Moving public health to local authorities could benefit everyone’s health – if the system is safe and effective
(Monday 5 March 2012)
It is vital that the Health and Social Care Bill leads to a safe and effective public health system that protects everyone's health, the Faculty of Public Health (FPH) said today.
The call comes after a recent debate in the House of Lords about the bill, in which peers proposed amendments to clarify the role that directors of public health will have if they are employed by local authorities, not, as is currently the case, the NHS.
Professor Lindsey Davies, FPH President, said: "FPH has called for the withdrawal of the Health and Social Care Bill because we believe that, overall, the risks it poses to the NHS - and therefore to people's health - outweigh the benefits. Our position on the proposals for public health is that we support, in principle, the move of public health staff to local authorities as it would give them more opportunities to directly influence wider issues that affect our health, such as housing, education, and employment. But there are risks here, too, and we must make sure that the whole new system is safe and effective. We have repeatedly raised our concerns with parliamentarians and other stakeholders."
In summary, those concerns are:
- In principle we welcome the creation of Public Health England, but believe it should be a special health authority, or a non-departmental public body, with an independent chair and board. It should not be an executive agency of the Department of Health run by civil servants. All public health professionals need the professional freedom to speak out on behalf of the people they serve.
- Directors of public health (DPHs) must be properly appointed, registered and regulated. We cannot let the demands of local politics take precedence over challenging but vitally important public health decisions.
- Responsibilities for managing health emergencies must be clear. The bill and fact sheets produced so far are contradictory and confusing. Local authorities should be responsible for ensuring that local outbreaks and emergencies are managed properly.
- There is a risk that public heath expertise – which saves lives and makes the NHS's precious resources go further – will be lost from health service planning. We need public health experts at every level of commissioning, from the national to the local.
- The bill means big changes to the way the NHS is run. We must ensure people do not miss out on the health services they need, by matching up the boundaries between local authorities and Clinical Commissioning Groups.
- We have already lost valuable public health jobs, people and skills because of the reforms. Public health expertise must have the right funding and resources to protect and improve the public's health.
Professor Davies continued: "Some public health experts feel strongly that the risks are such that the move to local authorities can't be supported. On the contrary, FPH is clear that if our concerns are addressed, the benefits of wider engagement of local authorities outweigh the potential risks of the move. Public health must continue to be involved actively in commissioning and service provision. We will continue to listen to and engage our members on this vital issue."
NOTES TO EDITORS
A more detailed briefing on our concerns follows below. Please contact us for further details or to arrange an interview:
Liz Nightingale, Media and PR Officer: tel 020 7935 3115, email , mobile 07773 350833
About the Faculty of Public Health (FPH)
FPH is the standard-setting body for public health in the UK with more than 3,000 specialist public health members. FPH is a registered charity and advocates for better public health in the UK and around the world, by stimulating debate on promoting, protecting and improving the public's health.
Briefing on FPH’s concerns about moving public health to local authorities:
1. In principle, we welcome the creation of Public Health England (PHE), which will be a national expert and authoritative body that advises and supports national, local and public and private sector organisations on all aspects of public health. PHE should be a special health authority with an independent chair, not an executive agency of the Department of Health. As an executive agency, PHE’s staff, as civil servants, would be constrained in what they can say in public. This makes no sense for a public health organisation whose primary duty is to promote and protect people's health and wellbeing. Public health professionals, wherever they are employed, must be confident that they retain the professional freedom to speak out on behalf of the population they serve, including voicing their concerns where systems and services aren't meeting people's needs.
2. Directors of public health (DPHs) must be properly appointed, registered and regulated so the public has trust and confidence in the decisions they make. That can mean saving lives by dealing with outbreaks and emergencies. A DPH employed in a local authority needs direct access to its cabinet and should be directly accountable to the CEO or leader to enable him or her to directly influence the decisions that affect people's health. Although the bill commits to DPHs producing an annual report, we need statutory guidance that DPHs and public health specialists based in local authorities can speak out on behalf of their population. We cannot let the demands of local politics take precedence over politically unpopular but vitally important public health decisions.
3. The Health and Social Care Bill proposes that local authorities will be responsible for making sure that plans are in place for dealing with outbreaks and other emergencies but not for making sure they are actually managed properly. This is irresponsible. Someone must be clearly in charge and able to hold other organisations locally to account. Our view is that this should be the local authority, acting on behalf of the local population.
4. There is a risk that public heath expertise will be lost from the planning of health services. This is a serious concern that we have raised repeatedly. Public health expertise saves lives and makes the NHS's precious resources go further. That's why effective health services cannot be effectively commissioned without public health expertise. We need public health experts in every level of commissioning – from the national to the local.
5. The bill means big changes to the way the NHS is run. We believe joined-up planning is vital so that the boundaries between local authorities and Clinical Commissioning Groups match up. That will ensure people will not miss out on the health services they need because they fall between the gaps, and health services can be properly planned to protect people's health.
6. Public health expertise needs the right funding and resources, as we have argued since the reforms were first introduced. We have already lost valuable public health skills because of the reforms. Public health roles need NHS-comparable terms and conditions, otherwise we will not attract the best candidates to protect our health, and the future of public health – as an ultimate aim/outcome and as a profession – will be put at risk.
Written: 05/03/2012 , last modified: 08/03/2012