Final Business and Regulatory Impact Assessment Title of Proposal The Public Health Scotland Order(s) Purpose and intended effect Background The Scottish Government carried out a Public Health Review in 2015 (Public Health Review ) to examine public health systems and functions and their contribution to improving population health and wellbeing and reducing health inequalities. One of the recommendations was to undertake further work to review and rationalise organisational arrangements for public health in Scotland. This work should explore greater use of national arrangements, including for health protection. Objective The new public health model seeks to deliver better health and wellbeing outcomes for communities by promoting a collaborative approach to planning and delivery, putting decision making in the hands of local communities and agencies who are best-placed to assess local public health needs. At national level, a new Special Health Board (to be called Public Health Scotland) will provide strategic leadership; support enhanced opportunities for innovation, research, learning and development; and provide assurance on the delivery of improved public health and wellbeing outcomes. Under the new model, the bodies Health Protection Scotland (a division of NHS National Services Scotland (NSS)), Information Services Division (also a division of NSS) and NHS Health Scotland (a Special Health Board) will cease to exist. Public Health Scotland will take over their current functions and services from 1 April 2020. Public Health England has some health protection responsibilities related to Scotland, especially on chemicals, poisons, and radiation. The UK Government and the devolved administrations have designated Public Health England (PHE) to act as the National Focal Point (NFP) for all of the UK and only PHE should communicate directly with the World Health Organisation (WHO) on International Health Regulations 2006 matters. This is a legally binding international instrument to: ‘prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international trade and traffic’. Public Health England (PHE), The European Centre for Disease Control (ECDC) and the World Health Organization (WHO) also have significant overall responsibilities through PHE acting as the nominated UK body for the ECDC, and the use of the International Health Regulations (IHR). Rationale for Government intervention Scottish Ministers announced in November 2014 that they had asked for a Review of Public Health in Scotland, the report of which was published February 2016. This Review found that Scottish public health needed to be more visible and that it needed to have a clearer vision. It concluded that public health needs to provide leadership which extends far beyond the NHS and health boundaries to influence wider agendas, policies and programmes in the public, private, third and independent sectors. The Review emphasised the cost-effectiveness of preventive approaches and the need for a more proactive public health effort in Scotland. In June 2018, the Scottish Government and the Convention of Scottish Local Authorities (COSLA) published Scotland’s Public Health Priorities , after working with a range of partners and stakeholders to develop a set of priorities for the whole system. The six priorities are: − A Scotland where we live in vibrant, healthy and safe places and communities. − A Scotland where we flourish in our early years. − A Scotland where we have good mental wellbeing. − A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs. − A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all. − A Scotland where we eat well, have a healthy weight and are physically active. The agreed Priorities reflect public health challenges that are important to focus on over the next decade to improve and protect the public's health and wellbeing. They set out Government’s vision for shared Public Health Priorities for Scotland, providing focus for public services to improve population health and wellbeing, reduce inequalities and increase healthy life expectancy. This provides a framework, consistent with the Scottish Government’s purpose and the National Performance Framework, to guide everyone working in the health system and beyond to align their efforts to make a real difference to our society and economy. Good health and wellbeing is beneficial for individuals and families, and also strengthens capacity for participation in learning, employment, caring, and many other activities. The new national body will therefore provide strengthened leadership and centralised, more aligned and coordinated national public health functions that will contribute to the delivery of the National Outcomes. Through the public health reforms and future work of Public Health Scotland, we want to create a culture for health in Scotland that enables us to: − plan and deliver services that centre on prevention and integration; − ensure decision making rests as close to communities as possible; − work with communities to deliver improved health outcomes and empower citizens; and − deliver local services that work together even more closely with communities to meet the needs of people who use them. Consultation Across Government Directorates across the Scottish Government have been consulted on these public health reform proposals, particularly those policy divisions with a direct interest in the Public Health Priorities outlined above. Their input supported the drafting of the document ‘Scotland’s Public Health Priorities’. Public Health England, Public Health Wales, Healthcare Improvement Scotland and Food Standards Scotland have also been directly involved in the Public Health Reform Programme governance. Public Consultation The Scottish Government and COSLA, working with a range of partners and stakeholders, engaged widely across Scotland to develop the Public Health Priorities. Engagement activity involved over 500 individuals from across all sectors. The 2015 Public Health Review also included broad membership from health boards, Healthcare Improvement Scotland, COSLA, the Farr Institute, Glasgow Centre for Population Health, Universities and the third sector. A number of these representative bodies are also members of the Public Health Reform Oversight Board, which was formed in June 2017 to provide advice, support and challenge to the reform programme. On 28 May 2019, Joe FitzPatrick MSP, the Minister for Public Health, Sport and Wellbeing, and Councillor Stuart Currie, Health and Social Care spokesperson for COSLA, launched “A consultation on the new National Public Health Body ‘Public Health Scotland’” seeking views on the role, structure and expected functions of Public Health Scotland, with some discussion of its interface with other bodies, partnerships and statutory frameworks. A total of 185 responses were received: 151 from organisations and 34 from individual citizens. The largest organisation sub- group was the Third Sector, with 51 respondents. The consultation closed on 8 July 2019. A partial BRIA was included with the public consultation to invite feedback on it but no significant comments were received. The responses generally highlighted the important role of both businesses and the third sector in the delivery of public health, as well as common concerns around the potential conflict of interest or negative consequences, arising from private sector involvement (e.g. the food and drink industry) in public health-related interventions. Officials met with Third Sector and Community Planning Forums to publicise the consultation, to talk through the various questions and invite comments on the BRIA. Business As mentioned, we included the partial BRIA with the public consultation and asked for related feedback but no substantive comments or concerns were received from particular businesses or third sector organisations. Broadly, the third sector organisations just wanted to ensure that they had appropriate gateways and forums to engage with and influence the work of the new body. Options Option 1 – Do nothing There are many challenges currently facing the NHS in Scotland, including increasing costs, growing demands and the continuing pressures on public finances. These challenges continue to intensify. Demand for healthcare services continues to increase and more people are waiting longer to access services. This is why the way wider population health activity is planned, managed and delivered at all levels in Scotland must change. The scale and interdependencies of health and social care make achieving the changes needed a highly complex and long-term undertaking. Previous approaches, such as providing more funding to increase activity or focusing on specific parts of the system are no longer sufficient. While improvements to budgets for treatment services have helped alleviate short-term pressures, doing nothing towards enhancing prevention and early intervention will simply mean we see increased and unsustainable pressures on treatment services over the medium and longer term. Option 2 - Establish Public Health Scotland as a standalone new body, without integrating existing NHS assets Creating a new, additional, national body to coordinate and provide leadership for public health activity would, in effect, increase rather