Public health should be overseen by the guardian of place, not the guardian of hospitals

Yes, public health expenditure has fallen, inevitably impacting on councils’ ability to improve outcomes. But to conclude from this, as the NHS long-term plan appears to, that public health would be better in NHS England’s orbit is to miss two fundamental points. Councils are in by far the best position to join up local services to facilitate improved population health and if they are not fulfilling their full potential it is largely because they are being strangled by the centre.

“Public health failed to prosper in the NHS, its home for 40 years, and would fail to do so again”

Central funding for councils has halved this decade – even before the government confirmed a further £85m cut in the public health grant before Christmas. This leaves councils facing tough decisions about cutting services, especially preventative ones which are often not statutory. Public health failed to prosper in the NHS, its home for 40 years, and would fail to do so again in a system in which the black hole that is acute care swallows up all too many resources. While the current health secretary Matt Hancock rightly seeks a system focused more on prevention than treatment, precedent suggests he will be thwarted, not least because it is tough enough rationalising hospital services when you do have a large parliamentary majority, let alone no Commons majority.

Councils are the guardians of place. They oversee the environment, leisure, housing and planning, not to mention children’s services and social care.They also use their democratic legitimacy to facilitate relationships with other public services, including the police, schools (and NHS), and with business. If they are properly resourced public health can run through the entire local system, rather than, as Wigan MBC public health director Kate Ardern put it, constitute a “biomedical set of lifestyle interventions plus stats and epidemiology”, as was the case under the NHS.

NHS England should unite with local government to reduce health inequalities, not embark on a destructive land grab.