New national public health body 'Public Health Scotland': consultation

Chapter 5: Functions of Public Health Scotland

1. In the course of the last year we have undertaken collaborative work to determine what functions the new body will be responsible for, and how this fits within our broader blueprint for change – i.e. how the body will, in practice, support and enable the wider system. Scottish Ministers and COSLA have agreed that Public Health Scotland will be responsible at the national level for the public health domains of:

• health improvement (currently delivered by NHS Health Scotland); 
• health protection (currently delivered by Health Protection Scotland);
• health care public health (HCPH). There is no existing national leadership role for this domain, although Information Services Division and Healthcare Improvement Scotland support elements of this work.

And alongside this:

• underpinning public health data and intelligence to support the delivery of these. Health intelligence is largely delivered by Information Services Division, but we also recognise the new body will increasingly need to access and use data that reflects the whole system. 

2. Additionally, we have agreed that the new body should have a leadership role in relation to public health research, data science and innovation, and for the development of the specialist and practitioner workforce within the whole system. Various Public Health Reform Programme Commissions have completed work to inform a detailed Target Operating Model (TOM) for the functions and services of Public Health Scotland. TOM 2.0 was approved by the Public Health Reform Programme Board on 2^nd May 2019. Work to implement Public Health Scotland has commenced and will be informed further by this consultation.

3. The Commissions are considering the following questions:

Improving health: 
What do we need Public Health Scotland to do to support the achievement of a ‘step change’ in Scotland’s health status and a reduction in health inequalities?  

Protecting health: 
What do we need Public Health Scotland to do to support an ongoing high quality, resilient and efficient health protection service for Scotland?

Improving services/health care public health (HCPH): 
What do we need Public Health Scotland to do to support effective HCPH input to the design and delivery of care services across Scotland to maximise their population benefits and their contribution to reducing health inequalities?

Underpinning data and intelligence: 
What do we need Public Health Scotland to do to provide the best possible public health intelligence to inform and shape public health activities across Scotland?

Leadership for public health research, innovation and applied evidence: 
What do we need Public Health Scotland to do to enable effective collaboration between multiple academic disciplines, practitioners, policy makers and the public – to maximise the potential for scientific and translational innovation and impact?

Leadership for Public Health workforce development: 
What do we need Public Health Scotland to do to provide leadership in ensuring a robust, resilient and competent public health workforce?

4. Under the new model, we propose that Public Health Scotland will perform the following key functions:

Provide national, professional and strategic leadership for public health in Scotland:

• Provide the strategy, vision and direction for the successful achievement of the body’s remit and lead the drive for improved outcomes for the public’s health and wellbeing, and reductions in health inequalities in Scotland;
• Act as the voice and champion for public health services across the public, private and third sectors, to raise their profile and highlight their contribution to delivering improved health and wellbeing outcomes and reductions in health inequalities in Scotland;
• Identify and recommend actions to address, as appropriate, institutional, legal, financial, workforce and any other systemic barriers to progressing improving and protecting health and wellbeing;
• Provide a credible, independent voice based on evidence and professional judgement, that can objectively assess and comment on the likely impact, benefits and risks to the public’s health and wellbeing of policy proposals;
• Promote partnership working at both national and local level by enabling engagement between partners in public health, health protection, population health improvement, local government, and other health and non-health fields across the public, private and third sectors;
• Engage with practitioner networks to identify best practice and develop guidance based on practice concerns;
• Support the development of a more strategic and co-ordinated approach to the involvement of the NHS, local government, community planning partnerships, the third sector and other partners and partnerships in improving and protecting the public’s health and wellbeing;
• Develop the vision for a more strategic approach to workforce development for public health practitioners, focused on the continuing professional development of all staff; 
• Work with existing bodies and partners to establish standards and expectations of good public health practice; 
• Support innovation by identifying and promoting national and international best practice, including within the fields of data science and behavioural science;
• Support effective HCPH input to the design and delivery of care services across Scotland;
• Support ongoing high quality, resilient and efficient health protection for Scotland.

Provide support to and oversight of the delivery of the Public Health Priorities in Scotland:

• Advise Scottish Ministers, COSLA and relevant local government partners on collective performance against delivery of the Public Health Priorities, with an emphasis on driving local, regional and national continuous improvement;
• Review local plans and annual reports as part of the assurance process to Scottish Ministers and COSLA / Local Authority Leaders;
• Engage with education, scrutiny and inspection bodies on arrangements for providing assurance on quality and continuous improvement of public health services; 
• Enable the benchmarking of local partnerships against each other and through existing arrangements to allow for collective and continuous improvement and identifying opportunities to extend best practice;
• Develop, in conjunction with local partners, a support programme and toolkit for effective partnership approaches to improve and protect the public’s health.

Identify and advise on how health and other resources could be aligned to improve outcomes for the public’s health: 

• Advise Scottish Ministers on how funding should be prioritised to support the Public Health Priorities, including any redistribution which may be necessary within the health sector and the better alignment of resources from out with the health sector; 
• Identify, with key partners and stakeholders, opportunities for deriving the greatest value from strategic planning^[14] of services in relation to public health, based on an analysis of need, evidence of what works and efficiency;
• Identify elements of the public health system that may be better undertaken at a national level, such as the coordination and employment of public health specialists; and
• support the delivery of effective, efficient and high quality health and social care services.

Management of any services which have been identified and agreed as being best delivered on a national basis:

• Strategic planning arrangements for the public’s health at a national level where necessary; 
• Oversight, development and delivery of national training and development for public health, in conjunction with NHS Education for Scotland (NES); 
• Management and monitoring of contracts awarded at a national level;
• Elements of learning and development, including effective practice;
• Oversight of the development and support of IT and information management assets to be managed at a national level;
• Core services and activities currently provided by Health Protection Scotland, Information Services Division and NHS Health Scotland, including:

• Health Protection Scotland: co-ordinating national health protection; monitoring health hazards; health risk assessment of environmental and infection threats; identifying risk management and risk communication options; incident and outbreak management; raising standards in health protection; health protection: research and development; expert advice; developing the workforce; monitoring emerging infections; support commissioning of Reference Laboratory Services.
• ISD: data management; analytics and intelligence; information and intelligence consultancy service; research, innovation, audit and clinical trials support; training and advice.
• NHS Health Scotland: health improvement and tackling health inequalities; strengthening the evidence base; support and promotion activities; strengthening services and collaboration; research and knowledge services; screening and immunisation advice; communications / marketing; advice and training and producing learning resources.

Shared services:

• Enter into arrangements with relevant partners to provide or secure goods or services;
• Services could potentially include administrative services, technical services, professional services, or accommodation services related to public health.

Question 8: What are your views on the functions to be delivered by Public Health Scotland?