Health services are crucial to any new endeavour to intervene early to deliver better outcomes for children and families via their unprecedented reach to disadvantaged families, high levels of trust, and community base. And as ministers in other government departments also point out, health is the place that still has the money to make it happen. But the reality on the frontline is that services are still fragmented. One potential solution to this lies in the government's proposals to hand back responsibility for public health in England to local authorities, with new health and wellbeing boards at a local level.
As health services enter a period of unprecedented reform, the stakes are high. Can a reformed public health system be a vehicle to deliver the crucial outcomes that will improve life chances, or will those opportunities get lost in the whirlwind of change? As the consultation on the public health white paper closes, the jury is firmly out.
So what can we take from the consultation? First, the focus on health in the early years is welcome. The evidence on impact is overwhelming and the new cadre of health visitors working with children's centres has the potential to effect real change in early identification and support, especially for the most vulnerable.
Second, recognition of the importance of health support through schools is also good to see, but the reality of this happening - in a climate of reduced budgets and increased focus on academic achievement - is low. Finally, overall, the proposed NHS Outcomes Framework is reasonably comprehensive if gaps around maternal mental health and health support for teenagers can be dealt with.
Making it happen is the real challenge. Realistically, as with most developments to date, the areas with a strong commitment to public health and partnership are likely to be the ones that will fly with these changes, leaving those with less enthusiasm in their wake. Directors of children's services see the potential in local authorities having more say in these areas, including over precious resources that can help them retain and develop crucial but cash-starved programmes. The new health and wellbeing boards have a strong hand to play and could make a powerful difference - from responsibilities for the new army of Sure Start health visitors, to bringing in the wider reach and expertise of the voluntary sector.
But here is the rub. No matter how much potential the arrangements offer, they are unlikely to succeed while the majority of NHS resources rest with GP consortia with no line of accountability to local democratic structures, including the boards themselves. We might end up bringing together public health with local authority-run services such as early years, but create a split between this and clinical services commissioned by GPs. Despite some shining examples, the track record of GP engagement in public and community health is not great, with few partnerships with wider professionals to build on and a pull towards clinical priorities.
The good news is that it can be fixed.
GP consortia should be made accountable to the new health and wellbeing boards for contributing to improving health in areas such as mental health, in addition to their reporting structure into the national NHS commissioning board. It would ensure that we do not replace the old silos with new ones and might alleviate some of the concerns being raised about accountability within wider NHS reforms.
It is now a year since Michael Marmot's review set out the reality of social and health inequality in England. A new public health system provides the chance to level this playing field. But only with genuinely integrated services at a local level and an accountability framework can it realistically happen.
Anne Longfield is chief executive of 4Children
