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Government sets out who will commission public health services

Immunisation, screening and public health for the under fives will in future be commissioned by the NHS Commissioning Board, under latest government proposals.

The Department of Health has today published a consultation document on its new public health service – to be known as Public Health England – setting out proposals on who will have primary responsibility for commissioning different services.

The majority of public health services will be commissioned by local authorities, on their own or in partnership with Public Health England (see list below).

However, the consultation paper – titled Healthy Lives, Healthy People: consultation on the funding and commissioning routes for public health – states that “it will be appropriate in some cases” for Public Health England to ask the NHS to take responsibility for commissioning those interventions or services.

It lists services that will be commissioned by the NHS Commissioning Broad, via the GP contract, as vaccine programmes for children and flu and pneumococcal vaccines for older people, contraceptive services, and cervical screening.

Outside of the GP contract, the board will also commission the remainder of the national screening programmes, children’s public health in the under fives – including health visiting and the Family Nurse Partnership – and public healthcare for those in prison or custody.

The document reveals the DH is still trying to calculate precisely how much is currently spent on “public health” although it estimates “over £4bn” is spent in total across the department itself, primary care trusts, strategic health authorities and arms length bodies.

The consultation document lists examples of “associated activities” that will continue to be funded from the main NHS budget in order to “illustrate the boundary of the public health role”. These include promoting opportunistic HIV testing, bariatric surgery for obese patients, and pre pregnancy smoking cessation programmes.

The consultation outlines more details on the “health premium”, the proposed mechanism by which the government will incentivise councils to act to reduce health inequalities.

It says disadvantaged areas will be given a greater premium if they make progress “recognising that they face the greatest challenges”, however it also suggests more affluent areas will not lose out if they are also successful in improving the health of their populations.

The paper says the premium will be “simple” and decided by a formula in order to minimise the “administrative burden” on local authorities.  It also asks which academics and experts should be represented in the group to develop the formula.

Elements of the Public Health Outcomes Framework, proposals for which were outlined in a separate document yesterday, will form the basis of the premium.

Launching the consultation, health secretary Andrew Lansley said: “We have set out a vision to ensure that the public health budget will be used as it should be – for preventing ill health and promoting good health.

“I want to hear views from the people that this new [public health] service will benefit and from those who provide the services we seek to improve; this is your chance to comment on our proposals and to let us know how you think key elements of the service should be designed.”

The consultation will close on 31 March 2011.

 

 

Proposed commissioning and funding responsibilities:
Current functions of the Health Protection Agency – responsibility will transfer to Public Health England.
Immunisation – Public Health England will be responsible for decisions on the make-up of vaccine programmes and their funding. The NHS Commissioning Board will commission all immunisation programmes except for those delivered in schools, which will be commissioned by local authorities.
Screening – Public Health England will design screening programmes and provide their funding. The NHS Commissioning Board will commission all screening services on behalf of Public Health England.
Sexual health – local authorities will commission open-access sexual health services and termination of pregnancy services from the public health budget. The NHS Commissioning Board will commission specialised sexual health services, such as HIV testing, and primary care delivered contraception.
Tobacco control, obesity, physical activity and nutrition – local authorities will commission local services and programmes, while Public Health England will run and coordinate national programmes. The NHS will commission surgery and drug treatment for obesity.
Alcohol and drug misuse – local authorities will commission treatment and prevention services, supported by guidance from Public Health England which will take on the core functions of the National Treatment Agency for Substance Misuse.
NHS Health Check Programme – local health authorities will commission the NHS to provide the programme, and the NHS will commission any further testing or treatment that results.
Early presentation and diagnosis – Public Health England will design and fund initiatives which local authorities “may choose” to commission.
Reducing birth defects – Public Health England will be responsible for the surveillance of birth defects.
Dental public health – responsibility for oral health surveys and fluoridation schemes will be the role of Public Health England while local authorities will provide local advice to the NHS.
Public mental health – local authorities will commission and fund mental wellbeing promotion, anti stigma campaigns and self-harm prevention. The NHS will commission mental health treatment.
Emergency preparedness and response – Public Health England will be responsible for preparing and responding to public health emergencies, working together with the NHS and NHS Commissioning Board.  
Public health information and intelligence – Public Health England will take on responsibility for public health information and intelligence, including the current functions of public health observatories, cancer registries and the Health Protection Agency.  
Children’s public health – Services for the under fives will be commissioned by the NHS Commissioning Board on behalf of Public Health England while those for children and young people aged five to 19 will be commissioned by local authorities.
Community safety, violence prevention and social exclusion – local authorities will commission appropriate services using their public health budget, possibly in partnership with other councils.
Public health for those in prison or custody – will be commissioned by the NHS Commissioning Board on behalf of Public Health England.
Armed forces public health – does not form part of the consultation.
Quality and Outcomes Framework – from 2013 Public Health England will decide, in partnership with national governments and NICE, on which public health indicators to include in the framework, A sum equivalent to round 15 per cent of the current QOF value will go towards public health and primary prevention indicators.  

Readers' comments (11)

  • This commissioning picture is now looking increasingly like a a number of small kittens getting all mixed up in several balls of wool.

    A family currently gets all its NHS services commissioned by a single PCT meeting locally in Public and co terminous with Local Government.

    In future the same family will have bits of care commisisoned by Public Health England, bits of care commissioned by the National commisisoning Board, bits of care commissioned by local government and bits of care commissioned by GP consortia who may well cover a number of different local government areas and who may or may not meet in public.

    In this new scenario how will the family know who is commisisoning which bit of their care and where the decisions are being made and to whom to direct concerns/complaints ?

    In this new scenario when the budget for our family is frragmented between multiple bodies how can one achieve the development of a business case which invests upstream in prevention to avoid spend downstream in secondary care ?

    In this new scenario how on earth will all these players work through a joined up commiussioning assurance programme for key risks such as child safeguarding ? [local under five care Health Visiting commissoned by NCB on behalf of public health england, GP and other primnary care contractors commissioned by NCB, over five care and care in school commissioned by Local Government and A and E and childrens acute care by one or more consortia !

    In this new scenario how do we reduce costs whilst at the same time increasing the number of players and 'hand off's'involved ?

    How will the national bodies based in Leeds have enough local intelligence about the family, about the street they live on, about the commuity within which the state sits, about the opportunities presented locally to transact their role ?

    I fear for this family as it is my own.




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  • I'm not sure the lack of GP commissioning of health visiting's safeguarding role is a major issue. GPs are so reluctant to get involved in child protection that I have never known one contribute to a case conference or report on a child and family in all my time in post. Mind, that only goes back to 1981, so I defer to senior colleagues!

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  • I like anon 11.52's analogy of kittens tied up in wool. Does anyone even understand what it means, this idea of being 'commissioned by the NHS Commissioning Board on behalf of Public Health England'? And services for Children’s public health – Services for the under fives being commissioned by one lot, while those for children and young people aged five to 19 will be commissioned by another? What happened to central control of the budget to expand health visiting services?

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  • Oh dear! It looks utterly complicated and has the scope for so many gaps for services to individuals to fall down; whoever could have dreamed this up? How will it improve efficiency, quality and care?

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  • Ian Bowns

    Complexity breeds error.

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  • Complexity provides the opportunity for passing the buck and avoiding responsibility.

    It takes a lot of time and work to join a jigsaw of little pieces together to see the bigger picture, and I am fearful that the next re-organisation of health services will come round before the full extent of the damage of fragmentation is identified.

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  • A mess .. and agree with comment on GP input into child protection case conferences - non-existent as it doesn't pay!

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  • Totally agree with colleagues above. The proposed models looks quite confusing. firstly who has overall responsibilty? is it the NHS commissioning board regionally or nationally, GPs or Local Authority? when does the DH through the Secretary of State intervene? how does the personalisation agenda that is currently being piloted fit into the overall agenda in relation to patient choice and control?

    We have had examples of where gaps has led to huge clinical and governance issues such as Baby P, victoria Climbie and several thousands in Adult social care.
    How will the S75s agreements and pooled funding work in the future?

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  • Ian Bowns

    One of Mr L's fundamental errors in all this is i thinking he can abrogate responsibility for any part of the NHS. Does he rally think that, following this redisorganisation, he can pass the buck to GPs, Natn'l Comm Brd, LAs, PHE, third sector, anyone else passing by? When things go wrong, he will find that the buck will wend its way back to him. He will also find it harder than he seems to think not to intervene as things start to go awry.

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  • A dogs dinner if ever there was one!!

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  • I agree with all the comments above except Anonymous 24/12/10 11:39 AM. By comparison, dogs dinners are fit for purpose, neat and tidy and usually do what they're intended to do. If we're talking tinned dog's dinners, at least they tend to be marked "not fit for human consumption"!

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