- COVID-19 has thrust public health into the spotlight. Proposals to reform the public health system come with risks, but also opportunities, for how population health is prioritised and resourced in the future, as part of the nation’s recovery from the pandemic, and in preparation for future threats to public health.
- While the future destination of Public Health England’s other responsibilities, in particular its health improvement functions, have yet to be set out in detail, it is vital that no expertise is lost, and that national and local leadership for these responsibilities is maintained with sufficient investment both to make up significant shortfalls over recent years and to ensure an effective function in the future.
- Years of cuts to public health budgets have undermined the sustainability of public health services. In the wake of the pandemic, it is all the more important now for the government to commit to robust and long-term investment in public health services, in recognition of the essential role they play in supporting the resilience to emergencies such as the pandemic.
- While the role of national leadership is critical during times of national emergency, there is a risk that embedding this into a future public health system will result in local government and local partners including trusts becoming further disempowered to act for the good of their local communities. Local leaders, who are closest to and understand most about their communities, who can tailor services and communications to meet their needs must be empowered to work flexibly according to what they know works. This should involve a partnership between NHS organisations, local government and the voluntary sector.
- As system working evolves, integrated care systems (ICSs) are more clearly becoming a forum for local partners to work towards shared goals in population health – indeed this is a core aim of the proposed new statutory partnerships involving local government, the NHS and wider public sector partners at the system level. As health improvement responsibilities are redistributed and potentially devolved to a more local level, it is vital that this takes place with system working in mind, and it will be all the more important for local authorities to have a seat at the table in discussions taking place about local resources and population outcomes.
- As part of the reconfiguration of public health responsibilities there is an opportunity to reconsider the commissioning arrangements for some public health services, which, since legislative reforms in 2012 have become fragmented and vulnerable to funding cuts, leaving those delivering the services (often community providers) struggling to meet demand for the resources available. Alongside a strengthened role for ICSs in public health and a robust voice for local government within systems, we believe clinical public health services would be better commissioned alongside other NHS services.