Healthy lives, healthy people: update and way forward (2011)

This policy statement provided an update on progress since the publication of the public health white paper Healthy lives, healthy people (2010), following public consultations.

A new public health service

Local authorities were to take on a new role in public health and, to support them, the government had proposed the creation of a new public health service (Public Health England (PHE)) within the Department of Health. This service was intended to take on the functions of the independent Health Protection Agency (HPA). The consultation response had highlighted concerns about the lack of independence of the new public health service and the government agreed instead to make PHE an executive agency. It was claimed that this would make the organisation more operationally independent, but legally, as an executive agency, PHE would not be distinct from the Secretary of State for Health.

The statement suggested that the consultation responses had been broadly favourable regarding the government's plans to transfer health improvement functions, but that concerns were raised about the possibility of service fragmentation.

Commissioning

In response to the consultation, the government confirmed that the NHS Commissioning Board would commission national programmes of immunisation and screening on behalf of Public Health England, and that the NHS would retain responsibility for children's public health services (including health visiting) until 2015.

The document outlined further detail on which services would be commissioned by which body and clarified which services would be commissioned by local authorities as part of their health improvement functions. These included:

• substance misuse services
• obesity and community nutrition initiatives
• assessment and lifestyle interventions as part of the NHS Health Check Programme
• public mental health services
• behavioural and lifestyle campaigns to prevent cancer and long-term conditions
• comprehensive sexual health services (termination of pregnancy services would later be take on by the NHS)
• promotion of community safety
• violence prevention and response
• local initiatives to tackle social exclusion.

Health Select Committee concerns

In November, the House of Commons Health Select Committee published a review of the government's planned changes to public health. Their report overwhelmingly agreed with the changes, but were concerned about a number of areas, namely:

• the status of Public Health England and its operational independence

• a lack of focus on health inequalities compared to health improvement
• the role (or lack thereof) of district councils in two-tier areas
• the risk that the health premium (payments made in response to improvements in health) might exacerbate inequalities
• the risk that the NHS would not receive sufficient public health advice given the transfer of responsibilities for health improvement to local government
• the focus on the responsibility deal and relationships with industry as a mechanism for resolving public health issues such as obesity, stating that 'those with a financial interest must not be allowed to set the agenda for health improvement'.