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The Office for Health Improvement and Disparities: one year on

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Amid all the recent political and economic upheaval you would be forgiven for not noticing an important anniversary. On 1 October the Office for Health Improvement and Disparities (OHID) was one year old.

OHID was set up as part of Matt Hancock’s (then Secretary of State for Health and Social Care) disestablishment of Public Health England. The argument for OHID (acting alongside its sister organisation the UK Health Security Agency (UKHSA)) was that bringing health improvement expertise into the heart of government, through the Department of Health and Social Care (DHSC), would ensure a stronger evidence-based influence over wider government policy decisions on health and health inequalities. It was accompanied by the announcement of a Health Promotion Taskforce, a Cabinet committee to help provide the cross-government vehicle for those decisions. So how has OHID been doing, or perhaps more aptly, been allowed to do?

Despite the folly of deciding to restructure critical national public health infrastructure in the middle of a pandemic, we welcomed the potential of OHID (then expected to be called the Office for Health Promotion), while cautioning about the risks in a letter to the Chief Medical Officer and Matt Hancock. The gains, being at the heart of government and therefore being closer to the levers of power, came with potential costs. These included the risk of OHID being slowly dissolved into the rest of the DHSC and losing its identity, expertise, purpose and ability to influence in the process; and of it being less visible and less part of the public debate on health than its predecessor.

'Of course we can only see what we can see, and that’s the final problem, OHID has disappeared into the shadows and it’s really hard to see its imprint. Just where is OHID?'

Unfortunately those risks appear to have been all too real. In the past few weeks some big-ticket OHID-linked policy announcements have reportedly been cancelled or under significant review including moves on obesity and the already much-delayed health disparities White Paper. While some of this is related in the near term to political change and priorities of a new leader and ministerial team, the fact that these are unlikely to survive also tells us something about how effective OHID has been in establishing itself in the centre of government in the year since its creation. Other less high-profile ‘losses’ such as shutting down of funding for weight-management services, the continuing under-funding of local government public health, the seeming disappearance of the Health Promotion Taskforce, and the conspicuous lack of response to the Khan Tobacco Control Review alongside suspicions the government will row back on a commitment to publish a plan to tackle smoking to add to the tally.

On the ‘gains’ side of the ledger, healthy life expectancy being chosen one of the levelling-up missions is likely to have been influenced by OHID although there seems to be no plan to make that a reality; the welcome government response to Dame Carol Black’s drugs review and the HIV Action Plan are likely to have had OHID influence. The government has also announced £50 million for health inequalities research in local government through the National Institute for Health and Care Research. Of course we can only see what we can see, and that’s the final problem, OHID has disappeared into the shadows and it’s really hard to see its imprint. Just where is OHID?

'Regionally OHID has provided an important bridging function and worked with other members of the ‘public health family’ in the NHS and local government helping define the offer to ICSs to move beyond a focus only on care integration.'

To answer that we need to look elsewhere. One of the strengths of Public Health England was its focus on supporting local and regional systems through its national expertise and regional teams. OHID is, in fact, alive and doing pretty well out of the national spotlight, led by regional directors of public health, co-appointed with NHS England. Over the past year these teams have been resetting their vision, purpose and role as they transitioned from Public Health England to OHID (with the loss of health protection functions that went to UKHSA); but also to the new world of emergent integrated care systems (ICSs). There is lots to play for here, in particular around how strongly ICSs will remain focused on the four underlying principles, on partnerships beyond the health and care system, and ultimately on improving population health, not just on the integration of care services. Our view a year ago was that regional bodies and collaboratives would become more important in supporting this to happen including through connecting public health expertise with ICSs.

Regionally OHID has provided an important bridging function and worked with other members of the ‘public health family’ in the NHS and local government helping define the offer to ICSs to move beyond a focus only on care integration. Over the past year, we’ve seen and supported work going on in London, in the North East and North Cumbria, in Cheshire and Merseyside, and, with a focus on health inequalities, in the Midlands,  to name a few. While there remains much more to do, and OHID nationally seems to have found it difficult to establish itself and maintain a public voice, there is a lot of good work happening beyond the national glare. I look forward to celebrating OHID’s second birthday this time next year.