Public health transformation

It is six years since public health transferred to local government, and with each successive LGA annual report we see how public health is becoming an increasingly effective and vital part of local government. It leads and supports our aims to develop healthy, prosperous and inclusive communities and environments.

Councillors with responsibility for health and wellbeing and directors of public health (DsPH) from more than 50 councils have contributed to a series of annual reports.

In this year’s report, ‘Public health transformation six years on: partnerships and prevention’, it is again clear that – despite the challenges they face – DsPH and their teams love their work, because they see results and there are always new opportunities to make a difference. Lead councillors are equally enthusiastic and point out how, over the years, their colleagues are increasingly engaged in improving health and wellbeing.

“In 2019, despite huge financial constraints, public health teams have continued to do an excellent job across the whole spectrum of activity

In 2019, despite the huge financial constraints facing public health and councils overall, public health teams have continued to do an excellent job across the whole spectrum of activity: mental health and wellbeing for children and adults; the best start for children and young people; supporting healthy behaviours; better data and intelligence; healthy places – both rural and urban; addressing the wider determinants of health, including economic growth; and tackling health inequalities by working with neighbourhoods.

A theme identified in this annual report is that, having built a sound foundation of services that have been effectively reshaped and recommissioned, public health is able to give more time to developing partnerships. Key partnerships for upper-tier councils are with districts and boroughs, many of which are now extremely proactive in shaping their work to promote health. Later this year, the LGA will publish a report on good practice in districts to help all reach their full potential.

Partnerships with the NHS are also a high priority, with many DsPH leading the prevention strand of sustainability and transformation partnerships (STPs). Unfortunately, while relationships are good and there are examples of excellent joint work, we are disappointed that the main focus has been on tackling NHS priorities, such as reducing A&E attendance and organisational deficits. This is a missed opportunity to collaborate to improve health and wellbeing, and to reduce future demand on health and care services.

This year, it is important to reinforce the reasons why responsibility for key public health functions was transferred to local government. The case studies in the report – written before the publication of the NHS Long Term Plan – show the excellent work that public health in local government is doing to commission for quality and best value across all areas.

All of this outstanding work is in the context of a reduction to public health grant funding of more than £700 million in real terms between 2015/16 and 2019/20, at a time when the NHS is to receive additional funding of £20.5 billion over five years and prevention is high on the national agenda.

The forthcoming government Green Paper on prevention should allow us to consider the opportunities for prevention from a system-wide perspective, which includes all the social determinants of health. However, it must be based on engagement with councils and the public health community, and – for any progress to be made – it must be accompanied by proper funding for local government public health.

The report, ‘Public health transformation six years on: partnerships and prevention’, which includes case studies, is available at


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Local Government Challenge 2019