See also PDF version Contents Foreword Executive summary The role of legislation Our proposals for legislation Delivering for patients, citizens and local populations – supporting implementation and innovation Annex A: Proposals for legislation Annex B: integration, partnerships and accountability Annex C: stakeholder engagement Excerpts on Fluoride and Fluoridation Foreword … These legislative measures are intended to support improvements already under way in the NHS. They should be seen in the context of those broader reforms. And they are by no means the full extent of this government’s ambition for the nation’s health. We will also bring forward changes in social care, public health and mental health. We also remain committed to the sustainable improvement of adult social care and will bring forward proposals this year. The targeted public health interventions we have outlined here in relation to obesity and fluoridation, sit alongside our proposals for the future design of the public health system, including the creation of the National Institute for Health Protection (NIHP). We are also bringing forward legislation to bring the Mental Health Act up to date, as set out in our white paper last month. Proposals relating to public health Alongside the government’s proposals for the future design of the public health system, including the creation of the National Institute for Health Protection (NIHP) and the closure of Public Health England, we are bringing forward a range of targeted proposals in primary legislation relating to public health. Taken together, the proposals will strengthen local public health systems, improve joint working on population health through ICSs, reinforce the role of local authorities as champions of health in local communities, strengthen the NHS’s public health responsibilities, strengthen the role of the Department of Health and Social Care in health improvement, and drive more joint working across government on prevention. We are also taking measures to intervene in one of the biggest health problems this country faces: obesity; recognising that there is an opportunity to help people make better informed food choices and to help them improve their health. Fluoride is a naturally occurring substance that has been shown to improve oral health. We will work to streamline the process for initiating proposals for new schemes for fluoridation of water in England by moving the responsibilities for doing so from local authorities to central government… Public health power of direction Under existing legislation in section 7A of the 2006 Act, the Secretary of State for Health and Social Care can make arrangements for his public health functions to be exercised by other bodies including NHS England. Currently, this delegation is made by agreement by way of the ‘NHS public health functions agreement’ which is made annually between the Secretary of State and NHS England for commissioning a range of public health services, often referred to as ‘section 7A services’. Under this agreement, NHS England currently commissions a range of services which include national immunisation programmes; national population screening programmes; child health information services; public health services for adults and children in secure and detained settings in England; and sexual assault services (sexual assault referral centres). Water fluoridation Water Fluoridation is clinically proven to improve oral health and reduce oral health inequalities. It has a protective effect which reduces the impact of a high sugar diet or poor oral hygiene. Around 10% of the population of England currently receive fluoridated water. In the most deprived areas fluoridation of water has been shown to reduce tooth decay in 5-year olds by a third. Since 2013, local authorities have had the power to propose, and consult on, new fluoridation schemes, variations to existing schemes, and to terminate existing schemes. The Secretary of State for Health and Social Care has responsibility for approving any proposals submitted by local authorities. Local authorities have reported several difficulties with this process including the fact that local authority boundaries are not co-terminous with water flows, which requires the involvement of several authorities in these schemes, in a way which is complex and burdensome. In addition, local authorities are responsible for the oversight of revenue and costs associated with new proposals, including feasibility studies and consultations, while having no direct financial benefit from any gains in oral health. In light of these challenges, we are proposing to give Secretary of State for Health and Social Care the power to directly introduce, vary or terminate water fluoridation schemes. The Secretary of State for Health and Social Care already has the existing power to decide on whether proposals for water fluoridation should be approved and responsibility for the administration of schemes. This removes the burden from local authorities and will allow the Department of Health and Social Care to streamline processes and take responsibility for proposing any new fluoridation schemes, which will continue to be subject to public consultation. Central government will also become responsible for the associated work, such as the cost of consultations, feasibility studies, and the capital and revenue costs associated with any new and existing schemes. As is the case now, once a scheme is agreed, the agreements held with the water companies will continue to be held centrally. *Original html report online at https://www.gov.uk/government/publications/working-together-to-improve-health-and-social-care-for-all/integration-and-innovation-working-together-to-improve-health-and-social-care-for-all-html-version#executive-summary Print PDF
Print 
PDF