Public health post-2013 Contents

Conclusions and recommendations


1.Cuts to public health are a false economy. The Government must commit to protecting funding for public health. Not to do so will have negative consequences for current and future generations and risks widening health inequalities. Further cuts to public health will also threaten the future sustainability of NHS services if we fail to manage demand from preventable ill health. (Paragraph 40)

2.We recommend that the Government sets out how changes to local government funding and the removal of ring fencing can be managed so as not to further disadvantage areas with high deprivation and poor health outcomes. We plan to return to review the variation in funding and outcomes. (Paragraph 41)

Systematically improving public health and addressing unnecessary variation

3.We recommend that local authority directors of public health should be required in their statutory annual reports to publish clear and comparable information for the public on the actions they are taking to improve public health and what outcomes they expect to achieve, and to provide regular updates on progress. While public health priorities may be different for different areas, which is entirely appropriate, they should be presented in a standardised format, and underpinned by a benchmarking framework that allows for informed comparison and challenge. The Chief Executive of Public Health England, in his capacity as accounting officer, should publish an annual report drawing together and analysing local progress towards agreed plans. (Paragraph 64)

4.We also reiterate the recommendation of our recent report on the impact of the Spending Review on health and social care that the Government should set out clear milestones of what it expects public health spending to achieve, and by when. (Paragraph 65)

Politics and evidence

5.Benchmarking standards for all local authorities’ prescribed public health functions should be introduced, which should be transparently monitored to enhance accountability and provide reassurance that these functions are being maintained at an appropriate level. (Paragraph 70)

Boundary issues and fragmentation

6.The outstanding issue of who is responsible for commissioning PrEP for HIV needs immediate resolution, and we recommend that NHS England and DH clarify the position without delay. (Paragraph 79)

7.Where boundary issues are identified around responsibilities, PHE should set out the options for them to be addressed in the best interests of patients and the public and ensure that they are resolved without further delay. (Paragraph 80)

Leadership for public health at a national level

8.National system leadership is important to signal clarity of purpose and commitment to the local system when it comes to improving health and wellbeing. In order to demonstrate where national leadership for public health lies, and to avoid confusion and the risk of giving conflicting advice to the local system, the Government should produce a clear statement of who does what in respect of the main system leaders, namely, the Department of Health, Public Health England and NHS England. (Paragraph 91)

9.Embedding health in all policies is important at both national and local level. But while there is evidence of progress locally, there is less evidence of such an approach becoming embedded across Government departments. We urge the Government to take bold and brave action through its life chances and childhood obesity strategies in order to improve public health and reduce health inequalities. (Paragraph 92)

10.A Cabinet Sub-Committee on Public Health is unlikely in itself to be the answer to securing more effective joined-up policy to improve health and wellbeing. We consider instead that the strengthened cross-departmental working which is required is more likely to be achieved by vesting responsibility for providing political leadership for public health at a national level in a Minister in the department responsible for coordinating cross-departmental work, the Cabinet Office. We recommend that a Minister in the Cabinet Office be given specific responsibility for embedding health in all policies across Government, working closely with the Minister for Public Health in the Department of Health. (Paragraph 94)

11.Since Public Health England was established, the interface between it and the DH has lacked clarity. We therefore urge the Government to review the relationship between the DH’s Public Health Group and PHE. The ‘tailored review’ of PHE which DH is currently carrying out offers a good opportunity to do so. (Paragraph 95)

12.Likewise we urge NHS England and PHE to clarify how the two organisations are seeking to pool their expertise and resources around public health in order to ensure that the local health system feels adequately supported and not conflicted by confusing messages or requirements. (Paragraph 96)

Access to data

13.Our inquiry has identified numerous problems with access to data for public health professionals, which is creating barriers to effective joint working. We are pleased to note that efforts are now ongoing within Public Health England to address these problems. (Paragraph 102)

14.Public health teams need to be able to access data in patients’ interests. We were told by PHE’s chief knowledge officer that a change in policy was needed to remove the current restriction that all linkage of health and social care data can only take place centrally, within NHS Digital (HSCIC). We recommend that the Department of Health review these barriers. (Paragraph 103)

15.Some areas have managed to access the data they need, and others have not. Some areas also lack the capacity to analyse their data. A co-ordinated national support programme is needed to ensure that until data is easily available to local authorities, all areas at least understand what data they are able to access, and how they can do so. (Paragraph 104)

16.PHE identified two types of data public health specialists are having difficulty in accessing—access to population healthcare data, and access to operational data about the services they commission. Annex 1 to this report contains a compilation of the concerns public health professionals have raised to this inquiry regarding access to data, and we ask PHE and NHS Digital to provide a response to us on each point raised. We will revisit this issue to check progress in six months’ time. (Paragraph 105)

The public health workforce

17.Trends in the public health workforce can be adequately monitored only through the speedy introduction of the promised database. This is particularly important given the potential impact of reduced spending by councils on public health staffing. (Paragraph 118)

18.Barriers to workforce mobility must be removed, and we are concerned that this issue has not been resolved three years after the transfer of public health responsibility to local authorities. We will review progress in six months. (Paragraph 119)

19.As the Government develops its proposals for reform of professional regulation, it needs to ensure that it has a coherent, straightforward and evidence-based approach to the regulation of public health specialists. We recommend the Department of Health review its current policy in order to protect the public. (Paragraph 120)

Case study: Health protection

20.Health protection is a critical public health function, and more work needs to be done at a national level to support local areas to deliver a seamless and effective response to outbreaks and other health protection incidents. This work should begin with an audit of local arrangements, including a review of capacity in provider trusts, and the development of a national system to collate and disseminate lessons learned from incidents. We will review PHE’s progress on this work in six months’ time. (Paragraph 135)

Case study: Health in all policies

21.We urge the Government to be bold, and make good on its commitment to health in all policies, by enshrining health as a material consideration in planning and licensing law. (Paragraph 140)

The role of the NHS in public health

22.The system of enhanced public health accountability must be extended into the NHS, forming part of a broader national strategy to systematically and demonstrably implement the radical upgrade in public health called for in the Five Year Forward View. (Paragraph 151)

23.The NHS has an important role to play in prevention, and developing the skills of its workforce to deliver preventative advice as part of routine care is central to that. We will follow up progress on this issue when we next review the public health system. (Paragraph 152)

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30 August 2016