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Views And Reviews

The transfer of public health to local authorities suggests alternatives are possible

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2330 (Published 31 May 2018) Cite this as: BMJ 2018;361:k2330
  1. Eugene Milne, director of Public Health for Newcastle
  1. Newcastle upon Tyne, UK
  1. eugene.milne{at}newcastle.gov.uk

This spring marked five years since responsibility for public health was transferred from the NHS to local authorities in England. An Association of Directors of Public Health survey found 67% of respondents agreed that the move had weakened the relationship between public health and the NHS.

A recognised feature of the transfer, however, has been improved quality of commissioning. That many services are now delivered more cost effectively shows that reduced funding is not necessarily a service cut. For example, my own council (Newcastle upon Tyne) spends around half as much on stop smoking services as at transfer, but had an increased rate of supported quitters in 2016-17.

Perversely, the centrally imposed, counterintuitive, and ultimately counterproductive cuts to the public health grant have a been a driving force behind improved commissioning. Tighter specification of process and outcomes and more disciplined procurement have buffered us—but there is a …

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