HC 1048-III Health CommitteeWritten evidence from Rutuja Kulkarni (PH 145)

the creation of Public Health England within the Department of Health; It may be an opportunity to have local PH structures as a vital part of PHE along with Health Protection and Substance Misuse to ensure the integrity of the profession;

the public health role of the Secretary of State;- can the role be without an ongoing responsibility given the proposed changes were introduced by the Sec of State? “Politics” will certainly play a part of the local PH set up and without the matching central perspective would this lead to a lack of governance?;

the future role of local government in public health (including arrangements for the appointment of Directors of Public Health; and the role of Health and Wellbeing Boards, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies); considerable work needs to be in place prior to this being implemented in terms of the perception in Local Authorities about the HR Framework for the transfer and the ring fencing of the PH function. Local Authorities need to develop their own culture to be abele to “assimilate” PH teams into their structure. Clear guidance needs to be outlined to ensure that the DPH is NOT reporting into a Director of Social Services as this would limit the PH functionality and outcomes for the local population;

arrangements for public health involvement in the commissioning of NHS services; PH needs to be central to the commissioning of NHS services to ensure that upstream/Prevention is integral to secondary care and primary care commissioning;

arrangements for commissioning public health services; the proposals for commissioning PH services via four different bodies (GPC, Local Authorities, NHS Commissioning Boards and PHE) could result in fractured services and poorer outcomes for the health on the population. A preferred option would be to locate all of the PH commissioning in one body and have scrutiny located elsewhere;

the future of the Public Health Observatories; PHO need to work at a national level but must also provide a local picture;

the structure and purpose of the Public Health Outcomes Framework; Similar to the dispersal of commissioning in four different bodies, having four different organisations responsible for delivering the outcomes could create duplication. At present there is no link with the Integrated Performance Measures and this needs to be firmly established to drive down inefficiencies;

arrangements for funding public health services (including the Health Premium); It will be important to have accountability for the arrangements of funding for PH services including the health premium to ensure the Prevention aspect of QIPP is supported fully and funding is not diverted to downstream interventions at the expense of upstream interventions;

the future of the public health workforce (including the regulation of public health professionals); and PH workforce has been developed in the recent years for example through the UKPHVR and it is vital that such developments are not lost in this shuffle and processes are reinvented; and

how the Government is responding to the Marmot Review on health inequalities. It is essential for GPCs and Local Authorities to keep the JSNA in central focus when they commission services as the JSNA will highlight local inequalities and local progress. Governance and accountability should be built into any arrangements.

June 2011

Prepared 28th November 2011