Purpose

This guidance supports integrated care boards (ICBs) in embedding public health expertise into governance, commissioning and service transformation. The aim is to drive efficiency, improve outcomes and reduce health inequalities.

Developed by NHS England with support from the Department of Health and Social Care (DHSC), the Faculty of Public Health (FPH), the Association of Directors of Public Health (ADPH) and the Local Government Association (LGA), it provides practical models and frameworks for ICBs to help them fulfil their strategic commissioning responsibilities. This advice is based on recent system surveys and builds on the Model ICB Blueprint (Futures collaboration platform login required) and 10 Year Health Plan for England.

Within it you’ll find actionable strategies to integrate public health expertise across all levels of ICB planning and delivery.

Why embedding public health expertise matters

The wider public health workforce brings specialist skills in Population Health Management (PHM), data and analytics, epidemiology, evidence appraisal, health economics and socioeconomic insights. These skills are essential for ICBs to:

• understand the local burden of disease, drivers of health and care needs and health inequalities
• reduce avoidable service demand through targeted prevention strategies
• embed value-based, person-centred healthcare within resource allocation decisions
• enhance system-wide efficiency and productivity by aligning commissioning and service delivery with evidence-based public health strategies
• evaluate evidence and prioritise resources for maximum impact based on population health
• address health inequalities through an understanding of unwarranted variation and by ensuring equitable access to services

Public health expertise can also support ICBs in delivering on the 3 strategic shifts described in the Model ICB Blueprint (Futures collaboration platform login required) and the development of neighbourhood health, as well as the priorities set out in the 2025/26 priorities and operational planning guidance.

Capitalising on existing public health expertise

Each ICB has access to an existing registered specialist public health workforce across the system, spanning:

• ICBs and NHS trusts, including an increasing number of public health consultants within provider organisations
• approximately 150 directors of public health and their teams in local authorities, where most public health consultants are based, who cover all 3 domains of specialist public health (health improvement, health protection and healthcare public health)
• specialist health protection expertise in UK Health Security Agency Health Protection Teams who can advise on outbreak management and emergency planning
• regional and national expertise that includes Healthcare Public Health; emergency preparedness, resilience and response (EPRR); screening and immunisation and prevention

Local directors of public health (DsPHs) have a responsibility to support ICBs by providing the ‘core offer’ of essential public health advice required to plan and commission services efficiently and effectively. This statutory responsibility is outlined in the Health and Social Care Act 2012 (as amended by the Health and Care Act 2022), funded through the Public Health Grant, and is often discharged through the Health and Wellbeing Board and leadership on the Joint Strategic Needs Assessment and the Health and Wellbeing Strategy.

Contacting local DsPHs in local authorities is therefore a good starting point for ICBs looking to embed public health expertise.

The NHS Confederation’s 2025 review of integrated care systems’ (ICSs) progress on improving population health outcomes highlighted strong examples of good practice. It also identified areas for further work to fully embed public health expertise into strategic commissioning, service transformation and system-wide prevention efforts.

System-wide collaboration will maximise the impact of public health expertise, ensuring co-ordinated, evidence-based decision-making that improves population health. This collaboration becomes even more important as the government creates simpler local government structures.

How public health expertise can support ICB’s core functions

Strategic commissioning is the backbone of an effective, equitable, and sustainable health system. To fulfil this role, the Model ICB Blueprint outlines 4 core functions:  

1. understanding local context – assessing population needs now and in the future, identifying underserved communities and assessing quality, performance and productivity of existing provision
2. developing long term population health strategy – long-term population health planning and strategy and care pathway redesign to maximise value based on evidence
3. delivering the strategy through payer functions and resource allocation – oversight and assurance of what is purchased and whether it delivers outcomes required
4. evaluating impact – day-to-day oversight of healthcare utilisation, user feedback and evaluation to ensure optimal, value-based resource use and improved outcomes

Registered public health professionals are central to realising this vision, providing the expertise that will help ICBs operate effectively within the revised running cost envelope. It’s not just about designing services on paper but ensuring they work in practice.

What follows takes a closer look at how public health professionals can directly strengthen each of the 4 core functions. While their input can benefit all areas, many elements will be led by other teams, making it important to know when and how to bring in public health expertise.

Core function 1: understanding local context

1.1 Population data and intelligence

Public health professionals can:

• use real-time data and predictive modelling to identify risk, understand variation and direct resources for greatest impact (allocative efficiency)
• support the development and use of Joint Strategic Needs Assessments (JSNAs) and linked health and care data
• work with local intelligence units to segment the population and stratify health risks
• analyse current and future population health trends, including determinants of health, monitoring of disease patterns, and mortality
• support community engagement to identify what matters to people and communities
• present data in clear, actionable ways to support strategic commissioning, service planning, evaluation and reduction of health inequalities

1.2 Forecasting and modelling

Public health professionals can:

• support the development of long-term population health strategies using epidemiological, actuarial, and economic analysis, including demand forecasting, scenario modelling and cost projections to ensure clinical and financial sustainability
• engage communities and system partners to co-produce, test, and challenge the assumptions behind health plans, modelling and investment decisions

1.3 Reviewing provision

Public health professionals can:

• review current services using data and insights from stakeholders, service users and communities.
• assess provider performance, including care quality (safety, effectiveness, experience), productivity, unit costs and outcomes

Core function 2: developing long term population health strategy

2.1 Developing strategy with options for testing and engagement

Public health professionals can:

• develop strategic commissioning options by combining population health analysis, evidence of what works, user priorities, international insights, innovation and value-based principles
• design care pathways in collaboration with local clinical leaders, service users, and partners, drawing on national guidance and local context
• align funding with population needs and expected outcomes, using local data and realistic cost estimates
• apply value-based prioritisation to ensure services are both efficient and equitable

2.2 Setting strategy  

Public health professionals can:

• support resource allocation, with the goal of improving health outcomes and improving access to high-quality care
• identify key areas for change, define priority outcomes, and establish population-level metrics to measure progress
• co-develop strategies with communities to address unmet needs and tackle health inequalities
• design innovative care models and contribute to major system transformation initiatives

Core function 3: delivering the strategy  

3.1 Strategic purchasing

Public health professionals can:

• use data-driven models to align funding with population needs
• define service specifications linked to measurable outcomes
• support quality assurance and develop frameworks to support continuous quality improvement
• identify and prioritise evidence-based interventions that reduce health inequalities

3.2 Market shaping and management

Public health professionals can:

• support the analysis of cost and outcome variations across different providers
• identify market gaps and identify where there is need for new providers or models of care
• collaborate with providers to understand the conditions needed for long-term service sustainability and the interdependence of services
• evaluate and design payment mechanisms and incentives to support system goals

3.3 Contracting

Public health professionals can:

• support contract negotiations to ensure that contracts align with population health goals
• monitor provider performance through ongoing evaluation of impact, access, equity, quality and outcomes

3.4 Payment mechanisms

Public health professionals can:

• support the development of incentive structures to promote equity, efficiency, and productivity, and the targeted delivery of population health outcomes.
• contribute to cost-effectiveness and return-on-investment analysis to guide resource allocation

Core function 4: evaluating impact

4.1 Utilisation management

Public health professionals can:

• analyse real-time data and conduct clinical audits to identify unwarranted care variations and over treatment
• work closely with providers to optimise care pathways

4.2 Evaluating outcomes  

Public health professionals can:

• evaluate the impact of commissioned services against population health outcomes
• monitor metrics to assess return on investment, using data to inform continuous commissioning improvements
• generate insights from communities, staff and system partners into evaluation processes to ensure services reflect real-world needs and experiences
• ensure evaluation captures long-term population health, prevention efforts, health outcomes and reductions in health inequalities, with results analysed as trends over time

4.3 User feedback, co-design and engagement

Public health professionals can:

• use co-design, evaluation and deliberative dialogue with people and communities to shape services, applying design thinking methodologies to ensure relevance and impact
• embed user feedback mechanisms into decision-making, ensuring that resource allocation and evaluation reflect lived experience and community priorities

Models of public health integration

The following 4 models describe some of the ways ICBs can access public health expertise from across the ICS and embed it into their structures and decision-making processes.

While these models are categorised under distinct headings, they are not mutually exclusive. Many systems successfully combine elements of different models to enhance their population health impact. Working with local health and care partners, ICBs should consider the model that works best in their local context.

Model 1: non-executive director sponsor

Non-executive directors (NEDs) can provide an effective way to integrate public health expertise into ICBs. They are uniquely positioned to champion population health at a strategic level and ensure that public health principles shape decision-making and service transformation, reinforcing the board’s commitment to improving outcomes and system-wise accountability.

Practical considerations for ICBs

• Nominate a dedicated NED for population health to lead on engagement with public health expertise and drive strategic alignment.
• Establish a governance and assurance structure focused on population health strategy and planning, ensuring accountability for reducing health inequalities and improving outcomes.
• Create a formal committee or sub-committee with a clear remit for population health, prevention, and inequalities, reporting directly to the ICB.
• Delegate authority to a sub-committee that is led by a NED (for example on population health) which reports into the ICB, which helps embed a culture of prevention.
• Ensure adequate resourcing for NED assurance, including dedicated secretariat support, structured information flows, and system-wide leadership buy-in.
• Secure senior leadership commitment, positioning population health as a core system priority rather than a secondary consideration.

Model 2: executive-level public health advice

By embedding public health expertise directly into the executive level, ICBs can enhance planning, extend their impact, and drive meaningful improvements in population health.

Directors of public health or consultants in public health can play a pivotal role in shaping system-wide strategies. With a direct voice at the executive level, registered public health professionals can advocate for prevention, elective recovery, health protection, and tackling health inequalities, while also contributing to system support priorities such as population health management and urgent care demand.

Various models exist for integrating public health leadership into ICB decision-making, including:

• regular representation of directors of public health at ICB board meetings, ensuring public health input into strategic discussions
• direct employment of a public health consultant by the ICB with a position on the board
• public health leadership of key delegated committees that inform ICB strategy, such as the partnership boards, population health committees, or other governance groups.

Practical considerations for ICBs 

• Cross-system collaboration requires registered public health expertise to be embedded in the development of ICB strategies, ensuring priorities are aligned across health, care, and local government.
• Alignment of ICB strategies with local authority-led initiatives is essential, particularly where multiple Health and Wellbeing Strategies, Health and Wellbeing Board (HWB) priorities and JSNAs are in place.
• Creating strong partnerships depends on clear links between the ICB and local directors of public health, ensuring seamless co-ordination on population health priorities for maximum impact.
• Careful management of the finite public health capacity within local authorities and other health and care partners is necessary to maximise system-wide benefits.

Model 3: co-location or sharing of specialist public health roles

ICBs can access public health expertise through shared leadership roles and pooled resources across local government and other NHS organisations, under the system leadership of directors of public health. Co-ordinating scarce specialist expertise in this way maximises impact, reduces duplication and ensures efficient use of funding.

Shared leadership roles, such as a consultant in public health working across an ICB, a local authority and a provider trust, can help create a unified approach to population health, prevention and system-wide efficiency, recognising that the director of public health  is already the lead for public health across the whole system.

Practical considerations for ICBs

• Shared leadership and specialist advice models require a flexible specialist public health workforce that can operate across multiple system organisations, such as ICBs, local authorities and NHS providers.
• Workforce-sharing agreements must be carefully structured to ensure clear accountability, reporting structures and fair resource distribution.
• Strong HR and legal support are essential for addressing contractual arrangements, employment conditions and cross-organisational responsibilities.
• Negotiation between system partners is crucial to determine the best fit for public health professionals within shared roles.
• Adopting this model requires a degree of system maturity and risk tolerance, as success depends on ongoing collaboration and organisational buy-in.
• Systems should plan for contingency measures in case an organisation withdraws from the arrangement.

Model 4: leadership of system-level programmes

Dedicated public health leadership for system-wide programmes offers ICBs another effective way to embed public health advice. Appointing public health professionals to oversee key programmes ensures an integrated approach that aligns strategies across the NHS, local government, and community services while addressing wider determinants of health.

This model strengthens joint commissioning arrangements, deepens collaboration with place directors and ensures commissioning decisions are informed by population health intelligence and evidence-based interventions. By embedding public health leadership within specific programmes, ICBs can enhance strategic alignment, service coordination and planning.

Feedback from systems already implementing this model highlights significant benefits, particularly in ensuring consistency in insights, population health metrics, and measurement frameworks. Additionally, this approach creates opportunities for efficiencies of scale, allowing resources to be targeted more effectively across the system while maintaining a clear focus on improving long-term health outcomes and reducing inequalities.

Practical considerations for ICBs

• Employment models should enable the best use of registered public health professionals to lead system-wide programmes across partnerships, especially where ICB geographies overlap multiple local authorities and providers.
• Capacity should support directors of public health to lead key prevention workstreams identified in the Joint Forward Plan.
• Governance and reporting structures should ensure that public health expertise is effectively integrated within ICB strategy and decision-making.
• System-wide collaboration is strengthened by embedding public health leadership into ICB programme governance, co-designed with local partners.

Implementation steps

Implementation should focus on embedding public health expertise across the ICB commissioning architecture, aligned with emerging capabilities in the Model ICB Blueprint. To do this, ICBs should work through the following steps in consultation with their local directors of public health.

• Set priorities – establish clear system-wide priorities and a shared mission.
• Build leadership – secure strong leadership from local authorities and ICBs, with dedicated teams and the necessary resources to drive progress.
• Clarify roles – define structure, identifies key levers and how these fit with operational priorities, and provides the support needed for delivery.
• Effective communication – align the collective public health workforce behind a unified vision where public health remains at the heart of strategic commissioning.
• Highlight early wins – motivate the system by sharing stories about the value of public health integration, including on productivity, efficiency and outcomes.
• Sustain impact – embed governance structures that prioritises prevention and population health in ICB reporting mechanisms and tracks measurable outcomes at a system level.
• Foster a strong multidisciplinary culture – promote collaboration and shared accountability and empower local champions to drive engagement.
• Continuously improve – set clear goals and defined leadership roles and evaluate, learn and adapt to create a dynamic systems framework.

Next steps: key questions for ICB leaders

ICB leaders can use these prompts to evaluate current challenges, identify opportunities for improvement and enhance the integration of public health expertise in strategic commissioning and service planning.

• How is your ICB and wider system currently receiving its public health advice?
• Does a director of public health have a lead role within the ICB?
• Does the ICB have its own public health delivery capacity?
• Is the ICB supported by local authority public health teams?
• How does the ICB use local Joint Strategic Needs Assessments (JSNAs) to inform its commissioning and service planning?
• How does the ICB board receive public health advice?
• Do local health and care partners have a strong link into the ICB Board?
• Could the reach and efficacy of your partners be increased?
• Is the rationale for the Health and Wellbeing Board fully understood within the ICB?
• What role do local NHS organisations have on the Health and Wellbeing Board(s)? Is there opportunity to strengthen this?
• What arrangements are in place – particularly across complex geographies – to ensure public health input to governance and assurance functions?
• What is your system currently doing to address equity?

Appendix 1 – Evidence base

An Association of Directors of Public Health (ADPH) survey covering 36 of 42 ICSs revealed that 42% of respondents rated public health input into ICB Boards as ‘good’ or ‘very good’, while 24% reported minimal or no public health representation.

These findings illustrate both progress and ongoing gaps in embedding public health expertise within ICB governance and decision-making.

Findings demonstrate that:

• while several examples of good practice exist, there is significant variation
• where ICBs have moved towards centralising functions, there can be risk of duplication and co-ordination challenges, particularly for ICBs spanning multiple local authorities. Where examples of this working well exist, they often have strong cross-system partnerships at system, place and neighbourhood level
• the geography or configuration for some ICBs lend itself well to relationship building and joint working, for better coordination and less duplication, and a stronger local focus. This also provides more opportunity for directors of public health, who are the system leads for public health, to avoid duplication and any overlap of workstreams. But this is not the case for all systems
• it was felt that public health effectiveness is maximised where there is senior public health leadership within ICBs, drawing on director of public health input and working with partnerships. Further consideration of variation between ICB approaches to ‘place’ could be useful
• there is a call for further clarity by systems, on the statutory duties regarding commissioning infrastructure and public health advice that sit with directors of public health as the system leaders

Findings from 2024 system-level surveys undertaken by NHS England, the Provider Public Health Network, The Faculty of Public Health, ADPH and The King’s Fund provided clear evidence that strong partnerships between public health and ICBs enable more effective service delivery, ultimately leading to better population health outcomes. By ensuring registered public health expertise is embedded in system leadership and decision-making, ICBs can enhance their ability to deliver sustainable, impactful improvements in population health across health and social care.

Key themes from the survey findings that were linked to providing effective public health advice to ICBs included:

Relationships

The influence and reach of public health expertise within an ICB is often shaped by the relationships held by the director of public health. While system challenges persist, many directors of public health emphasised the strong collaborative relationships they have developed within local systems, which have been key enablers for driving population health improvements.

Leadership

ICBs that actively included registered public health professionals in key committees and leadership groups benefited from enhanced population insights and tailored approaches that delivered measurable, population-level impacts. However, insights from the ADPH 2024 survey highlighted challenges for some directors of public health in securing a place in ICB decision-making, which in turn limited their ability to drive system-wide public health priorities.

Setting priorities

A clear system-wide framework for population health was frequently cited in the 2024 surveys as an essential enabler of effective public health integration. While the specific format of these frameworks varied across ICSs, successful approaches reflected the local system architecture, aligning ICB priorities with local needs and structures.

Partnership

Collaboration sits at the heart of modern health and care systems, marking a shift away from previous competition-based models. The King’s Fund has recognised this as the first time the NHS has been formally asked to act as part of

a system, prioritising population health and system-wide needs over individual organisational goals. Effective partnerships between ICBs, local government, and other stakeholders are not only essential for delivering high-quality care but also for co-ordinating services across localities in a way that maximises impact and efficiency, sharing knowledge and resources rather than building competing centres of expertise.

Professional expertise

Directors of public health, consultants in public health and public health leads play a pivotal role in supporting ICBs. Their expertise helps address health inequalities, strengthen system-wide planning and enhance focus on the wider determinants of health. These registered professionals lead teams with specialist skills in population health, contributing to data-driven decision-making, workforce capacity solutions, and the development of targeted health interventions.

Publication reference: PRN01960