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Feature Public Health Reform

How the erosion of our public health system hobbled England’s covid-19 response

BMJ 2020; 369 doi: (Published 21 May 2020) Cite this as: BMJ 2020;369:m1934

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  1. Richard Vize
  1. London
  1. richard.vize{at}

Tensions with government, challenges in collaborating with the NHS, and the legacy of savage cuts have all hampered the important role of public health in the pandemic. Richard Vize reports

The covid-19 pandemic has laid bare the impact of years of spending cuts and muddled structural reforms on the effectiveness of England’s public health services. It has also shown that their current position within local government is the best place for them but that they need clearer national leadership.

The 2012-13 reforms

Under the reforms implemented in 2013 by the then health secretary, Andrew Lansley, in the Health and Social Care Act 2012, public health in England moved back into local government, where it had been until 1974. Directors of public health became the strategic leaders tasked with a remit to tackle local health inequalities, as well as commissioning services including sexual health, smoking cessation, drug and alcohol services, and early years support for children, such as through school nursing and health visitors.

Public Health England was created to oversee emergency preparedness, health protection such as communicable disease control, and public health campaigns, as well as supporting local systems with data and evidence. It was an executive agency of the Department of Health, not an independent body.1

However, the NHS retained some aspects of public health—notably, vaccinations and immunisation, and the chief medical officer remained the lead advocate for public health throughout government and leader of the public health profession.

While most of Lansley’s reforms were heavily criticised, putting public health back into local government is widely regarded as having been the right approach. Jeanelle de Gruchy, director of population health at Tameside Council and president of the Association of Directors of Public Health, says, “Being in local government is crucially important in terms of getting close to local communities. You’re working …

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