RCP principles for an effective, integrated public health system

Public health improves the health and wellbeing of our population. It has wide-ranging roles in protecting groups and the population from health threats, preventing ill health and ensuring health services are effective, cost effective and equitable. Public health skills are vital to an integrated approach to policy and service implementation that leads to healthier communities and reduces demand for NHS services. Crucially, it is integral to reducing health inequalities, putting people on a more equal footing to enable them to live healthier lives.

Many structural changes have been made to the public health system and its delivery over the past few decades. Some of these changes have been positive, for example the implementation of a 'Health in All Policies’ approach in some localities. However, many have contributed to a deprioritised and fragmented system, including the defunding of public health, unclear roles and leadership responsibilities, complicated ways of working across public health organisations, and lack of capacity across the workforce. These, including the impact of COVID, have been linked to concerns about workforce morale.

Defining well-functioning, integrated public health was identified as a priority by the RCP’s advisory group on health inequalities. Throughout 2024, the RCP undertook research and engagement with stakeholders across public health. In November 2024 we held a private roundtable to discuss what an integrated public health system looks like in practice and the levers to make this possible. Representatives from the Faculty of Public Health, Association of Directors of Public Health, Royal Society of Public Health, NHS Confederation, NHS Providers, the Health Foundation and the King’s Fund all attended to share their views and experience.

All organisations agreed that improvements need to be made to the infrastructure of the system rather than reforming the whole system. A number of themes were identified as key target areas for improvement that national and local government, NHS England and health providers, and other stakeholders should prioritise. These included leadership, relationships, roles and accountability, and workforce.

Preventing disease, prolonging life, and promoting health through the organised efforts of society requires us to take account of the health and care needs of the populations we serve. Strong and careful integrated public health leadership is central to this.

These principles cover public health in England. Scotland, Wales and Northern Ireland have different arrangements and, in some aspects, public health functions are less fragmented.

Action to implement these principles should take account of good practice in other UK countries, and be led by national government, with support from local authorities, NHS England, Integrated Care Systems and NHS provider organisations, and voluntary, community and social enterprise (VCSE) organisations. Integrated Care Partnerships have the potential to bring together the work of local government, the NHS and VCSE sector, and therefore can act as an enabler to this agenda.

To improve the health of the country, public health needs to be made a bigger priority nationally with clear accountability. The upcoming government 10-year plan for health, health mission and the promised shifts provide key opportunities.

RCP principles for public health: An integrated approach to public health is one where…

1. Public health is embedded and joined up across national, regional and local organisations.
2. Public health skills and leadership are valued and central to delivering efficient and effective population health and improving inequalities across systems.
3. There are ambitious opportunities for effective and visible public health leadership at a level of influence locally, regionally, and nationally, with clear mechanisms for accountability within systems and at the highest level.
4. Those who work in public health across the system are collaborative and able to effectively work together, across the NHS, national and local government and community and voluntary organisations. There is a culture and structures that enable this.
5. The entire public health workforce, including the wider workforce, is invested in and supported through strategic workforce planning, with multiple accessible and alternative career pathways and opportunities for training and development.
6. The specialist public health and wider public health workforce are respected and given parity of esteem across the systems in which they work. This should be a commitment to diversity, equity and inclusion in the recruitment and retention of the workforce, and in its ability to meet the changing needs of the communities they serve.
7. Public health is sufficiently funded, including restoration and expansion of the public health grant, across the health and care system and local authorities, including long term funding to improve population health outcomes and prevent disease.
8. Decisions are based on shared public health goals across the system, with services informed by community and public health as well as societal and public need, and in so far as is possible, based on relevant evidence and data.

The RCP will continue to develop its thinking in this area and engaging with organisations that have a remit over public health. If you have feedback, please get in touch at policy@rcp.ac.uk. 

The RCP principles for well-functioning, integrated public health were developed through the RCP advisory group on reducing inequalities in health and wellbeing and in collaboration with the organisations who attended the November roundtable. The RCP advisory group on reducing inequalities in health and wellbeing comprises the RCP academic and clinical vice presidents, special adviser on population health, external health inequalities and public and population health experts and Patient and Carer Network representatives. The principles were approved by RCP Council prior to publication.