Changes to the Health and Social Care Bill: public health

The comparison below sets out the Health and Social Care Bill's initial proposals as regards public health, what has now changed and some key questions that remain unanswered.

The original proposals in the Health and Social Care Bill

  • National leadership on public health to be provided by Public Health England, a new body to be located within the Department of Health.
  • Responsibility for public health to be transferred to local authorities, who will receive a ring-fenced public health budget.
  • Duties on the Secretary of State, NHS Commissioning Board and commissioning consortia to have regard to the need to reduce health inequalities.

What has changed in the proposed reforms?

  • Public Health England now to be an executive agency of the Department of Health.
  • Explicit recognition that public health professionals should be involved in the commissioning process.
  • New duties on Monitor, the NHS Commissioning Board and clinical commissioning groups to promote integration of health services emphasise reducing health inequalities.
  • Explicit duty on clinical commissioning groups to commission services for unregistered patients.

What is still unanswered?

  • With Public Health England becoming an executive agency, will there be a strong enough voice on public health within government?
  • Will there be sufficient public health capacity to fulfil its various responsibilities?
  • Are the duties to reduce health inequalities strong enough to leverage the full potential of the NHS as a major contributor to the economy and employer, as well as a provider of services?
  • Will local authorities prioritise reducing health inequalities if they are not under a duty to do so?
  • How will the government use non-legislative levers and incentives to translate the duties in the Bill into practical action to reduce health inequalities?
  • Is the duty on commissioning groups to commission services for unregistered patients strong enough to ensure GPs prioritise public health?