Building a public health system fit for the future
24 February 2021
COVID-19 has thrust the importance of a robust and well-resourced public health system into the spotlight.
A new briefing from NHS Providers, A window of opportunity for public health, delves into the risks and opportunities which arise from the dissolution of Public Health England (PHE) and the creation of the National Institute for Health Protection (NIHP) – a new national body responsible for protecting the nation's health from external threats, incorporating NHS Test and Trace, the Joint Biosecurity Centre and PHE's infectious disease unit.
It also explores questions which must be addressed in the coming months, including about the future of PHE's other vital roles surrounding the broader determinants of health, the pressing need to put health inequalities at the heart of any reform to public health, and recovery from COVID-19.
The briefing makes clear that no expertise should be lost in the transfer of public health functions.
It recognises that while national leadership is critical during times of national emergency, there is a risk that an overly centralised response will lead to local government and health and social care partners, including NHS trusts, being hindered in their efforts to tailor services to their communities. The briefing makes clear that no expertise should be lost in the transfer of public health functions, and that there must be sufficient financial investment on both a national and local level to ensure services are sustainable. As system working evolves, this is particularly important because ICSs are becoming a forum for local government, the NHS and wider public sector partners to work towards shared goals of population health.
Reform provides the opportunity to reconsider how public health services are funded. Since 2012, public health commissioning has been fragmented and vulnerable to cuts, leaving providers struggling to meet demand with resources available. Alongside a strengthened role for ICSs in public health and a robust voice for local government within systems, NHS Providers says clinical public health services would be better commissioned alongside other NHS services, with close partnership working with local government and the voluntary sector as part of system working.
Commenting on the briefing, the deputy chief executive of NHS Providers, Saffron Cordery, said:
"During the first wave, questions arose about the country's preparedness for a pandemic, and whether our public health system was fit for purpose.
"COVID-19 has highlighted the impact of public health budget cuts, which have undermined the sustainability of services. In the nation's recovery from the pandemic, it is more important than ever for the government to commit to long-term investment in public health services, recognising the vital role they play in supporting resilience to national emergencies and supporting overall health and wellbeing.
Any reforms to public health must make sure that local leaders, who are closest to their communities, are empowered to work flexibly according to what they know works.Interim Chief Executive
"Any reforms to public health must make sure that local leaders, who are closest to their communities, are empowered to work flexibly according to what they know works. There should be stronger partnerships between NHS organisations, local government and the voluntary sector within systems.
"While we are concerned about the timing of reforms and the risks of separating health protection and health improvement, there is also a clear opportunity to address trust leaders' concerns around health inequalities and population health.
"The focus of NIHP on preparing better for future disease outbreaks is of course right, however the government must not lose sight of much needed investment in wider public health functions. Trust leaders are particularly worried about risks to preventative services including screening programmes, the national cancer registry, and public mental health functions."