WHAT'S THE POLICY CONTEXT?
The changes to the Public Health system are wide ranging and include the establishment of new structures and changes to responsibility at all levels of the system. As set out in the Health and Social Care Bill, the changes introduced by the coalition government will be subject to Parliament’s approval.
‘Healthy Lives, Healthy People - Update and Way Forward’ outlines the new public health system, detailing how localism will be at the heart of the reforms, with responsibilities, decision making and financial responsibility devolved wherever possible. Enhanced central powers will only be taken where absolutely necessary, for example in areas such as emergency preparedness and health protection.
The Public Health reform programme has a range of elements to it. Key areas include:
The role of the Director of Public Health
Directors of Public Health will be the strategic leaders for public health and tackling health inequalities in local communities. They will work in partnership with the local NHS and across the public, private and voluntary sectors. As a core member of the local Health and Wellbeing Board the Director of Public Health will be the principle adviser on health to the Local Authority.
The Director of Public Health will be:
The principal adviser on health to elected members and officials;
The officer charged with delivering key new Public Health functions;
A statutory member of the Health and Wellbeing Board;
The author of an annual report on the health of the population.
Health and Wellbeing Boards
Maximising opportunities for integration between the NHS, public health and social care, Health and Wellbeing Boards will promote joint commissioning, driving improvements in the health and wellbeing of the local population. They will provide the vehicle for local government to work in partnership with commissioning groups to develop comprehensive Joint Strategic Needs Assessments and robust joint health and wellbeing strategies.
Ring Fenced Budgets
There will be ring-fenced public health funding from within the overall NHS budget. Although ring-fenced this will still be subject to the running-cost reductions and efficiency gains that will be required across the system. A new health premium will be introduced to reward Local Authorities for progress made against elements of the proposed public health outcomes framework, taking into account their local health inequalities.
Public Health England (PHE)
PHE will be established as an executive agency to the Department of Health. The service will drive delivery of improved outcomes in health and wellbeing and protect the population from threats to health. PHE will ensure access to expert advice, intelligence and evidence and will provide a focus for the development of new approaches including adopting insights from behavioural sciences; and provide an expert and resilient health protection service.
NHS Commissioning Board
The NHS will continue to play an important role in commissioning and providing Public Health services While local authorities will become the lead local body for many Public Health services, where appropriate the NHS Commissioning Board will be required to commission specific services funded from the Public Health budget. The NHS Commissioning Board will set incentives for clinical commissioning groups to encourage local GPs to play an active role in Public Health.
Clinical Commissioning Groups
Clinical Commissioning Groups (CCGs) will take responsibility for the majority of NHS commissioning. Led by GPs, their membership will ensure involvement of patients, carers, the public and a wide range of health professionals. They will be under a duty to promote integrated services and will be required to operate in an open and accountable manner.
Health and Wellbeing Boards will also be involved as CCGs develop their commissioning plans and there will be an expectation, set out in statutory guidance, for the plans to be in line with the Joint Health and Wellbeing Strategy.
Based upon the current Local Involvement Networks (LINks), local branches of HealthWatch will provide the public with a single point of contact for local services. HealthWatch will give people real influence over decisions made about local services; it will support individuals as well as engaging communities; and HealthWatch England will ensure that consumer voice has influence not only locally but nationally also.
The Secretary of State will be accountable for the NHS, exercising their responsibility through their relationship with the new bodies, such as the NHS Commissioning Board. The Chief Medical Officer will have a central role in providing independent advice to the Secretary of State for Health and the Government on the population’s health. They will be the leading advocate for public health within, across and beyond government, and will lead a professional network for all those responsible for commissioning or providing public health.