2012- Present

DALYA MARKS: In 2012, the function of public health moved from the NHS into local government. And the idea was that because health– our health– is impacted by a number of different factors outside of health care, it made sense for public health to move closer to those departments and organisations that can influence our positive health outcomes. So departments like transport, the environment, education, employment, and the like, so the idea was that we would have stronger partnerships with organisations and departments that can influence the health agenda, and all must– health becomes everybody’s business. I think there are a number of different advantages of public health moving to local government. One of the advantages would be about stronger partnership working.

Public health could be part of the decision-making process at the very beginning. And in order to be able to influence the agenda and the work programme of our partners, if public health are seen to be close by, they would be invited to the meetings about making strategic decisions in, for example, transport, environment, education, and employment departments. I think another advantage of public health moving into the local authority is that they could be seen to be the honest broker. So they understand the language of both the NHS, but also of the local government.

So they could be seen to be objective, and to be able to use their health intelligence, and health needs assessment identification skills, in order to be able to provide a skill set to local government and to other partners that they previously might not have been able to have access to. A third advantage of public health moving to local government could be that there were opportunities to get involved in decision making and departmental agenda setting in areas we aren’t previously– we hadn’t previously been part of.

So, for example, culture and leisure facilities, health could become everybody’s business, and everybody in the local authority, social care, and the NHS could come to public health to provide the skills and input that, perhaps, previously they haven’t had access to. Some of the difficulties of moving from the NHS into local government was that many local authorities maybe perceived public health’s function differently, so they would welcome us in a different way. And what I mean by that is that, perhaps, some local government didn’t feel that prevention was a priority area for their local government.

I think a second challenge is that at the time when public health were shifted from the NHS into local government, we saw financial– we saw a time of austerity. Budgets were being tightened, and although the public health budget was ring-fenced for a couple of years, that was temporary. So public health relied on the goodwill of local government to maintain prevention and health and well-being as a priority for their organisations. Another challenge for public health is that, for example, the services the public health are required to commission focus on sexual health and substance misuse, but the thing is that about 2/3 of the budget are spent on treatment services, rather than preventative services.

So the challenge for public health and is ongoing challenge, is to maintain funding in prevention and our preventative services. Another practical difficulty would be the waste, I think. We had to move from one location to a different location, and there was a lot of money paid out in staff redundancies, and people got re-employed in other parts of the organisation. Public health hasn’t always been in the NHS. Previous to our position in the NHS, public health were in local government. And I think there are a number of lessons that we could use from previous experiences.

I think one of the lessons learned could be around ensuring that the director of public health has a senior position in the decision-making function of local government. I think another advantage, and lesson that could be learned would be around the place shaping and contribution to the environmental planning requirements of local government. So for example, previously, public health had a role in looking at the way that communities were planned and developed, and we can take lessons from previous times in being located in local government, and shifted across to our current experiences.