Introduction

As we saw in the previous two chapters, the UK now has a new public health settlement. As far as England is concerned, in place of Public Health England (PHE), there are now two bodies, the UK Health Security Agency (UKHSA), with primary responsibility for health protection, and the Office for Health Improvement and Disparities (OHID), with primary responsibility for health promotion. (UKHSA also has responsibility for non-devolved health matters for the whole of the UK.) In addition, the administrative structure of the NHS has been altered with the establishment of integrated care systems (ICSs) intended to bring together local authorities, the NHS and other agencies with the intention of taking a population-based perspective. The one part of the original 2013 Lansley reforms that survived these changes concerns the public health responsibilities of local authorities.

The English reforms have been high-profile changes. Developments in Scotland, Wales and Northern Ireland, while significant, have largely involved a concentration of public health responsibilities over time as part of planned changes to administrative arrangements. In each case, however, the direction of change is the opposite of what has occurred in England. Instead of a separation of health protection and health promotion, the devolved governments have created integrated bodies. These bodies still have to liaise with local government, but they do so from a position in which public health can be seen as a set of overall responsibilities.

This chapter focuses on the policy and process issues to which these new structures give rise. The Hancock reforms, like many machinery of government changes, underline the point that, in some circumstances, organisational arrangements become the prime object of policy. Reorganisation provides a way of deflecting blame and also a way of seeming to make a new start quickly and visibly. Moreover, machinery of government changes are attractive to high-level political representatives, since they signal interest in an area of policy without the need to go into detail about any one aspect of policy. Thus, the political attraction of reorganisation is that it makes the politician play the role of God in eighteenth-century Christian theology, whose responsibility was to create the system that would then look after itself, according to its own laws. However, successful policy must go beyond the establishment of new organisations.