How To Help A Healthy Populaton

Transcription

1 Publc Health n Local Government Factsheets

2 Publc Health n Local Government Local government leadng for publc health Local government has a long and proud hstory of promotng and protectng the publc s health datng back to Vctoran tmes. It was only n 1974 that the NHS took over most publc health functons. The Government s returnng responsblty for mprovng publc health to local government for several reasons, namely ther: populaton focus ablty to shape servces to meet local needs ablty to nfluence wder socal determnants of health ablty to tackle health nequaltes. Populaton focus Shapers of place Snce local government holds many of the levers for promotng wellbeng t makes sense to gve t greater responsblty and power to shape the localty n a healthy drecton. Every day of the year local councls have drect contact wth many of ther resdents. A fully ntegrated publc health functon n local government at both strategc and delvery levels offers exctng opportuntes to make every contact count for health and wellbeng. Ths local poltcal leadershp s crtcal to creatng the powerful coaltons we need to promote health and wellbeng. Local authortes are democratcally accountable stewards of ther local populatons wellbeng. They understand the crucal mportance of place n promotng wellbeng. In other words, the envronment wthn whch people lve, work and play, the housng they lve n, the green spaces around them, and ther opportuntes for work and lesure, are all crucal to ther health and wellbeng. Takng a populaton perspectve, whch s at the heart of publc health, s a natural part of the role of local government. Local authortes are also well placed to release nnovaton, tryng new ways to tackle ntractable publc health problems. They have consderable expertse n buldng and sustanng strong relatonshps wth local ctzens and servce users through communty and publc nvolvement arrangements, whch wll help extend the engagement of local people n the broader health mprovement agenda. Socal determnants of health The socal determnants of health are the condtons n whch people are born, grow, lve work and age, ncludng 1

3 Publc Health n Local Government: Local government leadng for publc health the health system. The strength of the evdence lnkng socal determnants to good and poor health has been clearly demonstrated n the Marmot Revew (2010) (Far Socety, Healthy Lves). Socal determnants are one of the man mechansms drvng health nequaltes. Tacklng health nequaltes Local authortes have ample experence of the realty of health nequaltes n ther communtes. Many of the socal determnants fall wthn ther ambt, so they can take strategc acton to prevent nequaltes across a number of functons, such as housng, economc and envronmental regeneraton, strategc plannng, educaton, chldren and young people s servces, fre and road safety. The Drector of Publc Health, located wthn the local authorty, wll be well placed to brng health nequaltes consderatons to bear across the whole of the authorty s busness, and to thnk strategcally about how to drve reductons n health nequaltes, workng closely wth the NHS and other partners. However, they wll also need to look more wdely at ssues such as crme reducton, volence preventon and reducng reoffendng, whch may also prevent health nequaltes. They can do ths through lnks to exstng partnershp workng and through new relatonshps, for example wth ncomng Polce and Crme Commssoners. Lookng forward In one sense the Health and Socal Care Bll can be seen to be returnng publc health home. But at the same tme we recognse that local government has changed hugely snce 1974, as have the ssues for people s health. In partcular, there have been major gans from the close ntegraton of publc health wth clncal servces, not least a greater focus on preventon n pathways, on prortsaton and on reachng the whole populaton. There s a sound foundaton to buld on n terms of that close engagement wthn the NHS, whch wll reman crtcal to the delvery of publc health goals, n partcular n reducng rsks, and n prmary and secondary preventon. Local government for ts part has moved from a focus on delverng servces to a much wder role of shapng local places. Havng taken on the key role n promotng economc, socal and envronmental wellbeng at the local level, t s deally placed to adopt a wder wellbeng role. Therefore local leadershp for publc health s nothng new, but the context has changed. Brngng publc health back nto local government s not about recreatng a pre-1974 landscape. It s about buldng a new, enhanced locally-led 21st century publc health servce, where nnovaton s fostered and promoted, supported by the expertse to be provded by Publc Health England. Clear local poltcal leadershp wll be crtcal to success. 2

4 Publc Health n Local Government: Local government leadng for publc health Our vson for local government leadershp of publc health Buldng on local government s long and proud hstory of publc health leadershp, our vson s for local authortes to use ther new responsbltes and resources to put health and wellbeng at the heart of everythng they do, thereby helpng people to lead healther lves, both mentally and physcally. Ths means: ncludng health n all polces so that each decson seeks the most health beneft for the nvestment, and askng key questons such as what wll ths do for the health and wellbeng of the populaton? and wll ths reduce health nequaltes locally? nvestng the new rng-fenced grant n hgh-qualty publc health servces encouragng health promotng envronments, for example, access to green spaces and transport and reducng exposure to envronmental pollutants supportng local communtes promotng communty renewal and engagement, development of socal networks (n partcular for young famles and chldren, and solated elderly people), and the Bg Socety. Ths wll brng a focus on what a healthy populaton can do for the local communty, not least n terms of regeneraton Produced: December 2011 Gateway reference: talorng servces to ndvdual needs based on a holstc approach, focusng on wellness servces that address multple needs, rather than commssonng a plethora of sngle ssue servces, and usng new technologes to develop servces that are easer and more convenent for users makng effectve and sustanable use of all resources, usng evdence to help ensure these are approprately drected to areas and groups of greatest need and represent the best possble value for money for local ctzens. To do ths successfully wll requre a wllngness to use all the tools at local authortes dsposal n a new way and not just rely on commssonng tradtonal servces. Publc Health England wll have a key role n sharng and sgnpostng evdence on the most effectve, ncludng cost-effectve nterventons to mprove and protect publc health. For local authortes ths wll mean workng wth a wde range of partners across cvl socety, not least the thrd sector, ncludng through the shared leadershp of health and wellbeng boards. They wll be supported n ths by HealthWatch, whch wll better enable people to help shape and mprove health and socal care servces at both a natonal and, through ts seat on the local health and wellbeng board, the local level. Local authortes already do ths up and down the country. From 2013, wth new powers and new resources they wll be deally placed to go further n creatng healther communtes. Crown copyrght 2011 Produced by the Department of Health 3

5 Publc Health n Local Government Local government s new publc health functons Subject to Parlament, each upper ter and untary local authorty n England wll take on a new duty to take such steps as t consders approprate for mprovng the health of the people n ts area. An obvous way n whch local authortes wll fulfl ths duty wll be commssonng a range of servces from a range of provders from dfferent sectors, workng wth clncal commssonng groups and representatves of the NHS Commssonng Board to create as ntegrated a set of servces as possble. However, local authortes can fulfl ths duty n a wde range of ways, ncludng the way they operate the plannng system, polces on lesure, key partnershps wth other agences for example on chldren s and young people s servces, and through developng a dverse provder market for publc health mprovement actvtes. In all they do, local authortes wll want to ensure the health needs of dsadvantaged areas and vulnerable groups are addressed, as well as gvng consderaton to equalty ssues. The goal should be to mprove the health of all people, but to mprove the health of the poorest, fastest. Local poltcal leadershp wll be crtcal n ensurng that publc health receves the focus t needs. The role of the Cabnet lead for health wthn the councl s crtcal, but there needs to be a much broader engagement n ths agenda among all local poltcal leaders. It wll be vtal that dstrct councls are closely nvolved n the development and mplementaton of local strateges, and that exstng health and wellbeng partnershps n two-ter areas are bult on n the creaton of the new system. Commssonng In Healthy Lves, Healthy People: Update and way forward we publshed a provsonal lst of what should be funded from the publc health budget, and who the prncpal commssoner for each actvty should be. We have sought wherever possble to devolve responsblty and resources for commssonng publc health servces to local government, although n a number of cases, where a publc health servce s deeply ntertwned wth the delvery of clncal servces, or where servces are part of the prmary care contractual arrangements, the Secretary of State for Health wll ask the NHS Commssonng Board to commsson servces on hs or her behalf (for example natonal screenng and mmunsaton programmes). Our am s to create a set of responsbltes 1

6 Publc Health n Local Government: Local government s new publc health functons whch clearly demonstrate local authortes leadershp role n: tacklng the causes of ll-health, and reducng health nequaltes promotng and protectng health promotng socal justce and safer communtes. The lst of new local authorty responsbltes s set out n the Publc Health n Local Government: Commssonng responsbltes factsheet. For all commssonng decsons, local authortes wll want to ensure servces are delvered n ways that meet the needs of dsadvantaged and vulnerable groups and whch conscously respond to the three ams of the equalty duty. Local authortes wll also wsh to work wth clncal commssonng groups to provde as much ntegraton across clncal pathways as possble, maxmsng the scope for upstream nterventons. The health and wellbeng board wll be crtcal to drvng ths agenda. We also expect local authortes wll wsh to commsson, rather than drectly provde, the majorty of servces, gven the opportuntes ths would brng to engage local communtes and the thrd sector more wdely n the provson of publc health, and to delver best value and best outcomes. The recent Open Publc Servces Whte Paper outlnes how modernsng publc servces, ensurng hgh qualty and accessblty, requres ncreased choce, wherever possble, and publc servces that are open to a range of provders. It hghlghts the role that staff-led enterprses have to play n meetng the Government s commtment to mprovng choce and qualty n the delvery of healthcare servces. Ths rght to provde 1 enables staff to consder a wde range of optons, ncludng socal enterprse, staff-led mutuals, jont ventures and partnershps. Ther freedom to nnovate and respond to servce user need wll put them n a strong poston to drve up qualty and mprove health outcomes. We expect promotng choce of provder to drve up qualty, empower ndvduals and enable nnovaton. It wll also provde a vehcle to mprove access, address gaps and nequaltes and mprove qualty of servces where users have dentfed varable qualty n the past. Local authortes already have a wealth of experence n commssonng servces from a range of provders so we would encourage them to adopt ths dverse provder model whch wll ncrease the number of servce provders, maxmsng user choce, provded they meet the necessary qualty and safety requrements wthn a prce set by commssoners. Ths wll allow provders to compete for servces wthn the market a process whch s both qucker and less bureaucratc than tradtonal procurement by compettve tender, whch only enables competton for entry nto the market. Local authortes should decde whch servces to prortse for choce on a dverse provder model based on local needs and prortes. Ths should be nformed by the jont strategc needs assessment and early and contnung engagement wth health and wellbeng boards. More nformaton on ths can be found at: jsnas-jhws-explaned 2

7 Publc Health n Local Government: Local government s new publc health functons Local authortes are also n an excellent poston to test out new and jont approaches to payment by outcomes, such as reducng drug dependency and to extend such approaches wth external nvestment, such as the proposals beng developed on socal mpact bonds to mprove servces and outcomes. We envsage that Publc Health England wll dssemnate the learnng from such developments wth a vew to encouragng further nnovaton at the local level. Mandatory steps The Health and Socal Care Bll ncludes a power for the Secretary of State for Health to prescrbe that local authortes take certan steps n the exercse of publc health functons, ncludng that certan servces should be commssoned or provded. The purpose of ths power s not to dentfy some servces as more mportant than others. Rather the ssue s that n some servce areas (partcularly health protecton) greater unformty of provson s requred. In others the Secretary of State for Health s currently under a legal duty and needs to ensure that that oblgaton s effectvely delvered when a functon s delegated to local government (the provson of contracepton s an example). Fnally, certan other steps are crtcal to the effectve runnng of the new publc health system at a local level, for example, ensurng that the local authorty provdes publc health advce to NHS commssoners. The mandatory servces and steps that were dentfed n Healthy Lves, Healthy People: update and way forward ncluded: approprate access to sexual health servces steps to be taken to protect the health of the populaton, n partcular, gvng the local authorty a duty to ensure there are plans n place to protect the health of the populaton ensurng NHS commssoners receve the publc health advce they need the Natonal Chld Measurement Programme NHS Health Check assessment. We prevously sgnalled that we would be mandatng elements of the Healthy Chld Programme More work s stll requred to model the mpact of makng any elements of the programme mandatory to ensure value for money. We do not ntend to mandate any elements of the programme for The net result of these steps wll be that local authortes have key responsbltes across the three domans of publc health health mprovement, health protecton and healthcare publc health. Produced: December 2011 Gateway reference: Crown copyrght 2011 Produced by the Department of Health 1 Publc health practtoners can fnd more nformaton on how to exercse the rght to provde at: healthandcare.dh.gov.uk/rght-to-provde-what-t-meansfor-nhs-and-socal-care-staff 3

8 Publc Health n Local Government The role of the Drector of Publc Health In takng forward ther leadershp role for publc health local authortes wll rely heavly on the Drector of Publc Health and the specalst publc health resources he or she has at ther command. Indeed the Health and Socal Care Bll makes clear that the Drector of Publc Health s responsble for exercsng the local authorty s new publc health functons. We have hghlghted the duty on each untary and upper ter authorty to take such steps as t consders approprate for mprovng the health of the people n ts area. The Health and Socal Care Bll makes clear that each authorty must, actng jontly wth the Secretary of State for Health, appont an ndvdual to have responsblty for ts new publc health functons, known as the Drector of Publc Health. That ndvdual could be shared wth another local authorty, where that makes sense (for example, where the senor management team s shared across more than one authorty and the authortes are geographcally contguous). Below we cover key aspects of the functon and scope of the role of Drector of Publc Health. Appontments We are workng wth local government and publc health stakeholders to produce gudance, whch wll cover: appontments to exstng Drector of Publc Health vacances n a way that ensures they are ft for purpose for the future managng the transton of Drector of Publc Health posts to local government durng 2012/13 a process for local authortes and Publc Health England (n the Secretary of State s behalf), actng jontly, to appont new Drectors of Publc Health from 1 Aprl The gudance wll buld on the exstng jont appontments process for Drectors of Publc Health and be consstent wth Faculty of Publc Health standards, ncludng the use of appontments advsory commttees and faculty assessors, and best practce n local government recrutment. Ths wll ensure Drectors of Publc Health n local government have the necessary techncal, professonal and strategc leadershp sklls to promote, mprove and protect health and provde hgh-level, credble, peer-to-peer advce to the NHS about publc health n relaton to health servces. 1

9 Publc Health n Local Government: The role of the Drector of Publc Health Reportng arrangements We promsed n Healthy Lves, Healthy People: update and way forward to dscuss wth stakeholders how best to ensure that that the Drector of Publc Health has an approprate status wthn the local authorty, n lne wth the poston of the Drectors of Chldren s Servces and Adult Socal Servces. We have consulted local government and publc health nterests, and ntend to brng forward amendments to the Health and Socal Care Bll to reflect our desred polcy poston. Subject to Parlament, we wll add Drectors of Publc Health to the lst of statutory chef offcers n the Local Government and Housng Act After Royal Assent, we ntend to ssue statutory gudance on the responsbltes of the Drectors of Publc Health, n the same way that gudance s currently ssued for Drectors of Chldren s Servces and Drectors of Adult Servces. Whle the organsaton and structures of ndvdual local authortes s a matter for local leadershp, we are clear that these legal responsbltes should translate nto the Drector of Publc Health actng as the lead offcer n a local authorty for health and champonng health across the whole of the authorty s busness. Ths means that we would expect there to be drect accountablty between the Drector of Publc Health and the local authorty Chef Executve for the exercse of the local authorty s publc health responsbltes and that they wll have drect access to elected members. Responsbltes The Drector of Publc Health as a publc health specalst wll be responsble for all the new publc health functons of local authortes, ncludng any conferred on local authortes by regulaton. The Health and Socal Care Bll wll n addton make t a statutory requrement for the Drector of Publc Health to produce an annual report on the health of the local populaton, and for the local authorty to publsh t. Drectors of Publc Health wll also be statutory members of health and wellbeng boards, and wll wsh to use the boards as the key formal mechansm for promotng ntegrated, effectve delvery of servces. What these legal responsbltes should translate nto s the Drector of Publc Health actng as the lead offcer n a local authorty for health and champonng health across the whole of the authorty s busness. Thus the Drector of Publc Health wll be the person elected members and other senor offcers wll consult on a range of ssues, from emergency preparedness to concerns around access to local health servces. Often the Drector of Publc Health wll not be personally responsble for the problem, but he/she wll know how to resolve t through engagng wth the rght people n the new system. He/she wll be able to promote opportuntes for acton across the lfe course, workng together wth local authorty colleagues such as the Drector 2

10 Publc Health n Local Government: The role of the Drector of Publc Health of Chldren s Servces and the Drector of Adult Socal Servces, and wth NHS colleagues. The Drector of Publc Health wll work wth local crmnal justce partners and the new Polce and Crme Commssoners to promote safer communtes. And he/she wll engage wth wder cvl socety to enlst them n fosterng health and wellbeng. In short, the Drector of Publc Health wll be a crtcal player n ensurng there are ntegrated health and wellbeng servces across the localty. Wth regard to the rng-fenced grant, formal accountablty rests wth the Chef Executve of the local authorty, but we would expect day-to-day responsblty for the grant to be delegated to the Drector of Publc Health. Core sklls To delver ts new publc health functons the local authorty wll need a specalst traned Drector of Publc Health and publc health support wth the full range of approprate sklls to delver the functons we have descrbed. That means we wll need to ensure that job descrptons reflect the hghest possble standards as set out by the Faculty of Publc Health. It s mportant to reaffrm that the Government beleves the multdscplnary nature of publc health s a key strength of the professon. We beleve that the transfer of new publc health responsbltes to local authortes n no way changes ths, and ndeed reaffrms the mportance of attractng to publc health hgh-qualty ndvduals from a wde range of dscplnes ncludng, but not lmted to, medcne. We wll publsh a Publc Health Workforce Strategy, accompaned by a formal publc consultaton. The strategy wll seek to ensure the development and supply of a professonal publc health workforce, set out proposals for how learnng and development wll be taken forward n the reformed health system, and outlne optons for how publc health knowledge can best be embedded across the wder workforce. The new arrangements wll provde opportuntes and challenges for employers, ncludng the wder local authorty workforce. Professonal apprasal and support, and capacty buldng Contnung professonal development s a professonal oblgaton for all publc health professonals, both medcal and non-medcal. It ensures that publc health professonals develop and mantan the necessary knowledge, sklls and attrbutes to practse effectvely and work towards mprovng the health of communtes. Local authortes wll wsh to support ths professonal development. Way forward The Drector of Publc Health s new role offers a great opportunty to buld healther communtes. But to make the 3

11 Publc Health n Local Government: The role of the Drector of Publc Health most of ths Drectors of Publc Health wll need to: be fully engaged n the redesgn of servces that address the comng challenges nfluence and support colleagues who have a key role n creatng better health, such as plannng offcers and housng offcers facltate nnovaton and new approaches to promotng and protectng health, whle brngng a rgorous approach to evaluatng what works, usng the resources of Publc Health England contrbute to the work of NHS commssoners, thus ensurng a whole publc sector approach. Produced: December 2011 Gateway reference: Crown copyrght 2011 Produced by the Department of Health 4

12 Publc Health n Local Government Commssonng responsbltes Local authortes wll be responsble for: tobacco control and smokng cessaton servces alcohol and drug msuse servces publc health servces for chldren and young people aged 5-19 (ncludng Healthy Chld Programme 5-19) (and n the longer term all publc health servces for chldren and young people) the Natonal Chld Measurement Programme nterventons to tackle obesty such as communty lfestyle and weght management servces locally-led nutrton ntatves ncreasng levels of physcal actvty n the local populaton NHS Health Check assessments publc mental health servces dental publc health servces accdental njury preventon populaton level nterventons to reduce and prevent brth defects behavoural and lfestyle campagns to prevent cancer and long-term condtons local ntatves on workplace health supportng, revewng and challengng delvery of key publc health funded and NHS delvered servces such as mmunsaton and screenng programmes comprehensve sexual health servces (ncludng testng and treatment for sexually transmtted nfectons, contracepton outsde of the GP contract and sexual health promoton and dsease preventon) local ntatves to reduce excess deaths as a result of seasonal mortalty 1 the local authorty role n dealng wth health protecton ncdents, outbreaks and emergences publc health aspects of promoton of communty safety, volence preventon and response publc health aspects of local ntatves to tackle socal excluson local ntatves that reduce publc health mpacts of envronmental rsks. We have undertaken a further check of where commssonng responsbltes for a range of servces mght st n the future. As part of ths work we have taken the opportunty to look agan at where commssonng of aborton servces mght most approprately be placed. Gven the hghly clncal, and n most cases surgcal, nature of aborton provson we have reconsdered our earler decson to place these servces wth local authortes. We have provsonally concluded that aborton should reman wthn the NHS and be commssoned by clncal commssonng groups. However, we are keen to seek a range of vews on ths revsed commssonng route. A consultaton on ths revsed recommendaton wll begn n due course. In Healthy Lves, Healthy People: Update and way forward, we sad we were stll consderng where to place responsblty for sexual assault referral centres (SARCs) and for campagns to promote early dagnoss of, for example, cancer. We have

13 Publc Health n Local Government: Commssonng responsbltes decded that, subject to resolvng some further ponts of detal, responsblty for sexual assault servces, ncludng SARCs, at least n the short to medum term, should rest wth the NHS Commssonng Board. Ths s n our vew the best way to ensure the delvery of unformly hghqualty servces across the country. On early dagnoss we are commtted to gvng both Publc Health England and the NHS Commssonng Board clear responsblty for delvery, based on a shared set of outcomes. Only some of the above servces are to be mandated. The commssonng of other servces wll be dscretonary, guded by the Publc Health Outcomes Framework, the local jont strategc needs assessment and the jont health and wellbeng strategy. There was consderable comment durng our consultaton on commssonng responsbltes about the splt of responsbltes for the publc health of chldren and young people, ncludng the Healthy Chld Programme, wth pregnancy to fve servces beng commssoned by the NHS Commssonng Board. We accept the many benefts to be had from the ntegraton of publc health nto the wder commssonng of chldren s and young people s publc health, partcularly n terms of the preventon and safeguardng agendas. Nurse Partnershp, gven the commtment to a 50% ncrease n the health vstng workforce and a transformaton n the health vstng servce by 2015, and to ensure assocated mprovements n support for famles. Our medum-term am s to unfy responsblty for these servces wthn local government by 2015 when the ncreased health vstng workforce and new health vstng servce model and the Healthy Chld Programme offer to famles should be n place. In lne wth ths drecton of travel, we are also transferrng responsblty for commssonng effectve Chld Health Informaton Systems to the NHS Commssonng Board, also to be funded by the publc health budget. Ths decson wll be revewed n 2015 to determne longer-term plans. We wll engage further on the detal of these proposals, partcularly n respect of transton arrangements and the best way to begn to nvolve local authortes n local commssonng of these servces n partnershp wth the NHS. In the meantme, Publc Health England wll retan a close nterest n the specfcaton of Chld Health Informaton Systems, to ensure publc health requrements, such as accurate and effectve collecton on the delvery of chldhood mmunsatons, are met. As we explaned n Healthy Lves, Healthy People: Update and way forward, we beleve that the NHS Commssonng Board wll be best placed to lead the commssonng of publc health funded servces for chldren under fve n the frst nstance, ncludng health vstng, the Healthy Chld Programme and Famly 2 The lst of commssonng responsbltes above s of course not exclusve. Local authortes may choose to commsson a wde varety of servces under ther health mprovement duty, and ndeed we would hope to see much nnovaton as local authortes embrace ther new dutes. Ths freedom s delberately wde, to encourage

14 Publc Health n Local Government: Commssonng responsbltes the knd of locally-drven solutons that le at the core of localsm, underpnned by a robust analyss of the needs and assets of the local populaton. Publc Health England wll promote ths local nnovaton through encouragng peer sharng of best practce and learnng experences, and through supportng rgorous evaluaton of new approaches to mprovng and protectng publc health. Sexual health servces Local authortes wll become responsble for commssonng comprehensve open-access accessble and confdental contracepton and sexually transmtted nfectons (STIs) testng and treatment servces, for the beneft of all persons of all ages present n the area. Transfer of these servces offers great opportuntes to ntegrate sexual health servces and to lnk servces to wder servces, ncludng alcohol and drugs, for partcular target groups, such as young people, vulnerable people and other groups at rsk of sexual ll-health. We are gong beyond merely transferrng responsblty for sexual health servces to local authortes and actually mandatng them for two reasons. Frst, STI testng and treatment servces are a central part of protectng health. The Government therefore beleves that hgh-qualty servces must be avalable n all areas, although the servces provded wll be talored to meet local needs. these people, and the supply of any contraceptve substances and applances. Ths duty s currently delegated to prmary care trusts, who are requred to provde open-access servces whch are not lmted to ther own resdents. Mandatng these servces of local authortes n the future wll allow the Secretary of State for Health to meet ths duty fully, over and above what s provded for va current GP provson. Health protecton plans At present Drectors of Publc Health n prmary care trusts play a key leadershp role n plannng for, and respondng to, health protecton ncdents, supported by local Health Protecton Agency health protecton unts. Subject to Parlamentary approval, the Health and Socal Care Bll wll provde that the Secretary of State for Health s responsble for takng steps for the purpose of protectng the health of the populaton. However, we want the Drector of Publc Health to contnue to provde a coordnaton role to protect the health of the local populaton when transferred to local authortes. Our vson s that the local authorty, and the Drector of Publc Health actng on ts behalf, should have a pvotal place n protectng the health of ts populaton. We therefore propose to use a regulaton-makng power n the Bll to requre local authortes to take steps to ensure that plans are n place to protect the local populaton. Second, the Secretary of State for Health currently has a duty, reterated n the Health and Socal Care Bll, to provde advce on contracepton, medcal examnaton of people seekng advce on contracepton, the treatment of 3 Under ths duty, local authortes (and Drectors of Publc Health on ther behalf) would be requred to ensure that plans are n place to protect the health of the local populaton from threats rangng from relatvely mnor outbreaks to full