Putting the public into health

6 May 14

Public health funding is back where it belongs, with local authorities. And one year on from the transfer, councils’ efforts are beginning to show results

It has been one year since the transfer of public health responsibilities from the NHS back to where it belongs in local government. This change represents the greatest opportunity to improve the public’s health in 40 years. Councils are best placed to decide what’s important for the people who live in their communities and, working with key partners, determine how best to direct all available resources to achieve maximum impact in improving the public’s health.

This is an important and exciting change to the public health system. Supporting local authorities in this task, has involved the transfer of about £2.7bn of funding from the NHS, 3% of the health budget, in the form of a ring-fenced public health grant.

Good health and wellbeing is not solely the absence of illness. Employment, decent homes, friends, the environment we live in and our own individual choices all play their part.

Councils are perfectly placed to use all available resources to engage on all these fronts because they have the ability to leverage public health benefits from the whole of their spending power and not just the ring-fenced grant. In fact, many local authorities are putting additional investment into public health services.

During the past 12 months I have visited local authorities all over the country and have seen at first hand the enthusiasm and hunger to take on the challenge of improving the public’s health. Local authorities are passionately and genuinely committed to the health of their communities.

There is no ‘one-size-fits-all’ approach and I am energised by the diverse evidence-based approaches being taken to improve health – from creating thousands of jobs from Hartlepool in the north to Medway in the south, to free access to swimming and to exercise in places like Blackburn with Darwen.

Although their population profiles and needs are necessarily varied, what these councils all share is a profound understanding that their new duty is to improve the public’s health rather than per se provide a public health service, as important as that is. During my meetings with local teams I see extraordinarily able local leadership from officers and politicians, and a focus on assets and possibilities rather than problems and deficits.

We are acutely aware of the huge challenges that local authorities are currently facing. Local authorities are operating in an unprecedented financial environment and all have tough decisions to make. Public Health England maintains an ongoing dialogue with councils and where there are fine judgments to be made we will work closely with them and offer advice.

Recently, fears have been expressed that public health budgets are being routinely diverted away from public health interventions. We do not believe this to be the case. Local authorities are free to spend these budgets to improve the health of their local population in ways that they see fit.

Councils don’t have to ask permission as to how they spend their public health grant, but will, ultimately, be judged on their outcomes against the measures in the Public Health Outcomes Framework. That said, I expect directors of public health in each local authority to ensure their public health grant is being utilised appropriately. In addition, as the accountable officer for this spending, I have written to every local authority in England explaining what I need by way of assurance that councils are using the ring-fenced grant in line with the conditions.

It is natural that local authorities will have different priorities and spending plans from the pattern that they inherited and we are pleased to see the ring-fence beginning to be combined with other funding streams and focused on the wider determinants of health.

Public Health England’s role is clear. Our job is to support local government in every way we can, including occasionally holding up a mirror and connecting authorities to others facing similar challenges.

This has been a fast moving and productive first year and good foundations have been set. While there is still much to do, I am very happy with the progress made and I have been deeply impressed by councils, each in their own way getting on with and taking their public health responsibilities extremely seriously. The public’s health is most definitely in safe hands and we are well on the journey from transition to transformation.

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