Public health reforms in England

The Health and Social Care Act 2012 radically reforms the way that health care is commissioned in England. As part of these reforms, local public health services will move from the NHS into local authorities. A new body – Public Health England – will be set up to provide strategic leadership support and health protection functions. This fact sheet outlines these major changes, and the RCN’s views on them.

The RCN agrees in principle with the creation of Public Health England as a dedicated body to oversee health protection and emergency planning across the country, and with the new responsibilities assigned to local authorities. Local authorities have an opportunity to develop public health services in a holistic way, taking into account the multitude of factors which impact on public health which they can influence (for example housing and transport).

Integration of services is key to improving efficiency and to providing better patient care and population outcomes. However, we feel strongly that there is a risk that the changes could instead lead to fragmentation, as health services will now be commissioned by many different organisations (for example LAs, the NHS CB and clinical commissioning groups). There is still a lack of clarity over where responsibilities lie, and it is imperative that no services “fall between the gaps” during the transition period.

Health and wellbeing boards may offer a forum to prevent this, as they bring together representatives from all parts of the health and social care system and have a duty under the Health and Social Care Act 2012 to encourage integration. Whilst supporting the role of these boards, the RCN has identified a number of key challenges that may prevent them from effectively carrying out this duty, including a lack of clarity around their structure, funding and accountability. We feel that nursing insight is particularly important in any efforts to integrate care pathways, both within health and across care systems. Therefore the RCN believes that the nursing profession must be represented on health and wellbeing boards.

The RCN believes that in order to successfully deliver for the future public health needs of the country, the Government must recognise the links between poverty, poor housing and transport, social isolation, and poor physical and mental health. The health promotion aspect of public health will be crucial to meeting these growing challenges, and this preventative work must be prioritised by local authorities so that inequalities and health needs (and their financial impacts) can be reduced. With demand-led services like sexual health treatment and drugs and alcohol misuse services being funded from the same public health budgets, there is a danger that health promotion could lose out if it is not suitably championed and protected.

The RCN supports the focus on patient outcomes in the new public health system, as part of a national framework that allows for comparisons, bench-marking and for the development of local responses to local problems and needs. This approach should help to ensure that populations across England are not disadvantaged through poor commissioning, poor delivery or inappropriate allocation of resources. We believe that there would be value in including measures that are linked to the health and wellbeing of the public health workforce in the outcome frameworks, as these have been shown to have an impact on the quality of services and care delivered to patients.

For further information, please email papa.ukintl.dept@rcn.org.uk