NHS Structure and Performance (Public Health, State of the South West 2011)
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8.13.1 The following extract outlining the future structure and goals of the NHS is taken from pages 8 and 9 of the recent Public Health White Paper (2010): Healthy Lives, Healthy People: Our strategy for Public Health in England.
A new public health system with strong local and national leadership
12. To support this new approach and avoid the problems of the past, we need to reform the public health system. Localism will be at the heart of this system, with responsibilities, freedoms and funding devolved wherever possible; enhanced central powers will be taken where absolutely necessary, for example in areas such as emergency preparedness and health protection. Within this system:
a. Directors of Public Health will be the strategic leaders for public health and health inequalities in local communities, working in partnership with the local NHS and across the public, private and voluntary sectors. The Government will shortly publish a response to the recent consultation on proposed new local statutory health and wellbeing boards to support collaboration across the NHS and local authorities in order to meet communities’ needs as effectively as possible.
b. A new, dedicated, professional public health service – Public Health England – will be set up as part of the Department of Health, which will strengthen the national response on emergency preparedness and health protection.
c. There will be ring-fenced public health funding from within the overall NHS budget to ensure that it is not squeezed by other pressures, for example NHS finances, although this will still be subject to the running-cost reductions and efficiency gains that will be required across the system. Early estimates suggest that current spend on areas that are likely to be the responsibility of Public Health England could be over £4 billion.
d. There will be ring-fenced budgets for upper-tier and unitary local authorities and a new health premium to reward them for progress made against elements of the proposed public health outcomes framework, taking into account health inequalities.
e. The core elements of the new system will be set out in the forthcoming Health and Social Care Bill and will therefore be subject to Parliament’s approval.
f. The best evidence and evaluation will be used, supporting innovative approaches to behaviour change – with a new National Institute for Health Research (NIHR) School for Public Health Research and a Policy Research Unit on Behaviour and Health. There will be greater transparency, with data on health outcomes published nationally and locally.
g. 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. He or she 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.
h. Public health will be part of the NHS Commissioning Board’s (NHSCB) mandate, with public health support for NHS commissioning nationally and locally. There will be stronger incentives for GPs so that they play an active role in public health.
Making it happen
13. We are implementing our strategy to make early and substantial progress, so that we make a real difference to health from the earliest opportunity. Subject to the passage of the Health and Social Care Bill, the Government plans to:
a. enable the creation of Public Health England, which will take on full responsibilities from 2012, including the formal transfer of functions and powers from the Health Protection Agency (HPA) and the National Treatment Agency for Substance Misuse (NTA);
b. transfer local health improvement functions to local government, with ring-fenced funding allocated to local government from April 2013; and
c. give local government new functions to increase local accountability and support integration and partnership working across social care, the NHS and public health.
14. The transition to Public Health England will be developed in alignment with changes to Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs), and the creation of the NHSCB. The detailed arrangements will be set out in a series of planning letters throughout the course of 2011.
15. To get the details of the new system right and ensure that it delivers significant improvements to the health of the population, we will be consulting on some elements. A number of consultation questions are set out in Chapter 4 and summarised in Chapter 5 of this White Paper, and we would welcome your views. The consultation on these questions closed on 8 March 2011.
16. The Department of Health has published a review of the regulation of public health professionals by Dr Gabriel Scally. A consultation question about this is in Chapter 4 of this White Paper. We would welcome views on this report.
17. Forthcoming consultation documents will set out the proposed public health outcomes framework, and funding and commissioning arrangements for public health.
