Lost in, or Coming out of, Transition of Public Health to Local Government?

1. Lost in, or Coming out of, Transition of Public Health to Local Government? David Hunter Professor of Health Policy & Management 14th March 2013 School of Medicine Pharmacy & Health

2. Questions from Brighton & Hove Delegation on PHOF (1) Q. Where does accountability lie for the delivery of the public health outcomes framework (PHOF), i.e. to whom is the local authority accountable for delivery? Accountability lies with local authorities – sector-led improvement based on self-assessment, peer review; no top-down performance management; potential roles for LGA and PHE (as a ‘critical friend’); LAs accountable to their communities Q. Where there is cross-over between PHOF and NHS outcomes framework, where does accountability lie? No idea! But LA will be accountable to its community and not to some higher authority or agency; HWBs and CCGs working together. School of Medicine Pharmacy & Health

3. Questions from Brighton & Hove Delegation on PHOF (2) Q. What performance mechanism will there be for reporting the PHOF and to whom? There won’t be one single mechanism applicable to all. Localism will prevail. But it’s likely LGA and PHE, and possibly also DH and DCLG, will have an interest in monitoring progress. But there will be no formal mechanism put in place – not in the early stages and possibly never. PHOF itself may change – viewed by some in local government as too biomedical and NHS facing. Q. What will be the nature of the relationship between PHE and LAs? Can they tell us what to do re delivering the PHOF? Or is ‘localism’ the trump card? For the time being, localism is the trump card. PHE exists to support, facilitate, enable, cajole but it can’t/won’t direct LAs. Relationship of PHE to LAs will be one of ‘critical friend’. Possible role for NICE in developing QS for public health which will serve as the benchmarks to which LAs will be expected to aspire to. School of Medicine Pharmacy & Health

4. Questions from Brighton & Hove Delegation on PHOF (3) Q. Will there be a combined inspection framework across partnership priorities, similar to the old Joint Area review (JAR)? Will there be an equivalent framework based on ‘Place’? Not aware of any plans to introduce a JAR type arrangement. Framework based on place is certainly possible and could be what the PHOF becomes. School of Medicine Pharmacy & Health

5. In the News • State of health in the UK: could do better (The Lancet) • House of Commons Communities & Local Government report – coming soon School of Medicine Pharmacy & Health

6. Key Conclusions & Recommendations (1) • Ensure that Health and Wellbeing Boards focus on public health and wellbeing and do not get captured by health and social care agenda • Health and Wellbeing Boards need to ensure they have the skills in leadership, partnership engagement and analysis to do the job : relationships are key • CCG membership should include elected members if desired locally • Importance of JSNA and JHWS • Use PHE and NICE as sources of evidence and guidance on good practice

7. Key Conclusions & Recommendations (2) • Clarify role of DPH in health protection – lines of responsibility and accountability too vague, lack clarity • Put all child health services into local government rather than split them between LAs and NHSCB • Local authorities should self-assess their performance; role of Public Health England to be ‘critical friend’ and not a regulator • Move from ring-fenced budgets to place-based or community budgets