Councils "in the driving seat" to secure public health improvements, says Lansley

Local authorities will be “in the driving seat” when it comes to securing improvements in public health, Health Secretary Andrew Lansley claimed today on the publication of the government’s keenly-anticipated White Paper.

Town hall chiefs said the proposals represent a great opportunity for local authorities, but warned that they do not go far enough and there was a risk of a swing towards central control.

Key proposals in Healthy Lives, Healthy People, which was published today and only applies to England, include:

• The creation of Public Health England – located within the Department of Health – as a service to give “more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics”. It will take on full responsibilities from 2012. Public Health England will combine experts from bodies such as the Health Protection Agency and the National Treatment Agency. It will also be a “knowledge bank” for evidence on behaviour change techniques and monitoring data
• Ring-fencing of public health funding from the overall NHS budget. Government estimates suggest that Public Health England will have responsibility for £4bn.
• Local health improvement functions will be transferred to local government, with the ring-fenced funding allocated to upper-tier and unitary authorities from April 2013. Local authorities will have a duty to take steps to improve the health of their population
• Local government will also be given new functions to “increase local accountability and support integration and partnership working across social care, the NHS and public health”
• The majority of public health services will be commissioned by local authorities from their ring-fenced budgets or by the NHS through Public Health England’s new public health budget
• Directors of Public Health will be employed by the relevant upper-tier or unitary local authority “and be the ambassadors of health issues for the local population”. This means in practice that they will lead discussion about how the ring-fenced money is spent and also influence investment decisions right across the local authority. The White Paper says directors will be able to “make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions”. The role can be shared with other local councils if agreed locally
• The government will take forward detailed proposals for the establishment of health and wellbeing boards in every upper-tier local authority. “They will also have the flexibility to bring in the local expertise of district councils”. There will be a proposed minimum membership of elected representatives, GP consortia, Directors of Public Health, Directors of Adult Social Services, Directors of Children’s Services, local HealthWatch, and, where appropriate, the participation of the NHS Commissioning Board
• The new general power of competence will provide local authorities “with much greater freedom and flexibility to act in the interests of their communities”
• A health premium will take into account health inequalities and reward progress on specific public health outcomes. The Department of Health will consult on the detail of how the outcomes framework and the funding will work, but disadvantaged areas will receive a larger premium if they make progress
• The Department of Health will publish documents on mental health, tobacco control, obesity, sexual health, pandemic flu preparedness, health protection and emergency preparedness in 2011. The government wants to see a more coherent approach to mental health in particular, and will shortly publish a new mental health strategy
• A new “Public Health Responsibility Deal” will be driven forward by the Health Secretary with a view to making it easier for people to make healthy choices. This is likely to include “better food labelling, more information about alcohol harms, and much bigger contribution from industry around campaigns like Change4Life”.

The White Paper said: “There is huge potential to meet people’s needs more effectively and promote the best use of public resources through close working relationships between local authorities and the NHS, to further integrate health with adult social care, children’s services (including education) and wider services, including disability services, housing, and criminal justice agencies. There will be sufficient flexibility in the legislative framework for health and wellbeing boards to go beyond their minimum statutory duties to promote joining-up of a much broader range of local services for the benefit of their local populations’ health and wellbeing.”

The core elements of the new system will be set out in the forthcoming Health and Social Care Bill.

The Department of Health has also published a review of the regulation of public health professionals. It said the government’s preferred approach was to ensure “effective and independently assured voluntary regulation for unregulated public health specialists”. This will be overseen by the Council for Healthcare Regulatory Excellence, as provided for in legislation currently before Parliament.

Lansley said: “Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health.

“People’s health and wellbeing will be at the heart of everything local councils do. It’s nonsense to think that health can be tackled on its own. Directors of Public Health will be able to champion local cooperation so that health issues are considered alongside housing, transport, and education.”

The Health Secretary argued that people should have services tailored for them, “at the right times in their life from the professionals closest to them”.

He added: “With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation’s health.”

Responding to the White Paper, Cllr David Rogers, chairman of the Local Government Association’s community wellbeing board, said: “Public health has been the core business of local government since its foundation. Many councils already put a lot of effort, resources and imagination into improving the health and happiness of their communities.

“We believe public health should be at the heart of all we do, so the government’s decision to give town halls a wider role presents us with a great opportunity to build on the good work which already exists across the country.”

He added: “This White Paper states it is time to free up local government and local communities to decide how best to improve the health and wellbeing of their citizens, but it doesn’t go far enough and leaves many questions unanswered. Behind the language of greater freedom lies a swing to central control which risks hampering town hall efforts to boost health.  

“With Public Health England employing the majority of the public health workforce, how can we make sure local and national needs work hand in hand? How can we answer to government when the people leading on public health don’t answer to us? Public Health Directors must be accountable to councils.”

Cllr Rogers praised the government for recognising that councils will need more money to perform the extra public health duties contained in the White Paper. However, he added: “Not only should we make sure they're given enough to do the job, they also need the financial freedom to effectively take on the challenges of improving their residents’ health. How the public health ring-fence will work must be made clear.”

The Chief Medical Officer (Interim), Professor Dame Sally Davies, said: “We need a strong and protected public health system to tackle our public health problems, and protect the public. So I welcome this Public Health White Paper which sets out how a new core public health service, Public Health England, will integrate public health expertise, providing national support and advice, for local delivery.

“By joining up the local work done by the NHS, social care, housing, environmental health, transport and leisure services and focusing on public health at a local level, this paper lays out a strategy to improve the health and wellbeing of the nation, and addresses the issues of health inequalities.”

A copy of the White Paper can be downloaded here. The deadline for responses is 8 March 2011.