Guidance

NHS public health functions (section 7A) agreement 2021 to 2022: letter from DHSC to NHSE

Published 18 November 2021

Applies to England

From:

Jonathan Marron
Office for Health Improvement and Disparities
Department of Health and Social Care
39 Victoria Street
London
SW1H 0EU

To:

Mark Cubbon
Interim Chief Operating Officer
NHS England and Improvement

8 November 2021

Dear Mark,

NHS public health functions (‘Section 7A’) agreement 2021 to 2022

Given the ongoing exceptional circumstances and unprecedented challenge of managing the response to COVID-19, I am writing to put on record the arrangements for the delegated exercise of the Secretary of State’s public health functions under s.7A of the National Health Service Act 2006 (‘s.7A’) in 2021 to 2022, which have been agreed by our respective teams, including functions transferring as part of wider public health reforms with effect from 1 October 2021.

The government’s mandate to NHS England and NHS Improvement published in March 2021 set out headline objectives including (objective 4) “improving revention of ill health and delivery of NHS public health services”, and setting out key additional expectations for NHS-commissioned public health services.

We have agreed that for 2021 to 2022, NHS England will commission the services listed at Annex A of this letter. These services will be provided in accordance with the relevant individual service and pathway requirements specifications. The department will continue to hold NHS England to account for delivery through the established ‘section 7A’ monitoring and accountability mechanisms.

Maintaining high coverage rates in our national immunisation programmes is very important to avoid outbreaks of vaccine-preventable diseases and to avoid increasing further the numbers of patients requiring health services. This includes the delivery of the annual seasonal influenza vaccine programme as detailed in the flu letter. Similarly, ensuring high coverage of time-critical screening opportunities (especially antenatal and newborn screening) remains an important population health goal, along with recovering performance on adult screening, school-age immunisation and other national public health programmes where activity was depressed by the pandemic. It remains important to focus on reducing inequalities in access to and outcomes from NHS public health services.

As in 2020 to 2021 we have opted not to set a ringfence in financial directions for these services for 2021 to 2022. Rather, NHS England will manage provision within the totality of its resources working closely with the department to share spending plans and appropriate reporting of expenditure.

Additional functions from 1 October 2021

In addition, with effect from 1 October 2021, these arrangements under s.7A for the delegated exercise of the Secretary of State’s public health functions by NHS England also include the following functions (previously exercised by Public Health England).

Screening: (i) functions providing national support for service commissioning and delivery of high quality, safe, effective, equitable and acceptable screening programmes

Functions relating to the development, oversight and quality improvement of extant and new population screening programmes, including:

• undertaking work to evaluate the effectiveness of innovation and changes in delivery models and advising other bodies and organisations about these functions
• arranging or securing the provision of IT and other services to support the provision of population screening programmes, to enable reporting and evaluation

Screening programmes will continue to be defined by the Secretary of State drawing upon recommendations of the UK National Screening Committee.

Screening: (ii) provision of an effective Screening Quality Assurance Service (SQAS)

Functions undertaking analysis, audits and inspections to assess and assure the quality of screening programmes:

• with appropriate arrangements for timely internal sharing of quality assessments to support learning and mitigations, and transparency via published reports to ensure public confidence
• SQAS should closely support commissioning and operational delivery, with the ability to escalate through a separate NHSE reporting line or to Care Quality Commission if necessary

Healthcare Public Health Functions – applying public health sciences to the planning, commissioning and provision of healthcare services

The promotion of healthcare public health, including through:

• the provision of training in public health with due regard to any standards and requirements set by other national bodies
• supporting healthcare organisations to understand and utilise population health data, including understanding their existing health inequalities and the evidence base for improving population health and reducing inequalities
• supporting healthcare organisations to interpret population health data and evidence and to undertake reviews of the likely effectiveness and cost-effectiveness of a range of interventions, developments and strategies on population health outcomes and to identify gaps or deficiencies in current care and to produce recommendations for improvements, including in relation to specific pathways of care
• using and supporting health organisations to use health economic tools to support decision-making and interpreting data about the surveillance or assessment of a population’s health to improve health outcomes and reduce health inequalities
• the development of population health policies and strategies and their implementation

As with other elements of the s7A agreement, the arrangements set out here are expected to be broadly stable and enduring from year to year and may be assumed as a basis for future planning.

Similarly, as with the s7A agreement as a whole, for the avoidance of doubt NHS England may take whatever steps it reasonably considers calculated to achieve the effective exercise of these functions within the available resource envelope.

Baseline funding allocated to Public Health England for these services for 2021 to 2022 will be transferred to NHS England. Budgets for subsequent years will be set in accordance with outcomes from the Spending Review. Statutory provision has been made for transfer of staff to support these additional functions from 1 October via regulations.

Further details to aid safe transition of the functions and associated data and support are to be set out in one or more memorandums of understanding and co-operation between the department, NHS England and the UK Health Security Agency. The department and NHS England will cooperate to ensure these are promptly and appropriately agreed and acted upon to ensure NHS England can effectively perform the functions.

I would like to take the opportunity to thank your teams for their continued strenuous efforts to maintain delivery of the NHS’ national public health services offer in these challenging times.

Yours etc

Jonathan Marron
Director General
Office for Health Improvement and Disparities