable forward planning. For 2011-12, the NHS Operating
Framework will set out the operational arrangements to manage the transition,
including setting the context for efficiencies across the system.
Commissioning of public health services
The White Paper proposes that Public Health England is responsible for ensuring the
provision of services such as health protection, emergency preparedness, recovery
from drug dependency, sexual health, immunisation, alcohol prevention, obesity and
smoking cessation.
Mike Sandys
January 2011