The White Paper ‘Healthy Lives, Healthy People’ sets out a radical change to the way public health is structured and delivered, but several aspects of the plans should be strengthened.
Under the White Paper proposals, the Director of Public Health and most public health specialists will move from primary care trusts (PCTs) to local authorities. Health and Wellbeing Boards will be established to oversee the health and social care services for each local authority area. Other public health functions, such as health protection, will be amalgamated into a new dedicated national organisation Public Health England, forming part of the Department of Health.
The Nuffield Trust welcomes the prominence given to public health by the coalition Government, including the focus on tackling the wider determinants of ill-health and inequalities at a local level. The Trust also welcomes the emphasis on the ‘life course’ approach as recommended in the Marmot Review. Nevertheless, the White Paper lays out a challenging agenda and it is likely to have a major effect on the future delivery of public health services.
Robust accounting rules must be specified to ensure that ring-fenced public health budgets are protected for use on public health initiatives and not diverted to pay for core services delivered by local authorities, which do not have a significant benefit for public health. Public health involvement in the commissioning functions of the National Commissioning Board also requires clarification in terms of roles, responsibilities and accountabilities to ensure commissioning is based on population needs assessment and a firm evidence base.
Nuffield Trust (2011) Public Health White Paper 'Healthy Lives, Healthy People': our consultation response. Consultation response. Nuffield Trust.