This article forms part of the LGA's Re-thinking local think piece series from Summer 2020.
The LGA, like many others, was blindsided by the surprise announcement of the dismantling of PHE in the middle of a global pandemic.
One of the most distressing aspects of the announcement was the way in which thousands of PHE staff heard about their fate via the media. Staff working on the frontline, protecting us all from the devastating impact of covid19, expect and deserve better.
The timing and rationale for this move are a significant concern for the sector at a time when we need absolute stability, clarity and consistency in our public health services. The decision is not without its risks. The last six months have been extremely challenging and working effectively with PHE has been absolutely mission critical for local government.
There will be time to reflect on how national government and its agencies responded to the pandemic, but for now our focus must remain firmly on how best to prevent and manage a possible second wave in the weeks and months to come. What matters now is ensuring that the new National Institute for Health Protection (NIHP) works, and it will have to prove itself at lightning speed.
Local government needs answers from the government, and quickly, about what the short, medium and long-term future holds for public health - in particular, how the whole ‘public health system’ will be structured and work in future.
The establishment of PHE and the transfer of public health into local government were born out of the Health and Social Care Act 2012.
We have a vested interest in making sure that the public health system in England is match ready for whatever comes its way.
The transfer of public health from the NHS to local government remains one of the most significant extensions of its powers and duties in a generation. It continues to represent a unique opportunity to change the focus from treating sickness to actively promoting health and wellbeing.
The rationale for a local government lead is unchanged: that the greatest impacts on health are in the circumstances in which we live, employment, education, environment and impact of socio-economic inequalities. Local government can certainly have more of an impact on these factors than the NHS.
Bringing public health back into local government was never a ‘drag and drop’ exercise. It was, and continues to be, about building a new and enhanced, locally led, 21st century public health service, where innovation is fostered and promoted, supported by the expertise of professionals and key partners.
It is worth reminding ourselves, that before the transfer of responsibility to local government, public health was not in the best of health. There was too much reliance on top-down targets that limited local initiative.
Too many different organisations with a public health remit confused rather than clarified core messages. It became clear very quickly to those of us working in local government that public health services would have benefited from greater scrutiny by commissioners, an injection of local accountability and a relentless drive to offer better value for money to the taxpayer.
Councils and councillors all over the country have shown real leadership during this crisis and what can be achieved when responses are rooted in the local community. Despite funding pressures, councils have created new services, pulled partners together and instinctively protected the most vulnerable. These same leaders must now play a part in the design of a new public health system, a system that not only protects us but reduces health inequalities, and whose core purpose is to improve the health of the public. The LGA will be working to amplify these voices and messages in the coming months.
