This think piece, published by the ILC-UK, with the support of Sanofi Pasteur MSD, explores the extent to which England’s public health structures are able to respond to our ageing population after the radical reforms introduced by the Health and Social Care Act in 2012.

In December last year, ILC-UK hosted an event which explored this topic, bringing together representatives of local government with a series of experts who highlighted how the changes may affect key areas of public health. This paper builds on these themes by outlining the opportunities and challenges offered by the public health structures to our ageing society, highlighting examples of both good practice and potential pitfalls.

Opportunities and challenges highlighted include:

Opportunities
• Local Authorities know their residents best.
• Local Authorities are strategically placed to deal with today’s public health concerns.
• The move could encourage innovation.
• The public want these changes.
Challenges
• Privatisation may lead to a focus on short-term solutions.
• Localisation may worsen the effects of the ‘postcode lottery’.
• The changes may politicise public health.
• Localisation may shrink the size, budget and capabilities of the NHS.
ILC-UK make a series of recommendations that would help to ensure public health structures are able to respond to our ageing population by making the most of the opportunities, and overcoming the challenges created by the Health and Social Care Act, including:
• Local health strategies should prioritise long-term health initiatives over short-term target hitting. For example, Ageing Well strategies could usefully focus on increasing physical activity earlier in life to ensure people have an active, healthy old age.
• The NHS Commissioning Board should monitor healthcare commissioning to support consistency of quality across the country and help reduce differences in healthy life expectancies.
• Government should ensure that local authorities’ public health budgets continue to meet the needs of local citizens after the 2 year ring fenced period.

The think piece also highlights eight areas which should be prioritised in by local health and wellbeing boards to reduce costs and improve the public health of older people today and in the future. These are: smoking cessation, physical activity, nutrition, road safety, housing, loneliness, falls and immunisation.