The future of public health in England

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4834 (Published 28 July 2011) Cite this as: BMJ 2011;343:d4834
  1. Jonathan Shapiro, senior lecturer1,
  2. Chris Spencer Jones, director of public health2
  1. 1University of Birmingham, Birmingham B15 2T, UK
  2. 2South Birmingham Primary Care Trust, Birmingham, UK
  1. j.a.shapiro{at}bham.ac.uk

Its aspirations may be sound, but the new plan needs more common sense and certainty

There has been much rhetoric but less clarity in the current round of health reforms about the future shape of public health. The 2010 white paper mooted “the creation of a new Public Health Service, to integrate and streamline existing health improvement and protection bodies and functions.”1 This would support a wide variety of roles in research, analysis and evaluation, immunisation and screening programmes, and the management of public health emergencies. The other public health responsibilities of primary care trusts, such as health improvement, were to be transferred to local authorities, where they would be led by directors of public health appointed jointly with a newly created body: Public Health England. There was to be a ring fenced public health budget; figures of £4bn (€4.5bn; $6.6bn) were mentioned, to come from a reallocation of existing resources.

Since then, there have been several more publications,2 3 but although these were intended to describe operational arrangements, they seem to have engendered more confusion than light, at least in those organisations tasked with implementing the changes.4 So, is there a coherent thread running through the proposed changes, and if so, how can it be developed positively?

It may be helpful to consider Paul Batalden’s oft cited observation (personal communication to Eugene Nelson, 1992)—“Every system is perfectly designed to get the results …

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