Public Health Commissioning Intentions 2023–2024

Introduction

Purpose

This document sets-out the commissioning intentions for Norfolk County Council (NCC) in relation to its Public Health services in 2023/2024.

Context

Though we adapt as a society to living with COVID, the significant disruption caused by the pandemic between 2020 and 2022, in terms of service delivery and public health outcomes for Norfolk’s population, is still being felt.

Though we continue to work with our providers to further understand and redress these impacts, we have also returned to a business-as-usual approach to our contractual oversight and performance management regimes; and in doing so drive forward service improvements and developments with respect to individual contract requirements.

As we exit our COVID response practices, Norfolk’s COVID Outbreak Management Centre has been stood down and our focus has been to support the emerging Integrated Care Board and the Health and Wellbeing Board develop place-based approaches, through the development of locality Health and Wellbeing Partnerships. We will continue with these developments in 2023/24 and will seek to support the development of place-based commissioning approaches where it makes most sense to do so.

Our 2022/23 commissioning intentions set-out how, as a result of COVID-19, Norfolk had experienced a material impact 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); and our expectation that, for some services, the impact would continue to be seen throughout 2022/23. As predicted, and despite the best efforts of partners across the health and social care system, this has been the case and as a result our efforts to recover the position of routine services is likely to continue through both 2023/24 and 2024/25.

In addition to those initiatives set out in our 2022/23 commissioning intentions, such as our catch-up programme, we also commenced work to:

Understand the impact of COVID on our populations, and to address any identified needs, vulnerabilities, and inequalities within the future shape of service delivery
Undertake a series of strategic reviews, ensuring our future services are designed to best meet the needs of communities, families, and individuals requiring them
Begin preparations to secure the best placed providers to deliver our services in the future; prioritising local need, whilst observing national policy and guidance.

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 public health support to NHS commissioning bodies.

Through the Department of Health and 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 and reproductive health services, and NHS Health Checks.

Norfolk Public Health is also responsible for commissioning drug and alcohol services, school-based health provision (excluding vaccination programmes), and lifestyle services such as smoking cessation, weight management, and suicide prevention programmes.

NCCs public health grant for 2022/2023 was £42,261,485, or £45.73 per head of population (estimated as 924,146), an increase in funding of 2.8% in comparison to 2021/2022. As of October 2022, it is not possible to state the expected value of the public health grant to NCC in 2023/2024 and beyond, but the current position portrays a reduction in value for Norfolk to the tune of -4.8% (in cash terms) from a 2015/16 baseline of £44,376,2441.

National context

The dissolution of Public Health England in October 2021 saw a split in responsibilities between the new UK Health Security Agency (UKHSA) and a DHSC based Office for Health Improvement and Disparities (OHID). This necessitated new ways of working from LA public health teams, alongside adaptations as a result of LA and DPH roles within the emerging Integrated Care Systems (ICS) in driving joined-up local action on population health.

It is worth noting here some key outcomes of the 2021 Comprehensive Spending Review 2021 (SR21), in relation to public health commissioned services, and the subsequent application of the different elements.

Published on 27 October 2021, the government committed to:

Maintain the Public Health Grant in real terms, enabling local authorities across the country to continue delivering frontline services like child health visits
Total investment to £150 million a year to continue and expand programmes that prevent crime and keep our communities safe, including… to tackle drug misuse, including through Project ADDER
Continuation of locally led, tailored interventions to move rough sleepers into secure accommodation, and will provide drug and alcohol treatment for people sleeping rough who need it
Continuing the £100 million investment per year announced at SR20 to help people achieve and maintain a healthy weight (via Tier 2 weight management services)

Subsequently:

When the Public Health Grant settlement was published in February 2022, the grant rose by circa 2.8% whilst inflation stood at 5.4%
On 1 April 2022, OHID announced that, despite commitments made in the Comprehensive Spending Review (CSR) for 2022/23 – 2024/25, “… additional funding for local authority commissioned adult tier 2 behavioural weight management services… will not be available in the financial year 2022-23”
In Norfolk we had focused these new investments on meeting the needs of men, people with Severe Mental Health conditions, and BAME communities to manage their weight. As these remained key priority groups for Norfolk public health, a decision was taken that for the financial year 2022/2023 the County Council would continue to provide funding into the associated services

A Commissioning Work Programme for 2023/2024:

Our commissioning intentions for 2023/24 serve to reflect the need to further develop the programmes we commission, including securing the continued delivery for a number of key services before the end of the financial year; in the context of local and national drivers.

In relation to investment in and oversight of public healthcare services; though the national context set out above has been one of change and some uncertainty, locally we have been in a position of stability both in terms of our funding levels and commissioning infrastructure.

Through 2022/23 NCC has neither sought any reduction in provision nor decommissioned any of our public healthcare services. Indeed, we have increased our spend in order to bring about new interventions (roll-out of e-cigarettes); grow our offer, even where associated government grants are withdrawn (weight management services for those with serious mental illness); and sustain services beyond grant funded pilots (suicide prevention programmes),and will raise our spending further during 2023/2024.

Norfolk County Council Public Health will also seek to further develop our route to commissioning through the exploration and development of the approaches we use to engage with service users, providers, partners and the wider public. We will instigate a programme of work, seeking to ensure that the voices of those who are engaged by; work in; or work with our services are heard and that this directly influences our decision making.

We will also seek to gather the views of those eligible to benefit from our commissioned services, but who are not currently engaged, to understand what barriers are being perceived and/ or experienced that may be deterring people from accessing the care and support we are procuring on their behalf.

There are a number of key national drivers right now, across the breadth of public health commissioned services, and it is important that they are acknowledged as they bring with them both opportunities but also obligations that need to be observed.

Though not an exhaustive list, some of those key drivers are listed here:

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

Better Together, For Norfolk
Flourishing in Norfolk
Ready to Change: Your Way to Better Health
Ready to Change, Ready to Act

Performance and assurance