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Government sets out plans for funding public health

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Health visiting and Family Nurse Partnership services will be commissioned by the new NHS Commissioning Board, under latest government proposals.

However, ministers want their planning and purchasing to eventually pass to local authorities or GP commissioning consortia.

The Department of Health has 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 funding, commissioning and providing different services.

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

For example, school nursing and other services for children and young people aged five to 19 will be funded and commissioned by local authorities from their new public health budget allocation.

However, some services will be commissioned – at least initially – by the NHS Commissioning Board on behalf of Public Health England, which will provide funding and have overall responsibility for them.

Among those services earmarked for commissioning by the board is health visiting, including leadership and delivery of the Healthy Child Programme for under fives, and the Family Nurse Partnership. Immunisation, screening and public health for those in prison or custody will also be commissioned by the board.

Referring to health visiting and family nurse services, the consultation document says: “In the first instance, these services will be commissioned on behalf of Public Health England via the NHS Commissioning Board. In the longer term we expect health visiting to be commissioned locally.”

“In commissioning these public health services, local areas will need to consider how they join-up with Sure Start Children’s Centres to ensure effective links.”

The consultation also notes that delivery of these services will require close working with NHS maternity services and children’s social care.

It adds: “The Department [of Health] will shortly publish an implementation plan which will set out how the government’s commitment to a larger, re-energised health visiting service will be achieved.”

Funding for public health will come from a pot worth an estimated £4bn, which Public Health England will distribute to local councils and other organisations, including the commissioning board.

The board will be created in shadow form next year before becoming fully operational in 2012.

Its main role will be to take over the overall planning of NHS services – along with local GP consortia – once primary care trusts and strategic health authorities are abolished and the Department of Health begins to take a less direct role in running the service.

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 public health 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 GP payment framework. A sum equivalent to round 15 per cent of the current QOF value will go towards public health and primary prevention indicators.  
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Readers' comments (2)

  • A good start for health visiting in the coming years.

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  • Where will Scotland fit into this? Would make more sense if we were all singing from the same songsheet!

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