Local government will take a leading role in proposals set out in the government’s prevention green paper but there must be further investment in public health budgets to tackle the “crisis” of health inequalities, Public Health England’s chief executive has said.
Duncan Selbie told LGC the green paper, expected ahead of the comprehensive spending review next year, would include measures to ensure effective cross-directorate collaboration in councils involving public health is mirrored across Whitehall departments to boost prevention.
He also said the long-term NHS plan due this month would separately set out the health service’s responsibilities for prevention, rather than allowing the NHS to continue “talking about what everyone else should do”.
The government’s “vision” to help people live well for longer, announced by health and social care secretary Matt Hancock last month, set out plans to “revolutionise the current approach to prevention” with a focus on the role of primary and community care services.
We don’t need a marginal improvement in the rhetoric on [public health], what we need to see is some genuine investment
The announcement comes in the context of an expected £700m reduction in public health funding between 2014-15 and 2019-20. In a recent interview with Health Service Journal, Mr Hancock said next year’s planned cut in public health spending will not be reversed as “budgets are already set”.
Mr Selbie insisted Mr Hancock’s understanding of the challenges is “sound” as he had directly acknowledged the NHS cannot improve the nation’s health “in the broadest understanding” on its own, and knows “good health begins with the economic circumstances in which people find themselves”.
Mr Selbie said: “There is an absolute understanding that directors of public health as part of wider local government teams are central to the prime minister’s ambition [for each individual] to see five more years of good health.
“What the vision was trying to do was to recognise that healthcare matters but a whole lot of other things matter more, and those things that matter even more are the point and purpose of local government.
“We don’t need a marginal improvement in the rhetoric on this; what we need to see is some genuine investment, both in the NHS and all of government – it makes economic sense.”
Mr Selbie said he had not been asking for “radical amounts of money, but just the movement of money”. He admitted the level of investment would be determined in next year’s spending review, and pointed out the NHS had been “early” to the process by securing an additional £20.5bn a year by 2023.
Mr Selbie also said the NHS had been a “public health-free zone” since 2013, when functions were transferred to local government. But he added a recent PHE decision to align its regional directors to each of seven new regions – two in the north, and one in each of the Midlands, East of England, south-west, south-east, and London – would ensure they would contribute to NHS decision-making.
Mr Selbie said: “Our work with the NHS is less than it might have been because we are not in the room. Our first responsibility is to frame what we do around how local government organises but we will in addition make sure that we have existing people also sitting on the management teams of the NHS.
Directors of public health… are central to the prime minister’s ambition to see five more years of good health
“What the NHS has tended to do is talk about what everyone else should do because their job is to simply deal with what comes through the door and that is not all right anymore. The long-term plan will make that clear.”
Public health has become “embedded” in more councils with directors of public health now part of corporate management teams and taking on wider responsibilities, said Mr Selbie.
He also said combined authorities were providing “the next source of energy and really shifting things” on this agenda.
Mr Selbie also praised local authorities such as Sheffield City Council which take an “evidence-led” approach to policy by utilising public health expertise. He said: “Much of local government lost its analytical capacity because of successive reductions [in funding]. Public health directors have given them a research and development function.
“No other health professional is trained on how to make difficult choices. Some of them never lost that capacity but many did.”