The government has set out its structural reforms to the public health system in England, which will see the health improvement functions – including substance misuse – currently housed in Public Health England transfer to a new Office for Health Promotion situated in the Department for Health and Social Care. PHE’s health protection functions, previously announced as moving to a new National Institute for Health Protection, will now move to the newly established UK Health Security Agency.
In a policy paper published this week titled “Transforming the public health system”, the government sketched an outline for how the Office for Health Promotion will carry out its role in the new landscape. While questions remain about the design and implementation of the new agency, the paper nevertheless contains some key points:
- The Office for Health Promotion will exist to provide expert public advice, evidence and analysis. It will be a “dynamic, multi-disciplinary unit” that will oversee policy development, house prevention delivery projects, and “develop evidence and policy advice on the links between prevention policies and long-term health expenditure on preventable conditions”.
- The Chief Medical Officer will provide professional leadership for the Office for Health Promotion while the Secretary of State will remain responsible for policy decision and direction.
- The unit will feed into a new cross-government ministerial board on prevention, which will “drive forward and co-ordinate government action on the wider determinants of health.”
- NHS England will be transferred “important national capabilities that will help drive and support improved health as a priority for the whole NHS.”
- Important data and analytical functions will be transferred to the unit, which will be overseen by CMO and the Department for Health’s Chief Scientific Advisor. The government intends to “put in place appropriate governance structures to ensure the independence and transparency of scientific evidence and analysis is preserved.”
- Crucially, the government does not propose making any changes to the scope of responsibilities of local authority public health commissioning.
- However, while the government will seek to strengthen support for the role of Directors of Public, they will also be expected to work closely with the new structures put in place when ICS’s are placed on a statutory footing, particularly the proposed Health and Care Partnerships.
- The role of regional Directors of Public Health will be strengthened.
- PHE staff currently embedded in NHSE&I will transfer to NHSE&I employment.
PHE will continue to operate over the summer while a formal staff consultation is undertaken and the design of the new public health structures is finalised. The government’s ambition is for PHE staff to transfer to the Office for Health Promotion in the autumn. The government is also conducting a survey on the reforms (deadline Monday 26 April) which Collective Voice will be responding to.
The timing of these changes could not be more crucial, as the substance misuse field awaits the publication of the second part of Dame Carol Black’s review of drugs. And although the government has already injected some much-needed financial support into the sector in recent months (though this funding is limited to one year), its response to Dame Black’s review will be hugely significant in signalling the level of long-term political and financial interest substance misuse can expect to receive in the coming years.
An autumn multi-year Comprehensive Spending Review – which is by no means guaranteed given the economic uncertainty caused by Covid-19 – will be the vehicle for the government’s ambitions, so in the coming months we will continue to make a case for a settlement that recognises the vital role treatment and recovery can play in improving health and wellbeing and creating safer communities. We stand ready to work with officials, commissioners, providers and people with lived experience in the new public health landscape to make this vision a reality.