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Public Health Commissioning Intentions

Introduction

Purpose

This document sets-out the commissioning intentions for Norfolk County Council (NCC) in relation to its Public Health services for the financial year 2025/2026.

Context

The Health and Social Care Act 2012 (effective 1 April 2013) gave upper tier local authorities duties both to improve the health of their populations as well to directly deliver, or arrange the provision of, some specialised healthcare services that previously had been the responsibility of the NHS. There is a requirement to appoint a Director of Public Health (DPH), who as a statutory chief officer holds a leadership role spanning health improvement; health protection; and public health support to NHS commissioning bodies.

Through the Department of Health & Social Care (DHSC), LAs receive a ring-fenced public health grant to fulfil these duties, which includes a series of mandated functions:

  • Steps must be taken to protect the health of the local population
  • Providing NHS commissioners with the specialist public health advice they need
  • Providing or arranging the provision of a range of services, namely: 0-5 public health services (Health Visiting), the National Child Measurement Programme (NCMP), open-access sexual & reproductive health services, and NHS Health Checks.

National picture

Since publication of the Public health grant allocation in England for 2024/25 on 5 February 2024, there was a change of government in July 2024 following which an Independent Investigation of the National Health Service in England was commissioned, which incorporated an overview of the public health grant and associated services.

Published in September 2024, the report found that "the public health grant has been slashed by more than 25 per cent in real terms since 2015" and stated that "given the potential power of preventative interventions, it is perverse that the public health grant to local authorities has been cut so substantially".

The author of the independent reviews report, the Rt Hon. Professor the Lord Darzi, and ministers of the new government alike have spoken repeatedly about the potential benefits of prevention, and the role of local authorities in relation to public health.

However, neither were specifically spoken to in the governments budget announcement on 30 October 2024 and as of publication of these commissioning intentions we are yet to have details of our funding allocations for 2025/26.

This includes whether there will be any inflation to our core public health grant allocation (£45,456,561 in 2024/25), or if all other government public health funding streams will continue (£6,055,240 to Norfolk in 2024/25).

We also do not know what additional expectations may be placed on Norfolk public health from central government come 2025/26. For example, the public health grant for 24/25 increased by 5.1% from the previous year, however for the first time the local authority was expected to manage the incremental cost burden of the Agenda for Change pay award within NHS delivered services from within our allocation (in previous years additional funds had been provided directly to NHS organisations towards meeting incremental pay costs).

Norfolk picture

As stated above, Norfolk County Council's public health grant for 2024/2025 was £45,456,561 or £48.78 per head of population (estimated at 931,943). However, of the total sum a value of £1,241,584 was explicitly aligned to meeting Agenda for Change pay costs within NHS delivered services.

When taking Agenda for Change monies into account, the actual baseline value of the public health grant allocation increased by 2.2% whilst inflation sat at 5.7% in 2023/24 (though fell to 3.2% in February 2024, the month of the announcement of public health grant allocations for the financial year 2024/25).

A Commissioning Work Programme for 2025/2026:

Our 2025/26 commissioning intentions reflect our continued programme of investment in and improvement of our externally commissioned public healthcare services. It sits alongside functions we deliver directly, many of which seek to deliver primary prevention activities, which in turn can alleviate demand for interventional services that are not only funded by public health but also by other key partners across Norfolk's integrated care system such as the NHS ICB, Adults Social Care, and Children's Social Services.

In the financial years of 2022/23, 2023/24, and 2024/25 NCC public health made a series of decisions around investment of its reserves, which had built-up over a number of years but were particularly a result of the COVID pandemic when a number of routine services could not be delivered in full and greater impacts on the public's health were observed.

Initially the investment of reserves looked at recovery, for example in expanding our NHS Health Check programme that had seen some 36,000 health checks missed during the pandemic; whilst in more recent times investment decisions have been made in relation to addressing health inequalities and reaching those in our 'Core20PLUS5' communities.

NCC public health will invest more of its reserves in 2025/26, though the context of this is that by 2026/27 those reserves will have been exhausted and so steps will need to be taken to return public health annual expenditure to balance with our annual grant allocation.

Key to ensuring maximum impact is achieved from public health investment is our part in the emerging Integrated Care System in Norfolk.  We have already established a number of joint commissioning approaches to care including aspects of women's health, mental health and wellbeing, and smoking cessation; and we will enter into new initiatives throughout 2025/26.

Locally there will also be several key initiatives that have a bearing on our priorities and approaches, examples being:

Locally there will also be several key initiatives that have a bearing on our priorities and approaches, examples being:

Performance and assurance

Our now established approach to performance management will be utilised in order to:

  • Embed our quality assurance framework, to further enhance our understanding of service performance and help drive service improvements where areas for development are identified.
  • Ensure all activity continues to be undertaken in compliance with the Commercial Continuous Improvement Assessment Framework (CCIAF).
  • Instigate processes aligned to our new governance obligations under the Provider Selection Regime, such as an annual publication of an annual summary of our contracting activity for the provision of health care services; and, annually, a report of compliance with the new regulations.

Service delivery models - common themes

We will work to consolidate the progress made with provider partners and wider stakeholders in order that we:

  • Progress further our work to digitise and modernise our services, including work in recognition that new systems and services are likely to include an element of AI as functionality in the future.
  • Review progress to date and take steps to expand and embed a continuous improvement approach both in how we commission public health funded services and how our contracted providers approach service change, including demand management.  
  • As we approach completion of our public health grant reserves investment cycle, in 2025/26 we will introduce and utilise a prioritisation framework to aid decision making in relation to public health investment going forwards.

Children and young people

Norfolk Healthy Child Programme (HCP)

(A set of services and partnerships to improve the health and wellbeing of CYP, including Norfolk's Healthy Child Service; an integrated provision for all 0-19-year-olds, their families and carers, offering services such as health visiting, school nursing, the family nurse partnership and our Just One Norfolk health resource website and helpline)

In the first half of 2024/25 we revised our model of 0-5 provisions in the Healthy Child Service, which went live in October 2024, before moving our focus to the development of our School Nursing (0-19) offer, aligning to the NCC school zone approach. 

We also commissioned a new CYP Healthy Weight management service, and have commenced a nicotine intervention development project.

Following on from this, during 2025/26 we will:

  • Drawing learning from the changes made to date, and the work under Start for Life, determine by the end of 2025/26 the delivery model of our Healthy Child Service that will become effective from October 2026. 
  • Work with system partners, to develop a shared collaborative commissioning approach to the Just One Norfolk, Just One Number and For Your Information provisions.
  • Establish and embed the newly commissioned CYP Healthy Weight service as a key aspect of Norfolk's wider children's healthy weight, nutrition and activity offer. 
  • Continue to learn from the Flourish schools survey about the public health & wellbeing needs of CYP and use this to help inform and influence the planned work outlined. We will complete a review of the survey, to determine its future frequency, use and approach. 
  • Develop our Healthy Child Programme partnership approach, bringing together a focus on the health inequalities of CYP. 
  • Work with partners, young people, and their families, as part of our young people's nicotine harm reduction intervention development project, to establish the most effective approaches.
  • Continue to support the development of, and a collaborative approach to, the Start for Life offer and family hub work in Norfolk, bringing together partners, providers and families to do this. 
  • Develop a shared understanding of CYP risk taking behaviours in Norfolk and complete an evidence base review of good practice in relation to this. 
  • Working with partners to review Norfolk's mental health and wellbeing prevention offer.

Young People's Drug and Alcohol and Affected Others services

Offering specialist support, advice and information for CYP using substances themselves, as well as those affected by someone else's substance misuse)

  • Continue to further embed the CYP substance misuse and Affected Others provision in Norfolk
  • Continue to develop the wider children & young people's drug and alcohol partnership approach; focusing on training, parent and carer support and dual diagnosis

Other

  • We will continue to embed Flourish, Norfolk's partnership strategy for children and young people based on the Flourish ambition, across our commissioning activities, and provide evidence of impact on related public health outcomes.
  • We will review Norfolk's MPower service.

Health and Wellbeing

NHS health checks

(A health check-up for eligible adults in England aged 40 to 74, designed to spot early signs of Cardiovascular Disease (CVD), stroke, kidney disease, heart disease, type 2 diabetes, and dementia.)

  • Work with Community Pharmacies, GP Practices, and their representative bodies (Norfolk's Local Medical Committee and Local Pharmaceutical Committee) to further develop our approach in relation to invitation to and delivery of NHS Health Checks
  • Continue to facilitate NHS Health Check Training for primary care practitioners in Norfolk, and build upon the outcomes and learnings of the Training Needs Analysis conducted in 2023/24.
  • Continue to respond to evaluation outcomes and gather more insight into experiences of NHS Health Check delivery by providers.
  • Mobilise a commissioned community NHS Health Check Provider that will engage with the Norfolk community to promote and deliver NHS Health Checks, with a focus on engaging CORE20PLUS populations.
  • Continue to deliver on the ambitions set out in our NHS Health Check Improvement Programme, to increase overall numbers receiving an NHS Health Check, particularly amongst those with the highest need and greatest disparities.

Stop smoking services

(Structured support and treatments to aid quitting smoking, including accurate information and advice, by expert advisers providing a range of proven evidence-based interventions)

Overarching developments

  • Continuation of the additional Local Stop Smoking Support Grant, if confirmed, will allow Norfolk to further develop and expand its suite of stop smoking provisions across the county, including:
    • Introduction of the CoSTED model in each of the counties three Emergency Departments (A&E)
    • Expanded access to Allen Carr's Easyway 
    •  Activities to drive take-up of stop smoking support in Norfolk, including public health improvement campaigns to increase the number of people seeking to quit smoking
  • Continued support to the Norfolk and Waveney NHS ICB in its delivery of stop smoking pathways of care aligned to the long-term plan.

Community (Level 2) Provision

  • Increased utilisation of community pharmacy as part of Norfolk's universal offer  
  • Implement a Level 2 Training Programme for smoking advisors.
  • Increase the number of trained Level 2 advisors across Norfolk and address current gaps in provision.

Specialist (Level 3) Stop Smoking Service

  • Fully integrate our 2024/25 commissioned Specialist Stop Smoking Service (Smokefree Norfolk) into the local system, and develop robust referral pathways.
  • Ensure this specialist support service reaches Core20PLUS5 and Inclusion Health groups through a series of campaigns alongside expanded engagement and outreach work.

Tier 2 weight management services

(Practical support to eligible individuals, helping them to lose weight and decrease the health risks associated with obesity through targeted advice, information and interventions on diet, nutrition, exercise, lifestyle, and behaviour change techniques)

  • Continue to commission Tier 2 Weight Management Services and promote direct access through our Ready to Change platform.
  • Continue working with Norfolk and Waveney NHS ICB and local acute care partners to develop a robust service offer, ensuring system-wide interventions are connected and complement each other.
  • Work with ICB colleagues to develop and promote an improved Weight Management System in Norfolk through local communications and/or campaigns.
  • Increase uptake of the Tier 2 Weight Management Service for those with the greatest need and most significant disparities.

Mental Health, Suicide Prevention, and Bereavement Support

(Services funded by Norfolk & Waveney NHS ICB and Norfolk Public Health that seek to improve individuals' wellbeing, reduce the risk of suicide and attempted suicide, and support those who have been affected by someone taking their own life)

  • Implement a joint performance management framework developed with mental health commissioners at Norfolk & Waveney NHS ICB. 
  • Increase investment in mental health literacy/ training. 
  • Review first-year progress against Norfolk's Suicide Prevention Strategy 2024-2028.

Sexual and reproductive health (SRH)

(Offering both contraceptive care and the testing & treatment of sexually transmitted infections, SRH services are available through GPs; Community Pharmacies; and our specialist iCaSH clinics across Norfolk, open to anyone present in our county)

Following completion of our 2023/24 strategic review of SRH services in Norfolk, and in-light of government policy announcements, in 2024/25 we will concentrate on:

Prevention and Behaviour Change

  • Introduce a recurring programme of SRH awareness raising campaigns, coordinated with provider and system partners.
  • Commission a PrEP focused health promotion campaign, centred in behavioural science, to encourage people, particularly those from key populations, to become informed about PrEP and its availability; to increase discussion amongst friends, family, colleagues, and social networks; and to motivate those who need PrEP most, to take action.
  • Implement a small grants scheme, in partnership with Norfolk Community Foundation, focused on Empowering Norfolk Communities who we too often fail to serve

Access to sexual and reproductive health prevention, interventions, and care

  • Support development of a Level 2 STI service in our south localities
  • Review & Benchmark our Level 3 Specialist iCaSH service, delivering necessary changes to delivery models to manage projected demand, and securing ongoing provision from April 2026

ICS wide developments

  • Aligned to the Women's Health Strategy for England and local development of a Women's Health Hub offer, develop further our co-commissioning work with local and national NHS partners to ensure women receive the right care, in the most optimal place.
  • Benchmark current provision, then work to coordinate and develop Norfolk's whole system offer relating to chlamydia screening and contraceptive provision; ensuring delivery is inline with national guidance and the optimal needs of women are met.

Drug and Alcohol Misuse and Dependence

(Services offering specialist clinical treatment and behaviour change approach to tackling drug and alcohol use across Norfolk, and broader work with system partners to increase success of our interventions and lessen the impact of addiction on our communities)

  • Complete an assurance review of our current core drug and alcohol treatment provision, in line with the Provider Selection Regime, to inform our future commissioning intentions.
  • Build on the work to date of the Norfolk Drug and Alcohol Partnership, to inform local policy and practice in line with the National Commissioning Quality Standards; and From Harm to Hope (10-year National Drug Strategy 2021). Implement and embed the Norfolk lived experience/Experts by Experience service, to ensure the voices of service users, parents, carers and friends are fully embedded within the Norfolk drug and alcohol treatment system.
  • Continue to jointly lead with the ICB the LTP Joint Forward Plan Priority for Dual Diagnosis to deliver on Year-2 objectives, including the implementation of a dual diagnosis pathway.

Road safety

(Promoting strategies, positive behaviours and skills to reduce road risk behaviours; achieved by working in partnership with leads across Norfolk for road safety, public health and active travel; and by commissioning services, providing information, training and creating tool kits)

Communities

  • Promote Bikeability as an inclusive offer to improve participation from children with SEND needs and children in rural schools.
  • Refine the Active Travel Survey Schools grant scheme to help schools embed a culture of road safety and active travel in schools and where data indicate wider health inequalities
  • Evaluate the progress and impact our road safety interventions have had in terms of changing behaviour and reducing risk taking.  

Driver development/skill

  • Continue to support the road safety partnership with key road safety themes with a strengthened commitment to safe systems, data and behaviour change.
  • Continue to commission approved driving instructors to deliver NDORS courses as an alternative to prosecution for some driving offences in line with national and local standards.
  • Develop and expand on our commercial road safety offer and promote this provision to businesses across Norfolk.
  • Create an older road user theory session using participation, feedback and best practise to help older drivers to drive well for longer and reflect on alternative forms of transport and support that best prepare them when the time is right to give up their license.
  • Commission services to support young drivers and create a tool kit to support parents supporting young and new drivers.

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