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Q&A: the public health outcomes framework

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All you need to know about the document at the heart of the new public health system

What is it?

It’s a 52-page document, published in January by the Department of Health, that sets out the government’s desired outcomes from the public health system when councils take over responsibility in April 2013. It also describes the measures by which progress will be monitored.

What are the outcomes?

Increased ‘healthy life expectancy’, and reduced differences in both total life expectancy and healthy life expectancy between communities.

How will success be measured?

There is a long list of factors that can be measured. They include teenage pregnancy, childhood obesity, smoking levels and alcohol-related hospital admissions. There are also some much wider factors, such as child poverty, reoffending, homelessness and fuel poverty.

Will councils be performance managed against these criteria?

In theory, this should not happen. “Guiding the relationship between national and local government is the principle of localism,” the document says. Councils will be under a legal duty to “have regard to” the document, and will have to measure their success against the factors it lists, rather than using their own definitions of success and failure. But they will only be asked to demonstrate improvements against the public health issues they have highlighted as a concern in their area.

The document suggests that closer intervention from the DH is possible. “The secretary of state will be accountable to Parliament for the ringfenced budget that would be granted to local authorities for public health,” it says. “The Public Health Outcomes Framework would help to focus local authorities on the areas where the ringfenced budget could be used.”

Will performance data be made public?

Yes. Public Health England will publish data showing how well councils are performing against the public health indicators, on a regular basis. It will also publish “tools that support benchmarking of outcomes between and within local areas”.

How will the measurements of councils’ success be used?

The DH is keen to use them as the basis for sector-led improvement on public health. They could also be used as the basis for incentive payments under the health premium. The document says the health premium will “incentivise action on a small number of indicators that reflect national or local strategic priorities”.

Will the measures be changed?

There will be an annual “refresh” of the framework, by DH civil servants, in November.

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