The Department of Health (DH) have released a suite of fact-sheets about the new public health system promised as part of the NHS Reforms. This includes further details of the responsibilities of local government and the operating model for the new Public Health England (PHE), following the Public Health white paper.
Public Health England (PHE) will be an executive agency of DH taking national leadership for public health issues. It will provide some services, including health protection, information and intelligence, and will continue to use social marketing and behavioural insights to guide activity in new directions. It will set out to be the driver for building an evidence base for public health activities, supporting the development of a specialist and a wider public health workforce working for a range of employers.
Directors of Public Health, jointly appointed and employed by LAs, will work with a range of new partners to tackle health inequalities and the links with crime reduction and the prevention of violence. The DH will provide the legal and policy framework and ensure that public health is central to government priorities.
Local Authorities (LAs) have a history with public health but in 1974 the NHS took over most public health functions. LAs may be considered best placed to co-ordinate partnership activities across areas of housing, regeneration, education, children and young people, strategic planning and fire and road safety. LAs will be expected to consider health and health inequalities in all their policies through the development of Joint Strategic Needs Assessments (JSNAs) and Joint Health and Well-being strategies, which will integrate efforts under the umbrella of a community wide approach.
The new model for public health will operate with an Outcomes Focus, due to be published in 2012, with statutory changes planned for April 2013. The NHS Operating Framework and Adult Social Care Outcomes Framework will include outcomes for increasing life expectancy, reducing premature death and reducing health inequalities. The key indicators are expected to measure improvements across the wider determinants of health.
Of course the NHS reforms have not been without controversy. A recent Health Committee report voiced concerns over the threat to public health spending given the scale of cuts facing LAs. It also questioned national level policy including the Responsibility Deal, asking at what point stronger intervention is applied if 'nudging' is not shown to be enough. Alcohol treatment has long been considered under-invested compared with drugs, so the forthcoming national alcohol strategy is much anticipated.
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