The Effects of National Legislation on the Public Health Role of Local Government in England

Oslo, December 2015

Professor John Kenneth Davies Centre for Health ResearchSchool of Health Sciences

Presentation Overview

• Historical perspective

• Health & Social Care Act 2012

• Funding

• Management & operation

• UK context

• Early implementation

• Conclusions

Historical Perspective

• Health in Towns Commission 1843 & Association 1844

• Public Health Act 1848

• Local Boards of Health 1848-1894

• Urban Districts 1894

• Expanded role 1900-1948

• NHS & Local Authorities 1948-1974

• NHS & Local Authorities1974-2012

Health and Social Care Act 2012

• Local authorities given responsibility for public health/improving local health (since 1974)

• Director of Public Health

• Health & Wellbeing Boards

• Public Health England – executive agency of DOH

• Public Health Outcomes Framework

Role of Local Authorities (L/As)

• Localism Act 2011

• Public Services (Social Value) Act 2012

• NHS Bodies & Local Authority (Partnership Arrangements, Care Trusts, Public Health & Local Health Watch) Regulations 2012

• Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013

Funding

• £6 billion spent annually on public health services

• 2015-2016 DOH ring-fenced grant of £2.79 billion to local authorities for public health

• Local authorities contribute additional £54m to public health in 2013-14 (housing, leisure, adult care, etc)

• 6.2% cut in money received by local authorities for public health in 2015-16

• Health Premium Incentive Scheme

• Current consultation to cut ring-fenced grant by £200m

• Will ring-fencing be removed in future?

Management & Operation

• 3 domains of public health

• Health improvement

• Health protection

• Health care/public health services

• Variety of organisational structures

• Dedicated team as part of corporate function

• Dispersed across a range of functions

• Key role of Director of Public Health

Situation in Wales, Scotland & N Ireland

• Size/Scale UK

• 64m (England 54m, Scotland 5m, Wales 3m, NI 2m)

• Divergence of approaches in structure & management

• Scottish Public Health Network

• Public Health Wales

• Public Health Agency of Northern Ireland

9 Key Areas to improve Public Health & reduce Health Inequalities

• Best start in life

• Healthy schools & pupils

• Helping people find jobs and remain in work

• Active and safe travel

• Warmer and safer homes

• Access to green and open spaces & leisure services

• Strong communities, wellbeing and resilience

• Public protection and regulatory services

• Health and spatial planning

King’s Fund 2013

Marmot Indicators for Local Authorities

• Give every child the best start in life

• Enable all children, young people and adults to maximise their capabilities, and have control over their lives

• Create fair employment, and good work for all

• Ensure healthy standard of living for all

• Create and develop healthy and sustainable places and communities

• Strengthen the role and impact of ill health prevention

• instituteofhealthequity.org

Initial Impact of Changes in England 1

• Changes welcomed

• Taking whole council approach

• Access to local politicians

• County councils PH links to district councils

• Good links to Clinical Commissioning Groups (CCGs)

• Building neighbourhood and asset based approaches

• Many moving to wider social determinants of health

• Using research and evidence

• Some building on regional developments

- Local Government Association (2014) Public Health Transformation: 9 Months On.

Initial Impact of Changes in England 2

• PHE have built good working relations with LAs

• Increased transparency of PH spending

• PH funding increased by 5.5% in 2013-14

• Spending in some LA areas not fully aligned with areas of concern

• Department of Health not decided how long ring-fencing should remain and impact of removing it?

- National Audit Office (2014) Public Health England’s Grant to Local Authorities.

Main Challenges

• Government Austerity Policy

• Impact on poor communities

• Limitations on data availability – PH Outcomes Framework

• Too early to assess whether PH outcomes are improving

• PHE not yet documented coordinated plan

• Capacity of LA PH functions?

• Ability of PHE to influence in absence of ring-fenced funding

• Are PHE giving value for money?

Future Needs

• Review how best PHE can provide support to PH staff in Local Authorities

• Improved tools and information available to Local Authorities

• Consider how to adapt working relations if ring-fencing removed

• Produce more cross-Whitehall studies

• Department of Health with PHE should codify their respective roles in policy making and speaking to the evidence

Conclusions

• Leadership

• Funding

• Public health service delivery

• Partnership working

• Data limitations

• Changing focus – public health vision