Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

ABSTRACT

This paper reports on the findings of a research project that examined the changes to the public health system in England introduced in 2013. Drawing on case study research and two national surveys the findings explore the impact of organisational change on the composition and role of public health teams. Views and experiences were obtained from public health leaders involved in the transfer of staff and functions from the National Health Service in England to local authorities. National surveys at two points in time aimed to compare and contrast views on the evolving changes. The new organisational and managerial arrangements had enabled public health professionals to widen their work and influence, and public health skills and budgets were welcomed by those in local government. Initially, in some areas, directors of public health were less certain of the benefits of the transfer to local government compared to high levels of confidence expressed by elected members, but perspectives changed over time and moved closer together. National headline figures were found to mask high levels of turbulence and churn being experienced by individual authorities identified in the case study research, and the trend of reducing capacity through cuts to staff, budget and services was a cause for serious concern.

KEYWORDS:

• Public health
• organisational change
• local government
• health policy

Acknowledgements

We are particularly grateful to our case study sites for allowing us to spend so much time with them and for being so open in discussing their work. We are also grateful to the survey and interview respondents for giving up their valuable time to respond to our questions. The PHOENIX stakeholder group have provided valuable feedback on an earlier draft of this report, and guidance and support throughout.

Disclosure statement

No potential conflict of interest was reported by the authors.

Disclaimer

This research is funded by the Department of Health. The views expressed are those of the researchers and not necessarily those of the Department of Health.

Additional information

Funding

This work was supported by the Department of Health [101/0001].

Notes on contributors

Stephen Peckham

Professor Stephen Peckham is Director of the Centre for Health Services Studies at the University of Kent and Professor of Health Policy at the London School of Hygiene and Tropical Medicine. He is Director of the Department of Health Policy Research Unit in Commissioning (PRUComm) and the Healthcare System. PRUComm is the Policy Research Unit in Commissioning and the Healthcare System which provides evidence to the Department of Health to inform the development of policy on commissioning and wider health system development and organisation. He led the research project examining the development of the new public health system in England.

Erica Gadsby

Erica Gadsby is a Research Fellow in the Centre for Health Services Studies at the University of Kent, specialising in public health policy and health systems research. She is a social scientist with public health training who, over the last 15 years, has accumulated wide-ranging experience in public health-related research and practice in the UK and abroad.

Linda Jenkins

Linda Jenkins is an associate researcher at the Centre for Health Services Studies, University of Kent. She was formerly aa Public Health Specialist in the Centre where she carried out a broad range of surveys, comparative and performance analyses, service evaluations and literature reviews, at international, national and local levels, and for a variety of EU, central government, NHS and third sector funders.

Anna Coleman

Anna Coleman is Senior Research Fellow in the Health Policy Politics and Organisation (HiPPO) research group at the University of Manchester. Since 2000, Anna has researched in the areas of health policy, partnership working, health scrutiny and commissioning and has recently been working on the development of CCGs, Health and Wellbeing Boards and changes to the PH and commissioning systems, as well as looking at health and care devolution.

Donna Bramwell

Donna Bramwell is an honorary Research Associate in the Health Policy Politics and Organisation (HiPPO) Research group at the University of Manchester. She has interests in medical sociology and organisational research and is particularly interested in health policy and the healthcare workforce. Donna has examined team working across primary care and community health services and has more recently researched changes to the PH system.

Neil Perkins

Neil Perkins is currently a Research Associate at Durham University. His previous roles include research at the University of Manchester engaged in studies focusing upon the transition of public health from the NHS into local government, the development of CCGs, commissioning and competition and cooperation in local health economies. Prior to this he worked at Durham University exploring the impact of public health partnerships in affecting public health outcomes and health inequalities.