Feature Public Health

BMJ briefing: meet the new masters of public health

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f4242 (Published 04 July 2013) Cite this as: BMJ 2013;346:f4242
  1. Richard Vize, freelance journalist
  1. 1 London, UK
  1. richard.vize{at}gmail.com

Public health felt the brunt of English health reorganisations last year as key parts moved from the NHS into local government—an area more used to housing and road problems than a mass measles outbreak. Richard Vize maps what’s happened to the old NHS run services and asks doctors how the new masters of public health are coping

How is public health run now?

Under the Health and Social Care Act 2012 most public health functions carried out by primary care trusts moved to 152 local authorities—unitary, metropolitan, and county councils and London boroughs. These authorities are responsible for promoting population health and reducing inequalities. Councils now run a diverse range of programmes such as smoking cessation, drug and alcohol services, obesity prevention, and prevention and treatment of violence.

The 2012 act created an executive agency, Public Health England, which is part of the Department of Health rather than NHS England. Its responsibilities include health protection, providing information and data, and developing the workforce. NHS England commissions the national immunisation and routine screening programmes, children’s public health services up to the age of 5 years, children’s health information systems, public health services for prisons, and sexual assault referral centres.

How is it funded?

At least for the first two years, local government public health funding—around £2.7bn (€3.2bn; $4.2bn)) for 2013-14—is ringfenced to ensure it isn’t consumed by other council departments facing cuts. Virginia Pearson, director of public health at Devon County Council, points out that the ringfence has a disadvantage: “Working alongside colleagues who are making cuts when you are sitting in a bubble is quite difficult. It could strain relationships . . . It doesn’t sit well with being a locally accountable structure.”

Are public health directors powerful figures in councils?

The Department of Health guidance on appointing directors of public health says they must be directly accountable to the chief executive. Generally, they are part of the …

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