Changes to Public Health in the NHS,
how will it work in the future?
Dr Mark Kroese
UKGTN Public Health Advisor
Genetic Alliance UK
22nd Annual General Meeting
1 November 2011
Outline
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Introduction to Public Health
Current Public Health structures in England
Proposed new structures for Public Health in England
Example of possible impact with specific reference to
population screening services
Conclusion
Public Health is…..
“The Science and Art of
preventing disease, prolonging life and
promoting health through the organised
efforts of the society”
(Sir Donald Acheson, Public Health in England: Report of the
Committee of Inquiry into the Future Development of the Public
Health Function, 1988 )
Three Key Domains
Health
Improvement
Health
Protection
Improving
Health and Social
Services
Health Protection
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Infectious diseases
Chemicals and poisons
Radiation
Emergency response
Environmental health
hazards
Surveillance
Health Improvement
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Smoking
Alcohol
Obesity
Healthy eating
Physical activity
Sexual health
Improving Health Services
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Clinical effectiveness
Efficiency
Service planning
Audit and evaluation
Clinical governance
Equity
Wider determinants of health
The Current Structure
Secretary of State for Health
Department of Health and NHS Executive
Specialised
services
Monitor
Strategic Health Authorities
Strategic Direction and Performance Management
GPs
(PBC)
PCT Provider Services
GPs, Dentists
Optometrists, Pharmacists
Walk-in Centres, NHS Direct
Social Care
Primary Care Trusts
Commissioning / Planning / Agreement of Secondary Care
Ind’
Sector
Care
Trusts
Mental
Health
Trusts
NHS
Trusts
Ambulance
Trusts
Provision of all local health and care services
Foundation
Trusts
The Current Structure
Secretary of State for Health
CMO
PH team
Specialised
services
Department of Health and NHS Executive
Monitor
Strategic Health Authorities
Strategic Direction and Performance Management
GPs
(PBC)
PCT Provider Services
GPs, Dentists
Optometrists, Pharmacists
Walk-in Centres, NHS Direct
Social Care
RDPH
PH team
DPH
Primary Care Trusts
Commissioning / Planning / Agreement of Secondary Care PH team
Ind’
Sector
Care
Trusts
Mental
Health
Trusts
NHS
Trusts
Ambulance
Trusts
Provision of all local health and care services
Foundation
Trusts
In addition
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Health Protection Agency
Public Health Observatories
National NHS bodies e.g. NICE
Department for International Development
Universities
NHS White Paper Equity and Excellence (DH 2010) states
that PCT responsibilities for local health improvement will
transfer to local authorities (LAs)
NHS White Paper Healthy Lives, Healthy People (DH
2011) reiterated that each upper tier/unitary authority will
lead a statutory Health and Wellbeing Board (HWB).
Power and responsibility for commissioning services
devolved to the healthcare professionals closest to
patients: GPs and their practice teams working in consortia.
Upper tier local authorities will have a role across the three
domains of public health.
Prescribed functions to be delivered by local authorities will
include:
• appropriate access to sexual health services
• Director of Public Health has a duty to ensure there are
plans in place to protect the health of the population;
• ensuring NHS commissioners receive the public health
advice they need
• the National Child Measurement Programme
• NHS Health Check assessment
• elements of the Healthy Child Programme
Proposed Structure
Proposed Structure
New integrated public health service – Public Health
England - will include
1. Health Protection Agency (HPA)
2. National Treatment Agency for Substance Misuse
(NTA)
3. Public Health Observatories
4. Cancer Registries
Public Health England will have three principal routes for
funding services
• granting the public health ring-fenced budget to local
government;
• asking the NHSCB to commission services, such as
screening services, and the relevant elements of the GP
contract; and
• commissioning or providing services directly, for example
national purchasing of vaccines, national communication
campaigns, or health protection functions
Roles in the new Public Health System
Local Authorities
• Duty to improve health
• Brings together holistic approach
to health and wellbeing
• Employ DPH
• Ringfenced PH budget
• Mandated services
• Core offer to the NHS, including
PH advice on health services
CCGs/NHS CB
PHE (local units)
Health and Wellbeing
Board
• Commissioning healthcare
• Commissioning some public health
services
• Local Health Protection Services
(functions in development)
Coordinates local strategy through
• JSNA
• Review of commissioning plans
UK National Screening Committee
• criteria for appraising the viability, effectiveness and
appropriateness of a screening programme
• developed policies on screening for dozens of conditions
• overseen the successful introduction of a number of
national screening programmes in England
• raised the profile of screening within the NHS and with the
general public
Screening programme
Antenatal screening programmes
Infectious diseases (IDSP)
Fetal anomalies and Down’s Syndrome (FASP)
Sickle cell and thalassaemia (SCTSP)
Newborn, infant and children
Sickle cell disease (SCTSP)
Disorders identifiable in newborn bloodspot
(NBBSSP)
 Cystic fibrosis, Medium chain acyl CoA
dehydrogenase deficiency (MCADD),
Phenylketonuria (PKU), congenital
hypothyroidism
Hearing loss (NHSP)
Congenital conditions identifiable through physical
examination (NIPESP)
Adult non cancer screening programmes
Diabetic retinopathy (NSPDR)
Abdominal aortic aneurysm (NAAASP)
Adult cancer screening programmes
Breast cancer (BCSP)
Cervical cancer
Bowel cancer
Issues to consider in future regarding screening
• NSC will exist as part of PHE
• Commissioning of screening services by NHSCB
• Antenatal screening services part of maternal care which
will be commissioned by CCGs
• Local responsibility for population screening
programmes remains unclear
Timeline
End of 2010:
White paper: Healthy Lives, Healthy People
July 2011:
White paper response, confirming new public health
system structure
By end 2011:
complete the operational design of the new system,
including the PHE Operating Model, how the
local system will work, and their links into the NHS.
Spring 2012:
chief executive and senior team for Public Health
England appointed.
April 2012:
start of transition year
April 2013:
Public Health England established
April 2013:
Local authorities take on their new public health
responsibilities
Thank you