Today, after months of integration, public health officially becomes the responsibility of local government once again. Many of those working in local government see this as “public health coming back home.” To understand the weight behind this statement it is important to question why public health moved from its ‘home’ originally.
To understand this question we need to look back to 1974. This year saw the first top-down radical reform of the NHS, and the removal of public health from local authority control. This decision was made because there was concern that local councils did not have the managerial and financial capacity to meet national public health goals set by central government.
However, the aim of the move was not to remove public health entirely from the hands of councils but was actually intended to promote the integration of preventative and after-care services between the NHS and local government. Indeed, under the reforms Local and Health authorities were required to establish joint consultative committees to advise on the planning and operation of services of common concern. This is almost identical to the political discourse surrounding the reform today.
So, the move of public health was not to remove ownership from local government to the NHS, but to encourage integrated working between the two – ironically the very same reason the politicians of today are now moving public health back to council control nearly thirty years later. In my view this is not a case of public health “coming back home” but recognising that public health has a home in both local government and the NHS. Local authorities now have another chance to recognise this and actualise integrated care where the NHS has failed these last thirty years.
The move is undeniably an excellent opportunity for local government to provide integrated public health services across the spectrum of care they already provide, for instance in social care. However, to learn from the past and effectively combine forces could result in the best public health care ever seen in history.
This is a guest blog from Annette Jack, an Executive in our Healthcare Advisory Team