• King’s Fund review finds directors of public health working beyond core duties and influencing policy
  • But warns of fragmentation of commissioning for services interlinked with the NHS
  • Adds STPs “have not done well” at engaging public health teams

Public health can have the biggest “influence and impact” on decisions that affect the health of the population from within local government rather than the NHS, according to an independent review.

The report, published on Monday, said the transition of public health from the NHS to councils since 2013 has been broadly successful but added directors of public health are having more influence on approaches to children’s services and social care than other key areas, such as economic development and planning.

The review by David Buck, senior fellow, public health and inequality at the King’s Fund, was commissioned by the Local Government Association.

He said directors of public health are increasingly working beyond their core responsibilities for commissioning services through the public health grant and are influencing policy at both local and regional level.

However, he highlighted some fragmentation of commissioning, mostly affecting those services interlinked with the NHS, such as sexual health and drug and alcohol services.

Mr Buck called for stronger joint commissioning of these services between local government and the NHS which, alongside pooled budgets and “rewards sharing”, would help address an “incentive trap” where “pay offs” from successful innovation by councils largely benefit the NHS.

As reported by LGC, the report said while there has been an absence of high-quality studies that show the impact of public health’s move to local government, one recent study by the University of York suggested public health grant expenditure is three to four times as cost-effective in improving health than if the same money was handed to the NHS.

Mr Buck also said Public Health England “needs to do more to support local government to define, diagnose, and tackle unjustifiable variation in practice and impact on population health outcomes (taking into account differences in resources)”.

“It has the data and intelligence to do so and, with the support of the LGA, the NHS and other partners, needs to use them more actively,” he added.

Mr Buck said the review has taken place in the context of reductions in overall central government funding for councils and the public health grant, which is now £850m lower in real terms than in 2015-16.

“The success or otherwise of the public health reforms need to be judged within this funding context,” he said.

Despite the government’s promise of a real-terms increase in the grant for 2020-21, the exact level of which is yet to be confirmed. Mr Buck said an extra £1bn would be needed to restore the grant to 2015-16 levels in real terms.

He added: “Despite the funding challenge, the opportunities from, and in, local government for public health are huge.

“They range from supporting communities to take more control over their own health, developing and influencing the whole of local government’s functions for health, and the design and implementation of place-based population health systems as they take root.

“This requires a breadth of knowledge, influencing and relationship skills and the ability to work through others, across communities, organisations and sectors.

“Fortunately, these strengths and skills — and the ability to seed them with others — lie at the heart of what it is to be a modern public health professional.”

Mr Buck added evidence suggests largely NHS-led sustainability and transformation partnerships “have not done well” at engaging public health teams in efforts to integrate services and have lacked a focus on prevention.

“It is no accident that in those few where local authority chief executives have been in the lead there has been a much stronger focus on the wider determinants of health, such as housing, and stronger engagement with local government public health,” he added.

Responding to the report, chair of the Local Government Association’s community wellbeing board Ian Hudspeth (Con) said: “Public health is in the right place for decisions to be made, as this report confirms, but there is potential to achieve so much more with long-term, sustainable funding.”