Briefing 3
Public Health Reform Update
January 2012
1. Background
The Government set out its intention for a major reform of public health in England in
November 2010, envisioning a major new role for local authorities (Healthy Lives,
Healthy People, Our Strategy for Public Health in England). This role was confirmed
and set out in greater detail in ‘Healthy Lives, Healthy People: update and the way
forward’ published by the Department of Health in July 2011. The paper promised
publication of the change a suite Public Health System Reform Updates to complete
the operational design of the public health system. The Department of Health
published two of these on 20 December 2011, together with a short summary.
These are:
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Public Health in Local Government
Public Health England Operating model
On 16 January, 2012 the Department of Health co-produced two further documents
with local authorities (working through the LGA), under the heading of ‘Creation of
the new local public health system’. These are more operational documents. They
are:
 Transition planning for Local Authorities and Primary Care Trusts covers
planning and accountability through the transition, including more guidance on
the requirements for the transition plans.
 The Local Government Workforce Transition Guidance builds on the high
level HR Concordat published November 2011 which covered some transition
principles.
These are not covered further in this briefing.
Still awaited, but with the first two at least expected later in January, are Reform
Updates covering
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The Outcomes Framework for public health (objectives and measurement)
Funding for public health (settling the ring-fenced grant for local authorities)
The two published Reform Update documents take the form of sets of factsheets on
different topic areas. This briefing will concentrate on the Public Health in Local
Government set.
2. Public Health in Local Government
There are 5 factsheets in this set, starting appropriately with leadership. The
headings and a brief summary are:
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Local Government leading for public health
The role of local government as a place shaper is stressed, as is local authorities’
democratic mandate, local knowledge and understanding, expertise in building
relationships with its population and strategic partners. The vision is for local
authorities to bring a health and well-being focus (its new statutory duty) to bear
across all its current business, focusing particularly on reducing health inequalities.
The Directors of Public Health will be well placed to help local authorities reduce and
prevent inequalities, taking a strategic approach, working with partners in the council,
the NHS and more broadly partners such as the incoming Police and Crime
Commissioners to look at preventing violence and offending.
Public health work in local authorities will require:
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Including health in all policies
Investing the new ring-fenced grant in high quality public health services
Encouraging health promoting environments
Supporting local communities
Tailoring services to individual need, taking a holistic approach
Making effective and sustainable use of all resources, using evidence to direct
support to areas and groups of greatest need.
Local Government’s new public health functions
Subject to legislation, upper tier and unitary authorities will have a new duty to
promote the health of their local population. It emphasises the importance of political
leadership of public health within the council, with broad engagement and
understanding of all members as well as the critical role of the cabinet lead for
health. The factsheet makes some general comments on commissioning, covered in
greater detail in another of this set of factsheets, including the expectation that
authorities will wish to commission rather than provide services and an
encouragement to use a wide variety of providers. The legislation will enable the
Secretary of Health to require that certain services are provided (mandated) which
will be used only where uniformity of provision is regarded as essential.
The role of the Director of Public Health
The Health and Social Care bill makes it clear that each local authority must have a
Director of Public Health appointed jointly with the State for Health (through Public
Health England). The Directors must be approved specialists and, subject to
amending the Local Government and Housing Act 1989) will have Chief Officer
status within the Council. Further guidance on their appointment is being developed.
The Government expects direct accountability to the local authority Chief Executive
for the exercise of the local authority’s public health responsibilities.
The responsibilities will be
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All public health functions of local authorities
Annual report on the health of the local population
Statutory membership of health and well-being boards
Promoting opportunities for action across the ‘life course’ working with
Directors of Children’s Services and Adult Services
Working with local criminal justice partners and proposed new Police and
Crime commissioners
Day to day responsibility for the ring fenced grant
The Directors of Public Health should be involved in the design of the new
arrangements and with all local authority colleagues to ensure an understanding of
the new role and with the new NHS commissioners.
Further advice on Workforce to ensure an appropriate supply of specialists and other
public health staff will be published, with consultation on the issue promised.
Commissioning Responsibilities
A very detailed factsheet, this one lists the services for which local authorities will be
responsible. ( See Appendix 1 attached). There is only one significant change from
earlier lists; the exclusion of termination of pregnancy services from the sexual
health responsibilities. They will remain provisionally with the NHS and will be
commissioned by Clinical Commissioning Groups (CCGs). Sexual Assault Referral
Centres (SARCs) will initially be commissioned by the NHS Commissioning Board.
The decisions on commissioning public health services for children, with local
authorities responsible initially for services for children and young people 5-19 is
reiterated along with the expectation of transfer of the responsibilities for 0-5s from
the NHS Commissioning Board in the medium term (2015).
More detail is given on the responsibilities for which the local authorities will be
working with other bodies, in particular health protection plans for the local
population, covering immunisation and screening and emergency and resilience
planning. The public health role role in health protection planning will be a key
leadership one. Further guidance on emergency planning is promised.
The provision Public health advice to commissioners is a key role of the new local
authority responsibilities. It is referenced in this fact sheet and covered in greater
depth in a separate one (see below).
Public Health advice to NHS Commissioners
This factsheet details the public health advice that local authorities will be expected
to give to NHS commissioners, in the form of a table which details each aspect of
provision with examples alongside. It is arranged under 5 headings:
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Strategic planning: reviewing service provision
Strategic planning: deciding priorities
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Procuring services: deciding the shape and structure of supply
Procuring services; planning capacity and managing demand
Monitoring and evaluation, supporting choice, managing performance and
seeking public and patient views
Professional appraisal and support and capacity building
This factsheet flags the point that Public health specialists (both medical and nonmedical professionals working in local authorities will need to undergo
revalidation/professional appraisal. Local authority chief executives will be
responsible for managerial appraisal.
3. Public Health England Operating Model
This document comprises 5 factsheets, headings and key points are:
Mission and values
The mission is given as to protect and improve the wellbeing of the population and to
reduce inequalities in health and wellbeing outcomes. Great emphasis is placed on
working across the new public health system with key partners including local
authorities.
Functions
The three functions listed are:
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Delivering services to national and local government, the NHS and the public
Leading for Public Health
Supporting the development of the specialist and wider public health network
Organisational design
Importantly, this covers the geography of the new organisation. There will be a
central national office and four geographical hubs, likely to match those of the NHS
Commissioning Board. One of these will cover North of England. Below this will be
25 hubs, based on existing Health Protection Agency (HPA) operating units. The
HPA has a hub covering the North East. Further work will be done on the design
and role of the units. They will have a major role in health protection and emergency
preparedness and provision of some local intelligence.
Status and accountability
HPE will be an executive agency of the Department of Health.
Next steps – establishing Public Health England
This contains a timetable with key milestones, completing in April 2013 (subject to
legislation).
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Conclusions
These documents are very helpful to the transition planning. They introduce no
major changes to previous announcements and imply no particular changes to the
public health transition planning in hand at local, north east regional, SHA cluster
and national levels. The next milestone being the development of transition plans at
local levels (local authority/Primary Care Trust) levels by the end of January 2012 for
finalisation by the end of March.
The publication of the outstanding documents (outcomes and funding) is important,
as some key decisions on staffing and services depend on decisions expected in
them.
Elaine Rodger
Senior Manager, Public Health
Elaine.rodger@northumberland.gov.uk
01670 533901
17 January 2012
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Appendix 1
Proposed Local Authority Public Health Responsibilities
The mandatory services include:
Appropriate access to sexual health services (except abortion services, which will
be commissioned by CCGs, and Sexual Assault Referral Centres (SARC),
which will be commissioned by NHSCB))
Duty to ensure there are plans in place to protect the health of the population
Ensure NHS commissioners receive public health advice they need
Deliver the National Child Measurement Programme
Deliver the NHS Health Check Programme
(The elements of the Healthy Child Programme (age 5-19) previously proposed as
mandated is subject to further review and will not be mandated during 2013).
Other commissioning responsibilities include:
Prevention and Lifestyle services
Tobacco control and smoking cessation services
Alcohol and drug misuse services
Public health services for children and young people aged 5-19
Interventions to tackle obesity such as community lifestyle and weight
management services
Locally-led nutrition initiatives
Increasing levels of physical activity in the local population
Public mental health services
Dental public health services
Accidental injury prevention
Population level interventions to reduce and prevent birth defects
Behavioural and lifestyle campaigns to prevent cancer and long term conditions
Local initiatives on workplace health
Health Protection
Supporting, reviewing and challenging delivery of key public health funded and
NHS delivered services such as immunisation and screening programmes
Local initiatives to reduce excess deaths as a result of seasonal mortality
Local authority role in dealing with health protection incidents, outbreaks and
emergencies
Local initiatives that reduce public health impacts of environmental risks
Wider determinants of health
Public health aspects of promotion of community safety, violence prevention and
response
Public health aspects of local initiatives to tackle social exclusion