Councils promised freedom to spend public health cash

Local authorities are to be given freedom to spend public health budgets transferred from the NHS, under the government’s public health White Paper, published today.

The document promised that local authorities would be able to set their own priorities for public health spending, when they take over responsibility for this area from primary care trusts from April 2013.

The White Paper said councils were best placed to tackle the health challenges their areas faced in areas such as drugs, alcohol, sexual health and obesity. It added: “We will keep to a minimum the constraints as to how local government decides to fulfil its public health role and spend its new budget.”

However, the scope to divert public health budgets into other areas such as preventative social care will be limited by a requirement for councils to fund some services such as open access sexual health provision and immunisations.

Councils will also be paid for their results in improving health outcomes against a new performance framework, through a health premium. This will form part of their budget and will be initially distributed purely on the basis of health need, in order to tackle health inequalities, before a payment by outcomes element is introduced.

The money for public health is expected to total over £4bn nationally, but some of this will be retained by a new national agency, Public Health England, within the Department of Health, which will commission and provide some services directly.

Public Health England will also jointly appoint local directors of public health, who will lead local strategies to improve health outcomes.

It will also take over the functions of the National Treatment Agency for Substance Misuse and the Health Protection Agency, which will both be abolished.

Health secretary Andrew Lansley said: “With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation’s health.”

The NHS Confederation welcomed the transfer of public health responsibility to local authorities from PCTs, which will be abolished in 2013 with their health commissioning functions transferred to new GP consortia.

“Moving public health to local authorities should have many benefits as councils have greater potential to impact on the causes of ill health,” said acting chief executive Nigel Edwards.

However, he said that the implementation would need to be got right “otherwise a good idea can do more harm than good”.

Others also raised concerns. Deborah Jack, chief executive of the National Aids Trust, said: “A ring-fenced budget could protect funds for HIV prevention, but we need local authorities to be up-skilled quickly and effectively in their new responsibilities. This is especially important given the proposal they also commission open-access sexual health services, which will be a completely new role for them.”

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