Finally there is more detail on how public health will be delivered in the future. The Government’s response to its consultation on the Public Health White Paper: 'Healthy Lives, Healthy People', goes some way to addressing the key gaps that we and others have identified around commissioning, but other issues are still far from resolved.
Right now public health specialists work closely with commissioners to conduct needs assessments and evaluate service outcomes. They help decide local priorities, design care pathways and forecast the future disease burden of the population.
As the NHS tries to respond to well known demographic changes their skills will be essential to support the planned shift towards prevention and new models of care. Moving the specialism into local government carries advantages, but the challenge is to make sure the NHS does not lose out as a result.
The Government has recognised this and their response is twofold. Firstly, all commissioning organisations will have a duty to use a broad range of professional expertise in the protection and improvement of public health. Secondly, local authorities will have to provide public health advice to clinical commissioning groups (CCGs). The Government plans to develop the exact nature of this 'offer'.
Offering public health advice to CCGs will mean that they will be able to access it at no cost to themselves. This may encourage CCGs to dip their toe in the 'public health' water. It will also give the message that public health involvement is important for commissioning.
However, the scope of that advice will very much depend on what local authorities are mandated to do, and could be limited if the public health budget is relatively small. There is also a risk that public health becomes an add-on provided by outsiders. To be truly effective public health needs to be embedded into the commissioning process - this could still happen, however these reforms may make it harder.
It is also still not clear how public health specialists will work with national commissioners. The update on the White Paper is vague in this regard, stating only that the NHS Commissioning Board (now NHS England) will look to Public Health England to 'ensure appropriate population advice is available to the NHS.'
Apparently the accountability arrangements will be further worked on, but so far, there has been no indication from the NHSCB as to how this will operate in practice.
Public health specialists are used to working with authority but without power. If they are going to really influence NHS commissioning beyond the joint strategic needs assessment process, the public health offer will need to be comprehensive, properly funded and enacted at a local level. At a national level Public Health England officials will need to have a seat at the table when specialised, prison and other services are being commissioned.
At the moment there is no clear vision on how public health specialists and commissioners can, and should work together. In order to fill in these gaps it will be essential that public health specialists working in the NHS, clarify to the Government and local commissioners what they can do to contribute to NHS commissioning.
Davies S (2011) ‘Public health specialists shouldn't wait to be asked’. Nuffield Trust comment, 27 July 2011. https://www.nuffieldtrust.org.uk/news-item/public-health-specialists-shouldn-t-wait-to-be-asked