By Lucy Phillips
30 November 2010
Plans to hand public health budgets back to local
authorities in England were announced today, with ministers promising financial
incentives to help councils reduce health inequalities.
Health Secretary Andrew Lansley published the government’s
white paper on public health, Healthy Lives, Healthy People, at
lunchtime. Budgets for tackling public health problems, such as obesity and
smoking, will be devolved to local authorities for the first time since 1974.
Councils will employ directors of public health, likely to
be transferred from the NHS, to decide how the money is spent and commission
local services from the private and voluntary sectors.
A ‘public health premium’ will also be introduced to reward
councils for progress on tackling health inequalities in an attempt to reduce
the life expectancy differential between rich and poor.
The changes are expected to take effect from April 2013,
with councils given shadow public health allocations the previous year to help
A new body called Public Health England will also be
established to run national initiatives and population-wide health
Lansley said a ‘baseline’ budget of £4bn would be
transferred from the NHS to local authorities and Public Health England. How
the money will be divided between them will be subject to another consultation
document, due to be published before Christmas.
All the money will be ring-fenced, including the local
authority budgets that councils will have to account for in their local public
Lansley said putting local authorities in the driving seat
was ‘bringing home’ responsibility for public health.
He added: ‘Too often in the past, public health budgets have
been raided by the NHS to tackle deficits. Not any more. The money will be ring-fenced
to be used as it should be – for preventing ill health.
‘People’s health and wellbeing will be at the heart of
everything local councils do. It’s nonsense to think that health can be tackled
on its own. Directors of public health will be able to champion local
co-operation so that health issues are considered alongside housing, transport
But the Local Government Association said the white paper failed to go far enough and left many questions unanswered. David Rogers, chair of the LGA's community wellbeing board, said: 'Behind the language of greater freedom lies a swing to central control which risks hampering town hall efforts to boost health.
'With Public Health England employing the majority of the public health workforce, how can we make sure local and national needs work hand in hand? How can we answer to government when the people leading on public health don’t answer to us? Public health directors must be accountable to councils.
'Whitehall has rightly recognised councils need more money to perform these extra public health duties. Not only should we make sure they're given enough to do the job, they also need the financial freedom to effectively take on the challenges of improving their residents’ health. How the public health ring-fence will work must be made clear.'
Nigel Edwards, acting chief executive of the NHS Confederation, said is was important to get the implementation right.
relationship between GP consortiums and local authorities is really
crucial. GP consortiums and local government need a shared plan for
health social and public health so we can prevent the lack of
co-ordination that has bedevilled this area in the past,' he said.
The Association of Chief Executives of Voluntary
Organisations warned that the plans could be derailed by council spending cuts.
Chief executive Stephen Bubb said: ‘With some local councils already cutting
back their support for voluntary organisations in order to “protect their own”,
there is a danger that Lansley’s vision will be undermined by local government
salami-slicing before the new public health service is even up and running.
Councils need to work intelligently with their local third sector to foster the
kind of thriving civil society which will enable them to deliver on the government’s
public health agenda.’