Public Health Commissioning Intentions 2022 - 2023

Introduction

Purpose

This document sets-out the commissioning intentions of Norfolk County Council’s Public Health service in 2022–2023.

Context

Throughout 2020–2021 and 2021–2022, the need to respond to the COVID Pandemic necessitated routine health and social care services, commissioned either by Local Government or the NHS, be delivered in a way that both sought to mitigate the risks of COVID, by way of changes to delivery models, but also respond to the need to deploy colleagues to work directly on pandemic response.

As a result, the way in which Norfolk County Council (NCC) Public Health commissioners applied scrutiny and contractual obligations on our providers had to adapt; working with partners to ensure those service model mitigations put in place (i) met or exceeded national guidance on ‘essential services’; and (ii) focused on safeguarding and protecting care provision for the most vulnerable.

The NCC Public Health team went through a restructure during 2020/21; reflecting our new COVID functions, alongside how future work will be shaped to meet emerging priorities, some of which are outlined in this document. We now have four arms overseen by our senior management team; Public Health Specialism Leadership, the Outbreak Management Centre, a Prevention and Policy team, and our Public Health Commissioning functions.

Background to Public Health duties and funding

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 PH support to NHS commissioning bodies.

Working through Public Health England, the Department of Health & Social Care (DHSC) provides Local Authorities with a ring-fenced grant to fulfil these duties. Whilst the aspirations of NCC Public Health in regards to primary prevention; tackling health inequalities; and intervening to alleviate ill-health are broader than the prescribed functions we hold, we are mandated to:

  • Take steps to protect the health of the local population;
  • Ensure NHS commissioners receive the specialist PH advice they need;
  • Provide or arrange the provision of: open-access sexual and reproductive health services, the National Child Measurement Programme (NCMP), NHS Health Checks, and 0-5 PH services (including Health Visiting).

Norfolk PH is also responsible for commissioning a range of other services including drug and alcohol services, school-based health provision (excluding vaccination programmes), and lifestyle services such as smoking cessation, weight management, and suicide prevention programmes.

Norfolk County Council’s public health ring-fenced grant for 2021/22 was £41,106,708, or £44.48 per head of population (estimated as 924,146). It is not possible to state at this time what our ring-fenced grant will be in 2022/23 and beyond, but the current position portrays a reduction in the value of the public health grant from government, in Norfolk’s case to the tune of -7.4% (in cash terms) from a 2015/16 baseline of £44,376,244.

National drivers

Effective October 2021 the responsibilities of Public Health England will be split between the new UK Health Security Agency and a DHSC based Office for Health Improvement and Disparities (OHID). This necessitates new ways of working from local PH teams, alongside a need for adaptations as a result of the role of Local Authorities, and their DPHs, in the emerging Integrated Care Systems; driving joined-up local The forthcoming Comprehensive Spending Review will see the government consider its priorities across all spending areas for the coming years. The implications for PH provision are considerable, and as such an essential element of our work in 2022/23 will be to consider the outcome of the CSR in relation to our commissioned services.

A commissioning work programme for 2022/23:

It will be apparent to all that COVID has had a detrimental effect on the health and wellbeing of the population, both directly (as a potentially fatal communicable disease) and indirectly; through disrupting the delivery of routine healthcare as well as people’s ability or determination to call upon the care they needed.

We know the impact of COVID on routine care, in the context of PH commissioned services, has been that less episodes of care has been delivered than would have been expected in an average year. As a result, Norfolk Public Health is initiating a Catch-Up Programme, over the coming period to end 2023/24.

Whilst vital that we work to stabilise our current services; seek to ‘catch-up’ with those provisions lost as a result of COVID; and initiate programmes to reengage with previous and reach-out to new service users – we must also begin work to:

  • Enable and support service recovery from the impact of Covid, whilst at the same time ensuring services can continue to respond to the pandemic as needed in order to safeguard service users, staff and the wider population.
  • Understand the impact of Covid on our populations, and work to reflect the identified, needs, vulnerabilities and inequalities within the future shape of service delivery.
  • Work through a process of reviews, in light of Covid, to ensure that going forwards our future services reach the right communities, families, and individuals; and are delivered in the right way to meet people’s needs.
  • Prepare for, and begin where necessary, the process of securing best placed providers to deliver our services in the future, working to local needs and priorities whilst observing national guidance and policy directives.

The following outlines our core intentions, in relation to our commissioned services, for 2022–2023 and should be read in that context.

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