New commissioning arrangements – key functions

It is possible to describe key functions in future commissioning arrangements in some detail on the basis of information in these white papers and consultation documents, and in the Health and Social Care Bill.

GP commissioning consortia will be responsible for commissioning the majority of care for patients. They will also have a duty to promote equalities and work in

partnership with local authorities on adult social care, early years’ services and public health. They will contribute to local authority-led joint strategic needs assessments (JSNA) and ensure that consortia commissioning plans reflect the health needs identified. The public health White Paper reaffirms their responsibility for the whole population in their area and for improving health and reducing health inequalities. Consortia will receive a management allowance to cover commissioning costs. They can decide what commissioning to carry out themselves and what

commissioning they will buy in from local authorities or the private and voluntary sectors.

Local authorities will be local leaders of the new public health system, with new ring-fenced budgets, enhanced freedoms and responsibilities to improve the health and wellbeing of their population and reduce inequalities. They will join up the commissioning of local NHS services, social care and health improvement and therefore be responsible for:

29 Promoting integration and partnership working between the NHS, social care, public health and other local services and strategies.

Leading joint strategic needs assessments, and promoting collaboration on local commissioning plans, including by supporting joint commissioning arrangements where each party so wishes.

Building partnership for service changes and priorities. There will be an escalation process to the NHS Commissioning Board and the Secretary of State, which retain accountability for NHS commissioning decisions.

Local authorities’ ‘convening role’ will provide opportunities for local areas to further integrate health and adult social care, children’s services (including education) and wider services such as disability services, housing, and tackling crime and disorder.

Clauses 178–180 of the Health and Social Care Bill set out the requirement on local authorities to establish a health and wellbeing board, and specify the board’s

composition and general functions. Each board will have four main functions:

assessing the needs of the local population and leading the statutory joint strategic needs assessment

developing a local, joint health and wellbeing strategy that will provide the overarching framework for specific commissioning plans for the NHS, social care, public health, and other services that the board considers necessary

supporting joint commissioning and pooled budget arrangements where all parties agree this makes sense

undertaking a scrutiny role in relation to major service redesign.

Health and wellbeing boards would enable local authority influence over: NHS commissioning and influence for NHS commissioners over health improvement;

reducing health inequalities; and social care. They would lead in determining

strategies and allocations involving place-based budgets for health. They would have

30 an important role in relation to other local partnerships. The minimum membership of boards would be elected representatives, GP consortia, DsPH, Directors of Adult Social Services, Directors of Children’s Services, local HealthWatch and, where appropriate, the participation of the NHS Commissioning Board.

Directors of public health will be employed by local government and jointly appointed by the relevant local authority and Public Health England. They will be responsible for the health improvement functions of upper-tier and unitary

authorities. They will be the strategic leaders for public health in local communities, working to achieve the best possible public health and wellbeing outcomes across the whole local population, in accordance with locally agreed priorities. They will collaborate with local partners on improving health and wellbeing, including GP consortia, other local DsPH, local businesses and others.

The NHS Commissioning Board will have five main functions, including national leadership on commissioning for quality improvement by, for example, ‘setting commissioning guidelines on the basis of clinically approved quality standards developed with advice from NICE, in a way that promotes joint working across health, public health and social care’. To ensure accountability to patients and the public, the NHS Commissioning Board, supported by NICE and working with patient and professional groups, will develop a commissioning outcomes framework that measures the health outcomes and quality of care achieved by GP commissioning consortia. As part of its mandate for public health it will work with Public Health England in supporting consortia to achieve maximum impact on improving health and reducing health inequalities.

Public Health England will be part of the DH. Its mission will be across the whole of public health – protecting the public from health threats, improving the healthy life expectancy and wellbeing of the population, and improving the health of the poorest, fastest. It will work closely with the NHS to ensure that health services play a strong part in this mission. Its role will include:

commissioning or providing national-level health improvement services, including appropriate information and behaviour change campaigns

31 commissioning some public health services from the NHS, for example via the NHS Commissioning Board

allocating ring-fenced funding to local government and rewarding them for progress made against elements of the proposed public health outcomes framework

jointly appointing DsPH and supporting them through professional accountability arrangements

providing public health advice, evidence and expertise to the Secretary of State and the wider system, including working with partners to gather and disseminate examples of what works

delivering effective health protection services.

Local requirements for public health evidence will drive Public Health England’s evidence function. Its approach to evidence will be based on principles of quality (evidence will be timely, reliable, relevant to the audience and aim, and produced in a scientifically robust and independent way), transparency (evidence will be as

accessible and user-friendly as possible), and efficiency (information will be collected once but used many times and new knowledge will be rapidly applied).

The outcome frameworks for the NHS, public health and social care will provide a major focus for efforts to improve performance through commissioning by each sector and by the sectors in partnership, and will be an important element in enabling accountability within delivery systems and to the public locally and nationally. The consultations on the NHS and adult social care outcomes framework presented fairly well developed models. The public health white paper presented only the five

domains proposed for the public health outcomes framework, pending further consultation. These domains are:

Domain 1 – Health protection and resilience: protecting people from major health emergencies and serious harm to health.

32 Domain 2 – Tackling the wider determinants of ill health: addressing

factors that affect health and wellbeing.

Domain 3 – Health improvement: positively promoting the adoption of

‘healthy’ lifestyles.

Domain 4 – Prevention of ill health: reducing the number of people living with preventable ill health.

Domain 5 – Healthy life expectancy and preventable mortality: preventing people from dying prematurely.