• NHS England could fund key public health services if funding not provided to local councils
  • CCGs must show how they will reduce inequalities over next 10 years
  • Commissioners will have to show how health inequalities adjustment is being used to improve access and outcomes

The NHS and government will look at funding key public health services from the NHS budget, the long-term plan has said.

They will “consider whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be”.

These services are currently funded from the local authority public health budget, which is set by central government. The new budget for 2020-21 onwards is due to be announced in the spring spending review.

HSJ understands the NHS is ready to take these public health functions back from local government, if the Treasury does not otherwise put sufficient money into public health via local government.

The funding local councils receive for public health “directly affects demand for NHS services”, the plan said, adding that action by the NHS ”is a complement to, but cannot be a substitute for, the important role of local government”. However, the public health grant from central to local government has been cut year on year since 2015.

Health visitors, school nurses and sexual health services are key to moderating demand on other NHS services and in many cases are already provided by the NHS, the long-term plan said.

Funding for health visitors was only moved to local government in 2015. The health visitor workforce peaked that year following a national workforce target but it has since shrunk by approximately 23 per cent, according to the latest workforce figures.

The plan also said local health systems will have to say this year how they will specifically reduce inequalities over the next decade.

Those clinical commissioning groups that receive a health inequalities adjustment will be, for the first time, obliged to show how they are targeting this funding “to improve the equity of access and outcomes”.

NHS England said it “will expect CCGs to ensure that all screening and vaccination programmes are designed to support a narrowing of health inequalities”.

There will also be a fundamental review of GP vaccination and immunisation standards, funding, and procurement to “support the goal of improving immunisation coverage”.

Priority will be given to improving childhood immunisation “to reach at least the base level standards” set out in the NHS public health function agreement.

Childhood vaccination statistics for 2017-18, published last year, showed coverage declined in most of the 12 routine childhood jabs. Some of the vaccinations, including the measles, mumps, and rubella shot, have been in decline for several years.

The long-term plan identified two public health interventions for cancer including “modernisation of bowel cancer screening programme” by introducing a new screening method, the faecal immunochemical test.

FIT is simpler than the current test and should increase participation “in previously marginalised populations”, including “people in ethnic minority backgrounds and people in more deprived areas”.

And, from this year, NHS England will commission more lung health check programmes in areas of England with the worst lung cancer survival rates, after successful pilots in Manchester and Liverpool.

Update: This story was updated at 13:17 on 8 January to include more recent statistics on health visitor numbers.