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The Department of Health and Social Care (DHSC) has published a new policy paper detailing how the UK’s public health system will be transformed, taking into account learnings from the coronavirus pandemic.

Entitled ‘Transforming the public health system: reforming the public health system for the challenges of our times’, the paper details a two-pronged approach to reforming the public health system:

  1. Focusing on health security
  2. Preventing ill-health and improving the general health of the population

Since 2013, national responsibilities for health security and health improvement have sat together within a single body, Public Health England (PHE). Now, the UK Government says that in order to improve the public health system in the long-term, both areas need to be effective and that a dedicated focus is needed for both.

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The final part of DHSC’s new public health plans is to strengthen local response, with a focus on collaboration between health and social care.

This push towards transforming the public health system follows on from the department’s recently-published whitepaper on NHS and social care reform, which stresses the need to place population health and prevention at the heart of the NHS and the whole system, while reducing bureaucracy and promoting integration.

As DHSC sets out reforms for the public health system, it is now seeking feedback from relevant people to help shape the future.

The department has also promised to publish a further update later in 2021 with final details on design, structure and implementation, as well as outline plans for the policies, delivery and outcomes it wants this reformed system to drive and deliver.

Focusing on health security

To help improve health security, a new UK Health Security Agency (UKHSA) will be formally established in April 2021 that will look to protect against infectious diseases and external health threats. UKHSA – previously given the title of National Institute for Health Protection – combines the health protection capabilities of PHE and NHS Test and Trace into one agency.

UKHSA is being created to ensure that the government brings together and enhances the existing expertise and new capabilities developed during the pandemic, so that the UK has an integrated organisation dedicated to protecting the public’s health. It will be a key part of the country’s critical national infrastructure and security infrastructure.

In addition, it will represent a core part of UK PLC, driving economic growth and resilience, protecting the country from the societal and economic shocks witnessed during the pandemic, and acting as an engine for the UK’s life sciences sector and diagnostics industry.

“It will bring together the UK’s cutting-edge capabilities in analytics and genomic surveillance with our growing test and trace capability,” the paper reads. “Together, they will form a permanent part of our national defences.”

A primary task of UKHSA, the paper details, will be to ensure the UK is well prepared for pandemics at all times.

Preventing ill-health and improving the general health of the population

The current health improvement, prevention and healthcare public health functions of PHE will transfer to new homes within the health system, aligned to achieve clarity of purpose, accountability and impact, DHSC says.

To help prevent ill-health as well as improve general population health, the government has created a new office that aims to exert influence across the health and care system and beyond. The new Office for Health Promotion, situated within DHSC and under the professional leadership of the Chief Medical Officer, will drive the prevention agenda across government.

It will help deliver proactive, predictive and personalised prevention, as well as embed promoting good health across the work of the whole government and the NHS.

The paper further details: “The Office for Health Promotion will be a dynamic, multi-disciplinary unit that will oversee policy development, expert advice and implementation on prevention of ill-health. It will house a range of skillsets and expertise, spanning functions such as policy making and delivery, data and actuarial science.

“It will set direction on prevention and will work to support and drive prevention across national government, local government, the NHS and the wider health system.”

Alongside this, DHSC pledges that it is strengthening NHS England’s focus on prevention and population health, transferring to it important national capabilities that will help drive and support improved health as a priority for the whole NHS.

As these changes are implemented, PHE will close, the government has confirmed.

Strengthening local response

As well as taking a national approach to improving public health, the paper says that strengthening local response also needs to be prioritised.

The policy paper recognises the important role that both local authorities and NHS organisations play in improving public health and commissioning public health services locally. DHSC explicitly states that it wants to preserve and build upon these strong foundations, as well as strengthen local public health systems.

Importantly, it says that it is not proposing to make any changes to the scope of local authority public health commissioning responsibilities.

To help strengthen local response, the paper says that ICSs must be a genuine ‘partnership of equals’ between NHS and non-NHS bodies in order to improve population health – with local authorities and the NHS taking decisions together, and adopting a broad-based approach which includes ‘upstream’ action on the wider determinants of health.

DHSC continues: “Given the critical importance of partnership working at place level, ICSs will build on existing effective partnerships, notably Health and Wellbeing Boards and the expertise of local Directors of Public Health and have regard to its constituent local Joint Strategic Needs Assessments.

“In addition, we expect local Directors of Public Health to have an official role in both the Health and Care Partnership and the ICS NHS Body. We will leave the precise arrangements for local determination, but this is a clear expectation and we will issue guidance to support ICSs to ensure they have the appropriate level of public health involvement.”

Significantly, the department is also legislating to include a ‘Health and Care Partnership’ as part of the ICS, which would be tasked with promoting partnership arrangements and developing a plan to address the health, social care and public health needs of their system.

Members of the ICS Health and Care Partnership could be drawn from a number of sources, the paper underlines, including Health and Wellbeing Boards within the system, partner organisations with an interest in health and care (including Healthwatch, voluntary and independent sector partners and social care providers), and organisations with a wider interest in local priorities (such as housing providers).

Protecting and improving public health

To enable everyone to live for longer in good health and to narrow the gap in health outcomes and experiences between the most and least disadvantaged, DHSC has outlined six key priorities to transform public health. It says that more detail will be provided on these priorities over the coming months.

The six priorities are:

  1. Focussing relentlessly on the biggest challenges to better, more equitable health
  2. Strengthening local and national public health systems
  3. Building world-class health protection capability for the future
  4. Driving action across government on prevention and the wider determinants of health
  5. Further embedding prevention and health improvement in the NHS
  6. Investing in critical capabilities and building the workforce to deliver them
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