The new public health role of local authorities

Transcription

1 Publc Health n Local Government Introducton The new publc health role of local authortes The Health and Socal Care Act 2012 receved Royal Assent on 27 March Ths s a crtcal step n the transton towards the establshment of a new publc health system. It s therefore tmely to reaffrm the Government s vson for the new publc health role n local authortes and to summarse the new legal framework for local government that underpns that vson. Ths note sets out our vson for publc health n local government and the new legal arrangements. It also sets out the mplcatons for the role of the drector of publc health, although ths s also the subject of separate and more detaled gudance n parts 1 and 2. Ths note wll prmarly be of nterest to local authorty elected members and offcers, and local publc health teams, workng wthn local government and supportng ther local clncal commssonng groups. The vson Local leadershp for publc health wll be at the heart of the new publc health system. Upper ter and untary authortes wll take on new responsbltes to mprove the health of ther populatons, backed by a rng-fenced grant and a specalst publc health team, led by the drector of publc health. Upper ter authortes wll be supported n ths by the exstng expertse wthn dstrct councls around envronmental health, for example. Local authortes should embed these new publc health functons nto all ther actvtes, talorng local solutons to local problems, and usng all the levers at ther dsposal to mprove health and reduce nequaltes. They wll create a 21st century local publc health system, based on localsm, democratc accountablty and evdence. Supportng local poltcal leadershp n mprovng health wll be the drector of publc health and hs or her team. The drector of publc health wll be the lead offcer n the local authorty for health, and a statutory chef offcer. They wll champon health across the whole of the authorty s busness, promotng healther lfestyles and scrutnsng and challengng the NHS and other partners to promote better health and ensure threats to health are addressed. He or she wll be a statutory member of the health and wellbeng board. 1

2 Contrbutng to the preparaton of jont strategc needs assessments and the development of jont health and wellbeng strateges wthn the framework of the natonal Publc Health Outcomes Framework, he or she should ensure a rgorous focus on local prortes and acton across the lfe course to ensure a preventve approach s embedded n the local system. The new local legal framework for publc health Secton 18 gves the Secretary of State the power to make regulatons as to the exercse by local authortes of certan publc health functons by nsertng new secton 6C nto the NHS Act Ths means that the Secretary of State can requre local authortes to carry out aspects of hs health protecton functons by takng certan prescrbed steps. It also means that the Secretary of State can prescrbe aspects of how local authortes carry out ther health mprovement functon. Broadly speakng, the Health and Socal Care Act 2012 ( the Act ) gves responsblty for health protecton to the Secretary of State and health mprovement to upper ter and untary local authortes. The Secretary of State wll also delegate some health protecton functons to local authortes. Local authortes wll mantan responsblty for ther exstng health protecton functons, many of whch are exercsed by lower ter and untary authortes. Secton 12 of the Act nserts new secton 2B nto the NHS Act 2006 to gve each relevant local authorty a new duty to take such steps as t consders approprate to mprove the health of the people n ts area. Ths secton also gves Secretary of State a power to take steps to mprove the health of the people of England and t gves examples of health mprovement steps that ether local authortes or the Secretary of State could take, ncludng gvng nformaton, provdng servces or facltes to promote healthy lvng and provdng ncentves to lve more healthly. Upper ter and untary local authortes are therefore takng on crtcal publc health responsbltes. Secton 30 then requres them, actng jontly wth the Secretary of State, to appont an ndvdual who wll be responsble for the local authorty s new publc health functons. That ndvdual wll be an offcer of the local authorty, and known as the drector of publc health. Ths secton also gves the Secretary of State the power to drect a local authorty to nvestgate the conduct of a drector of publc health n relaton to publc health functons delegated from Secretary of State, and to report back (although the Secretary of State does not have the power to termnate the employment of a drector of publc health. The local authorty as the employer does have ths power, but must consult the Secretary of State before dong so). Secton 31 nserts a new secton 73B nto the NHS Act 2006, whch gves Secretary of State the power to publsh gudance to whch the local authorty must have regard. 2

3 Such gudance may nclude gudance as to the appontment of offcers of the local authorty to dscharge ts publc health functons (for example, gudance on the nvolvement of the Secretary of State n the process of appontng drectors of publc health). The Government wll also publsh the refreshed Publc Health Outcomes Framework as gudance to whch local authortes must have regard. Under ths same secton, each drector of publc health s requred to produce, and the relevant local authorty to publsh, an annual report. The Government has not further specfed what the annual report mght contan ths s very much a decson for ndvdual drectors of publc health as to the ssues they feel are mportant to rase. Drectors of publc health wll also be statutory members of health and wellbeng boards (secton 194(2)(d) of the Act). Schedule 5 of the Act amends the Local Government Act 1989 to add drectors of publc health to the lst of statutory chef offcers. Fnally, sectons set out new arrangements for consultng and makng decsons on fluordaton schemes, whch wll become the responsblty of local authortes. These dutes mean that the local authorty wll have to take steps to ensure that t s aware of and has consdered what the health needs of ts local populaton are, and what the evdence suggests the approprate steps would be to take to address those needs. Local authortes wll have consderable freedom n terms of how they choose to nvest ther grant to mprove ther populaton s health, although they wll have to have regard to the Publc Health Outcomes Framework and should consder the extant evdence regardng publc health measures. The Government ntends to mandate a small number of steps and servces, as follows: steps to be taken to protect the health of the local populaton ensurng NHS commssoners receve the publc health advce they need approprate access to sexual health servces the Natonal Chld Measurement Programme NHS Health Check assessment. These steps and servces wll be mandated through regulatons made under new secton 6C of the NHS Act Mandatng steps and servces n ths way s not a means of ndcatng relatve mportance. Rather t reflects that there are some areas where a greater unformty of provson s requred (partcularly health protecton), or the fact that some steps are crtcal to ensurng there s an effectve local publc health system. Mandatng steps and servces s also a means of ensurng that, where there s a legal duty on the Secretary of State whch wll be dscharged n future by local authortes, ths duty wll be effectvely dscharged. 3

4 Implcatons for local authortes As noted above, local authortes already have mportant and wde-rangng publc health functons, for example under the Publc Health (Control of Dsease) Act 1984 (as amended). These wll contnue. However, under the Act and the regulatons lsted above, local authortes wll be takng on sgnfcant new publc health functons. The drector of publc health, as the lead offcer for these new functons, wll need to have specalst publc health expertse, and access to specalst resources, spannng the three domans of publc health, health mprovement, health protecton and healthcare publc health (e the populaton health aspects of NHSfunded clncal servces). The drector and ther specalst teams wll also need access to approprate nformaton and evdence on whch to base ther advce, ncludng detaled nformaton on patterns of provson of health care f they are to advse local NHS commssoners and health and wellbeng boards. Thus the drector wll have a crtcal role n defnng the needs assessment whch wll drve commssonng, buldng on the assets of the local area. Drectors of publc health wll support clncal commssonng so that t reflects the needs of the whole populaton. They wll also lead on health protecton, ensurng that approprate arrangements are n place, escalatng concerns and holdng local partners to account. 4 Addtonally, as lead advser on health to the local authorty and a statutory chef offcer, the drector of publc health wll be an mportant offcal wthn the authorty, nfluencng decsons across the range of the authorty s busness, as well as carryng out on the authorty s behalf ts new functons relatng to publc health. To be effectve, he or she wll need to be an effectve senor offcer wthn the authorty. Ths wll call for consderable nfluencng sklls and the ablty to balance the need to be an advocate for publc health and the requrement to respect the local democratc process. Local authortes wll lead the process of appontng drectors jontly wth the Secretary of State, whch wll help to ensure consstent appontment of people of the rght calbre, wth the rght expertse and experence, n these key posts. The Government s publshng separate gudance on ths process. Whle the organsaton and structures of ndvdual local authortes are matters 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 (or other head of pad servce) for the exercse of the local authorty s publc health functons, and that they wll have drect access to elected members.

5 The new publc health functons Below we set out what the new functons mean for local authortes n each of the three domans of publc health. Health mprovement The key new duty for local authortes wll be to take approprate steps to mprove the health of ther populaton. Ths new duty complements much of the local authorty s exstng core busness, and ts strategc responsblty for stewardshp of place. It wll normally be approprate for a Cabnet Member to take the lead among elected members for ths area and gve t the approprate poltcal leadershp at the local level. The drector of publc health wll support local poltcal leaders n ther ambtons to mprove local health. We would expect that he or she wll: contrbute fully to rgorous and wellnformed jont strategc needs assessments and jont health and wellbeng strateges take day-to-day management over the rng-fenced publc health budget, thereby havng responsblty and the resources to nvest to mprove health locally work more wdely wth wder partners to foster jont commssonng where approprate and to nform wder strateges, for example around adult socal care, chldren s servces, transport, housng and lesure provde offcers and elected members wth approprate advce, based on a rgorous apprecaton of patterns of local health need, what works and potental returns on publc health nvestment provde advce to partners more broadly (thus the local authorty mght wsh to offer publc health-related tranng courses). She/he should have a partcular focus on ensurng dsadvantaged groups receve the attenton they need, wth the am of reducng health nequaltes. When commssonng clncal servces such as sexual health and drug and alcohol servces drectors of publc health wll need to ensure that provders have approprate clncal governance arrangements n place that are equvalent to NHS standards. Health protecton The Secretary of State wll have the core duty to protect the health of the populaton n the new system. However, the Government sees local authortes havng a crtcal role at the local level n ensurng that all the relevant organsatons locally are puttng plans n place to protect the populaton aganst the range of threats and hazards. Ths wll lnk to, but be dfferent from, ther statutory responsblty for publc health aspects of plannng for emergences wthn local authortes. Most health protecton ncdents are contaned locally. The drector of publc health, wth Publc Health England, should lead the ntal response to publc health ncdents at the local level, n close collaboraton wth the NHS lead. 5

6 The NHS wll determne, n the lght of the mpact on NHS resources and wth advce from the drector of publc health, at what pont the lead role wll transfer, f requred, to the NHS. The drector of publc health should therefore: provde strategc challenge to health protecton plans/arrangements produced by partner organsatons scrutnse and as necessary challenge performance f necessary, escalate any concerns to the local health reslence partnershp (LHRP) receve nformaton on all local health protecton ncdents and outbreaks and take any necessary acton, workng n concert wth Publc Health England and the NHS. Ths may nclude, for example, charng an outbreak control commttee, or charng a look back exercse n response to a sudden untoward ncdent contrbute to the work of the LHRP, possbly as lead DPH for the area provde the publc health nput nto the local authorty emergency plans. To assst drectors of publc health n fulfllng ths health protecton role we recommend local areas consder settng up a health protecton forum or commttee, possbly lnked to the health and wellbeng board, for example as a sub-commttee of the board. Such an arrangement would help ensure that all key organsatons met regularly, shared nformaton and planned effectvely. Healthcare publc health The Government ntends to make regulatons to requre local authortes to provde publc health advce to NHS commssoners. The drector of publc health wll therefore have the responsblty and fundng for provdng a core offer of publc health advce to the NHS locally. NHS Commssoners wll need to ensure that local authortes and health and wellbeng boards have access to the nformaton they wll need to advse them. Ths arrangement provdes an excellent opportunty for local authortes to buld and mantan close lnks wth clncal commssoners, complementng health and wellbeng boards. She/he and ther teams should therefore, for example: help to ensure that jont strategc needs assessments reflect the needs of the whole populaton support commssonng strateges that meet the needs of vulnerable groups support the development of evdencebased care pathways and servce specfcatons contrbute advce on evdence-based prortsaton polces produce as necessary health needs audts and health equty audts provde other specalst publc health advce as requred. In delverng these functons drectors of publc health and ther teams wll beneft from the advce and support of Publc Health England. Thus for example Publc 6

7 Health England wll provde data and evdence of what works n relaton to the publc health outcomes framework, provde specalst health protecton servces, and gve advce on the populaton mpact of health servces. Resourcng the team The above descrpton of the publc health role wthn local authortes makes clear that there needs to be a specalst, experenced publc health professonal (the drector of publc health) supported by specalst publc health resources wth access to adequate nformaton and evdence functons. The sze of that resource wll depend on a range of factors, not least the sze and relatve needs of the local populaton. Concluson From Aprl 2013 upper ter and untary local authortes wll provde local leadershp for publc health, underpnned by new statutory functons, dedcated resources and an expert publc health team. Local poltcal leadershp wll delver a new focus on mprovng health and reducng health nequaltes. Ths new role wll complement but also extend exstng local authorty functons n terms of maxmsng the wellbeng of ctzens. The drector of publc health wll lead on delverng these publc health functons for the local authorty, supportng the poltcal leadershp. She or he wll have the overall role of advocatng for the health of the populaton locally. Ths does not mean that the drector of publc health wll have the accountablty and resources to delver all publc health functons, but t does mean that they wll need to be the lynchpn n the system the person who knows how to access advce and resources, and support local elected members and offcers n ther work n promotng wellbeng across the local populaton. To delver ths functon successfully the drector of publc health wll need to be a publc health specalst, wth hghly developed techncal sklls, and wth access to a range of publc health expertse n ther team. They wll also need to be sklled at workng n a poltcal envronment. In short, they wll need to be publc health change agents. Produced: October 2012 Gateway reference: Crown copyrght 2012 Produced by the Department of Health 7