EmailThe government has been warned that moving responsibility for public health from the NHS to local authorities could flounder without a shared plan between GPs and local authorities.
Nigel Edwards, acting chief executive of the NHS Confederation, said moving public health to local authorities, announced in yesterday's white paper, should have "many benefits".
He said councils can help people improve their health in ways that the NHS cannot. But he added: "It is important to get the implementation right, otherwise a good idea can do more harm than good."
Edwards said the relationship between GP consortia and local authorities would be crucial. "GP consortia and local government need a shared plan for health social and public health so we can prevent the lack of co-ordination that has bedevilled this area in the past," he commented.
Wellbeing boards
"We need to work out the details about what incentives there will be to encourage each part of the system to work together and also how to ensure clear accountability. For example, it may be sensible to mandate that GPs sit on local council health and wellbeing boards or keep some public health expertise inside the NHS. Without greater clarity on these issues, the risk is that the reforms will flounder."
According to the white paper, the government will give councils part of the £4bn NHS funding for public health. This will come after Public Health England, a new division of the Department of Health, meets the cost of national commitments such as health protection and immunisation.
Councils will host directors of public health and health and wellbeing boards for their areas, according to Smart Healthcare. The directors will be jointly appointed by councils and the Department of Health, and will report to the department's chief medical officer.
Health secretary Andrew Lansley emphasised the localisation involved in the change. "Local authorities will be accountable, not just to us, but their local community," he said. Although council chief executives will act as accounting officers for the funding, which will come from the NHS budget, he said the local democratic accountability would be more important.
Lansley added that he was happy to see councils using different methods to improve public health. "Health strategies in each locality will look different," he said. "We're going to put local government right at the forefront."
The white paper, Healthy Lives, Healthy People, says the Department of Health will keep "to a minimum the constraints as to how local government decides to fulfil its public health role and spend its new budget", although councils will receive extra money for progress against a new outcomes framework.
Funding will be based on an area's need: Lansley said poorer areas tend to have well funded NHS work, but that this does not currently apply to public health spending.
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