Guidance

Providing healthcare public health advice to integrated care boards

Published 13 January 2026

Applies to England

This guidance, created in collaboration with the Association of Directors of Public Health (ADPH) and the Faculty of Public Health, explains how local authorities should give healthcare public health advice to integrated care boards (ICBs).

Healthcare public health is one of the 3 core domains of specialist public health practice, alongside health improvement and health protection. Healthcare public health is concerned with maximising the population benefits of healthcare and reducing health inequalities while meeting the needs of individuals and groups. It does this by prioritising available resources, preventing diseases and improving health related outcomes.

Public health advice for ICBs is required by law under the NHS Act 2006. 

Local authorities are responsible for deciding how to meet these legal requirements. This guidance does not set out strict rules, it explains the arrangements and skills needed to deliver effective healthcare public health advice to ICBs.

Background information for reference is detailed in the 2013 document Public health advice service for clinical commissioning groups.

Partnership working between local authorities and ICBs

Local authorities and ICBs lead health and care services in their areas. They work together in different ways, such as through health and wellbeing boards. Working together brings wider benefits for both local authorities and ICBs, beyond just public health advice. This guidance focuses on healthcare public health advice only.

As the NHS and local government landscape changes, local authorities and ICBs will need to consider how the responsibility of providing public health advice can best support the new ways of working. With ICBs serving larger areas, directors of public health (DsPH) from different local authorities may need to work together with the ICB to provide the advice efficiently.

ICBs as strategic commissioners

ICBs are responsible for strategic commissioning. This means improving population health, reducing inequalities and making sure people get high quality and efficient care.

Strategic commissioning is central to the government’s 10 year health plan. The NHS England strategic commissioning framework describes the main functions and skills ICBs need, and specialist public health skills are an important part of this.

Healthcare public health advice for ICBs

Public health advice helps NHS commissioners make decisions for the whole population. This advice is informed by health and wellbeing intelligence to make sure services meet local needs - now and in the future - to improve outcomes and reduce inequalities. Decisions are based on what works and what is cost effective. This helps commissioners prioritise and redesign services to give better value.

Public health advice includes:

• evaluating existing healthcare services
• recommending how to make and monitor improvements in health and wellbeing

It includes expert input to commissioning and, when needed, supports clinical and public engagement.

Some of these skills are found in ICB commissioning teams, but experience shows that having population and public health experts involved adds value to commissioning decisions. DsPH and their teams ensure that the population served by their local authority get the healthcare that best meets their needs.

Regulations under the NHS Act 2006 require upper tier and unitary local authorities to provide public health advice to any ICB whose area overlaps with theirs. This advice aims to protect or improve the health of people in the local authority’s area.

Local authorities and ICBs agree together how this advice is provided. ICBs also have a legal duty to seek advice on preventing, diagnosing and treating illness, and protecting public health. A description of this is set out in Guidance on the ringfenced public health grant conditions and mandated functions in England (PDF, 299 KB). (Note: this guidance was published in 2016 by Public Health England and ADPH. The guidance is under review and until it is updated, it remains useful in its current state.)

Good public health advice for commissioning is more than producing a joint strategic needs assessment (JSNA) and joint local health and wellbeing strategy. It should support every stage of the commissioning process, as set out in the NHS England strategic commissioning framework and contribute to wider strategic direction. To do this well, local authorities and ICBs need to work closely together so public health advice is built into ICB decision making.

Aligning public health advice and skills to the strategic commissioning stages

Public health advice and skills need to align with strategic commissioning stages to ensure effective commissioning. The following stages, as described in the NHS England strategic commissioning framework, should be supported by specific public health advice and skills.

Understanding local context

Understanding local context involves:

• assessing population needs now and in the future
• identifying underserved communities
• assessing quality, performance and productivity of existing provision

This means interpreting and communicating public health intelligence to inform service design and resource allocation, including:

• epidemiological analysis
• identification of inequalities
• population modelling
• qualitative analysis
• population risk stratification

Developing long-term population health strategy

Effective long-term population health planning and strategy and redesigning care pathways maximises value, based on evidence. Public health advice and skills needed to synthesise evidence and inform commissioning include:

• clinical and cost effectiveness evidence review
• decision support
• health economics
• horizon scanning
• understanding of care pathway elements and inter-relationships
• service review methods

Resources and funding to deliver the strategy

Oversight and assurance make sure that what is commissioned delivers the required outcomes. Public health advice and skills that support better outcomes through commissioning include:

• defining outcomes and indicators for service specifications
• prioritising interventions that address health inequalities
• informing incentives to improve outcomes

Evaluating impact

This involves the oversight and continued evaluation of healthcare usage and user feedback to improve outcomes.

How to deliver the advice

Different models have been developed to deliver public health advice to ICBs. With the establishment of larger ICBs and changes to local authorities through local government reorganisation, many areas will be reviewing the best way to provide this most efficiently. These models will be determined locally, and the following principles can guide this:

• the DPH, as professional lead, should ensure that the ICB has access to all the skills needed within the ICB and local authority teams and, if necessary, additional support should be commissioned separately by the ICB
• the delivery of public health advice needs strategic leadership from the DPH and input from registered specialists in public health
• working arrangements will need to support embedding public health advice into ICB decision making, rather than it being a transactional arrangement
• arrangements will need to reflect the need for public health advice to support actions at ICB, place and neighbourhood levels

It is good practice for a memorandum of understanding and annual work plan to be agreed between the DPH and the ICB. This should include how the DPH is represented in the relevant decision making and detailing what is required from the ICB, for example, data sharing agreements or honorary contracts.

NHS England has published guidance on delivering a quality public health function in ICBs.

Building capacity in healthcare public health

The public health functions and skills outlined in this document:

• support local authorities to develop their plans to improve health
• are of value to NHS providers, as illustrated by increasing numbers of public health consultant posts in NHS trusts
• are vital to future integrated health organisations

To ensure the local authority population receives health and care services to meet its needs, healthcare public health capacity needs to be supported and developed. This includes:

• providing training placements across the health and local government system which develop skills in this area
• ensuring current practitioners access continuing professional development
• building capacity within commissioners and providers across the NHS