Public health commissioning for under 5s

Topic briefing

We have spoken to officials at the Department of Health to raise stakeholder concerns about potential fragmentation in commissioning for children and young people, and to understand the department’s plans. This briefing on public health commissioning for under 5s outlines the current position as of early August 2012.

New details on the changes to commissioning will continue to emerge between now and April 2013, and we will update this briefing as and when new information is available from the Department of Health.

Key issues in public health commissioning for under 5s

The Public Health Outcomes Framework and the indicators for child accident prevention provide a real opportunity for progress in reducing serious unintentional injuries to children. A temporary split in responsibility for commissioning public health for children and young people means that some services will be commissioned by the NHS Commissioning Board (NHS CB) and some by local authorities.

From April 2013, responsibility for public health commissioning for 5–19 year olds will transfer from the NHS to local authorities. Responsibility for public health commissioning for 0–5s will also transfer to local authorities, but not until 2015. Until then, it will be the responsibility of the NHS CB.

Despite this split in commissioning responsibilities across age groups, local authorities will have lead responsibility for delivering on the Public Health Outcomes Framework indicator to reduce hospital admissions from unintentional and deliberate injuries for the whole 0–18 age group, with support from other partners in the new public health system.

The NHS CB will be taking over commissioning of the following programmes:

  • health visiting
  • Family Nurse Partnership programme
  • Healthy Child Programme for 0-5s.

These are key programmes providing universal and targeted support for families with young children who are at risk of preventable serious injuries, especially from accidents in the home.

Throughout England there will be 27 NHS CB local area teams, which will act as the ‘eyes and ears’ of the national board, gathering intelligence and working closely with clinical commissioning groups and local authorities. They will also link up with health and wellbeing boards – in some cases, they might have a formal role within the organisation, but this will be down to individual boards to decide. As of July 2012, the NHS CB had appointed 16 of the 25 local area team director posts.1

The full details of how NHS CB local area teams will operate and the roles within them are still in development, but there will need to be strong links between the local area teams, clinical commissioning groups, health and wellbeing boards and local authorities, to make sure that services operate effectively.

Why the split in commissioning responsibilities

The rationale for the split in commissioning responsibilities is to support significant investment in building capacity in public health services for 0-5 year olds, particularly in the number of health visitors and Family Nurse Partnerships. The NHS CB will be responsible for doubling the number of Family Nurse Partnership clients at any one time to 13,0002 and recruiting an additional 4,200 health visitors3 by April 2015.

This will of course need to be delivered across local health and care services, with a strong emphasis on evidence-based practice. Local services working together such as social care and health visiting and through education and youth services, will continue to be essential.

Policy context

The government will use Section 7A of the NHS Act 2006, as inserted by the Health and Social Care Act 2012, to delegate responsibility for specified public health functions to the NHS CB. This includes commissioning of public health services for 0–5s. The Health and Social Care Act 2012 will also be used to hand responsibility for public health commissioning for 5–19s to local authorities.

The Department of Health and the NHS CB Authority (a special health authority and the shadow form of the NHS CB) are jointly developing a Section 7A agreement that will set out the programmes and key deliverables that the NHS CB will be responsible for. The expected publication date for the agreement is autumn 2012.

At this stage, we know that the NHS CB key deliverables for public health for 0–5s will focus on:

  • introducing health checks for 2–2.5 year olds
  • increasing health visitor numbers
  • rolling out the Family Nurse Partnership programme. 

Wherever possible, key deliverables are being linked across to the Public Health Outcomes Framework. However we understand from officials in the Department of Health that an indicator for reducing hospital admissions from unintentional and deliberate injuries among under 5s (equivalent to the Public Health Outcomes Framework indicator for under 18s) will not be built into the Section 7A agreement.

As such, local authorities should continue to work towards this indicator for the whole 0–18 age group, in partnership with health and wellbeing boards and clinical commissioning groups.

What the changes mean in practice

The Section 7A agreement will include service specifications that will set out the evidence base and the core components for all the programmes that are being included, to inform the commissioning process. These are currently being developed by the Department of Health for the three public health programmes for 0–5s that the NHS CB will be commissioning.

We will have more insight into what these changes will mean in practice once these specifications have been published. For now, we know that the NHS CB does not intend to take a ‘one size fits all’ approach and that local requirements will be taken into account during the commissioning process. This is an important part of laying the groundwork for a smooth handover of responsibility to local authorities in 2015.

In July 2012, the public health and prevention subgroup of the Children and Young People’s Health Outcomes Forum included the following recommendation in its report to government:4

“We suggest…the NHS CB, in collaboration with Public Health England, works closely with local authorities to ensure the smooth transition of commissioning public health services for children under five years from NHS CB responsibility to local authority responsibility by 2015. The two years, 2013/14 and 2014/15, provide an opportunity to develop joint commissioning of all components of the Healthy Child Programme.”

Existing programmes

Local arrangements for health visiting, Family Nurse Partnerships and the Healthy Child Programme that are already in place will continue once the NHS CB takes over responsibility for public health commissioning for 0–5s. In these cases, the NHS CB, through its local area teams, will work with local authorities to take a shared approach to commissioning. The NHS CB will also honour joint commissioning arrangements that are already in place.

Existing accident prevention services that fall outside of these three programme areas will also continue uninterrupted and remain the responsibility of the local authority.

Commissioning additional accident prevention services locally

Local authority teams will be free to work with their local health and wellbeing board to commission services for 0–5s outside of the three NHS CB-led programmes. This means that teams can continue to develop and implement targeted accident prevention campaigns based on local needs, as identified in the area’s joint strategic needs assessment and joint health and wellbeing strategy.

Working with partners, including those from the voluntary sector, will remain an important part of local unintentional injury prevention work. Public Health England will be taking on the work of public health observatories so will be a key source of data for accident prevention professionals.

How Making the Link can help you

Making the Link is here to support people with a role to play in child accident prevention throughout England.We know that some people working in unintentional injury prevention are experiencing difficulties in getting plans approved and new programmes off the ground during this time of transition. It is important to continue with your efforts to keep child accident prevention on the agenda and to adopt a ‘business as usual’ approach even though key stakeholders will change under the new arrangements.

You can use the resources on our website to help make the case and provide evidence for your plans.

We also hold regular master classes where you can explore key issues with a panel of invited experts – public health commissioning for under fives was the topic of our last master class training event held on 11 July 2012. Officials from the Department of Health attended to present the department’s plans and answer questions from local stakeholders.

In addition, there may be national-level support available to you if you reach a standstill with efforts to introduce new services. For example, if you need support to get a Family Nurse Partnership off the ground, then the Family Nurse Partnership national unit may be able to get involved and help you to move forward. It is worth making contact even if you’ve already tried this approach previously, as change is taking place very rapidly and they may now be in a position to offer more proactive support.

Please do contact us to tell us about any challenges you are facing in your work as a result of these changes, or to share how you have found ways to work around these issues. Your input will help us to produce helpful resources for the Making the Link website, develop our programme of master class events, and communicate your concerns and achievements to Department of Health officials.

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Useful links

Making the Link site links

External links

  • The new public health system: a Department of Health overview of the new public health system, published in December 2011. Resources available for download include a factsheet on commissioning responsibilities.
  • Public Health Outcomes Framework publication: the Department of Health’s January 2012 publication Healthy lives, healthy people: Improving outcomes and supporting transparency.
  • NHS Commissioning Board: news, publications and resources from the NHS Commissioning Board.
  • Children and Young People’s Health Outcomes Forum report: overview of the recommendations made in the July 2012 report, including the report of the prevention and public health subgroup. Also includes a factsheet on commissioning in the new NHS for children, young people and their families.

Download this topic briefing as a PDF

Notes for this feature

  1. Appointment of the first local area team directors, NHS Commissioning Board, 19 July 2012.
  2. The Family Nurse Partnership Programme, Department of Health.
  3. Health visitor numbers rising, Department of Health, 6 July 2012.
  4. Report of the public health and prevention sub-group, Children and Young People’s Health Outcomes Forum, July 2012.
Updated December 2013