Let's talk business: Public health, people and money

The Government’s reform of public health services (detailed in the White Paper: Healthy lives, healthy people: our strategy for public health in England) has reignited debate about the importance and future of public health in the English NHS.  Although admittedly that discussion has sometimes been drowned out by the sound and fury provoked by the wider structural reform programme.

The key argument for retaining public health involvement in the new system is a simple one.  We need to ensure that commissioning decisions affecting the health and well being of local populations are informed by public health skills, and that there are sufficient funds available to be able to deliver on our promises.

As it stands the duty to obtain public health advice runs the risk of becoming a tick box exercise, one completed to satisfy the performance management regime of Clinical Commissioning Groups but with little real impact on how commissioning decisions are made at a local level. 

In response, the Health Committee’s recent report looking at the proposed changes calls for the Government to further strengthen the role of the Director of Public Health and public health input into commissioning, echoing a point made in our submission. 

But to ensure public health skills inform commissioning decisions, both commissioners and public health specialists will also need to change.  The former must recognise the skills and expertise of the latter, while public health specialists also need to be more forthright about what they bring to the table.  

The actual testimony heard by the Committee is worth reading as much as the report itself, especially with regards to the public health budget and front line services.  The lack of clarity from the Government on national budget allocations and how the money should be spent will only add to the frustrations of new organisations trying to plan in the current financial climate. Answers need to come succinctly and quickly.

The Committee also proposed limiting the ring fenced public health budgets to three years, suggesting that any longer would be a barrier against integration. Removing the fence around public health is a concern as past experience suggests that in times of recession public health is one of the first things to go. 

Arguably there may be more long term gain in getting the Department of Health to prescribe what services are legitimately public health (e.g. sexual health services) alongside a statutory duty on the directors of public health to ensure public health is an integral part of departmental plans across their local authorities. 

Taken as a whole the Committee’s report will not have been surprising to keen observers, but its conclusions are welcome for what it does to focus attention on important areas that need addressing sooner rather than later to enable commissioners and providers to get back to business.