Public health reforms

Local leaders must play a part in the design of a new public health service that improves and protects our health.

The timing and rationale for the dismantling of Public Health England (PHE) are a significant concern at a time when we need absolute stability, clarity and consistency in our public health services. 

The past six months have been extremely challenging, and working effectively with PHE has been absolutely mission critical for local government in tackling COVID-19. 

There will be time to reflect on how national government and its agencies responded to the pandemic, but, for now, our focus must remain firmly on how best to prevent and manage a possible second wave in the weeks and months to come. 

What matters now is ensuring that the new National Institute for Health Protection (NIHP) works, and it will have to prove itself at lightning speed. 

Local government needs answers from the Government, and quickly, about what the short, medium and long-term future holds for public health – in particular, how the whole ‘public health system’ will be structured and work in future.

We have a vested interest in making sure that the public health system in England is match ready for whatever comes its way.  

The establishment of PHE and the transfer of public health to councils were born out of the Health and Social Care Act 2012. This transfer to local government from the NHS remains one of the most significant extensions of its powers and duties in a generation. 

It continues to represent a unique opportunity to change the focus from treating sickness to actively promoting health and wellbeing. 

The rationale for a local government lead is unchanged: that the greatest impacts on health are in the circumstances in which we live – employment, education, environment – and the impact of socio-economic inequalities. Local government can certainly have more of an impact on these factors than the NHS. 

Bringing public health back into local government was never a ‘drag and drop’ exercise. It was, and continues to be, about building a new and enhanced, locally led, 21st-century public health service, where innovation is fostered and promoted, supported by the expertise of professionals and key partners. 

It is worth reminding ourselves that, before the transfer of responsibility to local government, public health was not in the best of condition. There was too much reliance on top-down targets that limited local initiative. 

Too many different organisations with a public health remit confused, rather than clarified, core messages. It became clear very quickly to those of us working in local government that public health services would have benefited from greater scrutiny by commissioners, an injection of local accountability and a relentless drive to offer better value for money to the taxpayer. 

Councils and councillors all over the country have shown real leadership during the coronavirus crisis and what can be achieved when responses are rooted in the local community. Despite funding pressures, councils have created new services, pulled together partners and instinctively protected the most vulnerable. 

These same leaders must now play a part in the design of a new public health system, a system that not only protects us, but reduces health inequalities, and the core purpose of which is to improve the health of the public. 

The LGA will be working to amplify these voices and messages in the coming months.

This article forms part of the LGA’s ‘Re-thinking local’ series of think pieces, see www.local.gov.uk/about/campaigns/re-thinking-local

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