PHE was established in April 2013 as part of the government’s NHS reforms to distribute a £2.7bn public health grant to councils and provide them with advice and evidence about approaches that work.
In a review of its work to date, the NAO concluded that PHE had made a good start but had encountered some problems with the accuracy of how local authorities were recording what had been spent on public health.
It also noted that historic decisions by the NHS on public health funding left authorities with significantly more or less resource than they would have been given on basis of need.
Questions over whether the ring-fence will remain in place beyond 2015/16 will also have a knock-on effect on the department’s effectiveness.
NAO head Amyas Morse said: ‘Public Health England is accountable for achieving the public health outcomes the Department of Health wants, but it is local authorities who are responsible for delivering improved public health. ‘The agency is developing a good relationship with its local stakeholders to whom it is providing tools, support and advice.’
But he added: ‘There is a difficult balance to be struck between localism and the agency’s responsibility for improving health. The agency’s ability to influence and support public health outcomes will be tested further if the grant paid to local authorities were no longer to be ring-fenced.’
The report concluded that it was too early to say whether PHE was providing value for money and too early to see if the activities it funds were leading to healthier lives. But it noted progress in some areas, including in the provision of blood pressure and cholesterol checks now offered by every local authority.
The NAO did, however, urge the agency to identify and support authorities where there was poor alignment between spending plans and local needs.
PHE chief executive Duncan Selbie welcomed the NAO’s broadly positive findings and said the organisation was committed to building on its good start.
'We accept the findings of the report and are actively working to address the recommendations, each of which we have agreed,' he said.
‘We have recently published our strategy document From Evidence to Action which sets out our key priorities for the next five years and is fully aligned to the NHS Five Year Forward View. We were pleased to see this acknowledged in the NAO report [and] believe this gives us a platform on which to build and develop our service offering to local government and also the NHS.’
On the ring-fencing issue, Selbie added: ‘Our advice to government is that the ring-fence should remain in place for the foreseeable future.
'Should, at some point, the ring-fence be removed we agree this will present a set of challenges to ensure continued investment in public health, although we are encouraged by the fulsome commitment of local government to their statutory duty to improve the public’s health.’
