Introduction

In the previous chapter we saw how Public Health England (PHE) was the product of the Lansley broader reforms of the NHS, reforms that also included the return of public health functions to local government. A notable feature of the transformation of the UK since 1998 has been the extension and devolution of powers from Westminster and Whitehall to Scotland, Wales and Northern Ireland. Devolution means that in areas of policy that are not reserved to the UK government, which in health policy are very few, the governments of the home nations have the freedom to determine their own policies, priorities and structures. This has been notably true in the provision of health care services, where the Welsh, Scottish and Northern Ireland governments have opted for greater stability in place of successive structural reforms, and have not made competition and performance management a central guiding principle as the UK government has done to an increasing degree since the Thatcher reforms. However, the distinctiveness has also shown up in public health policies and structures.

Looking at public health in the devolved governments is important for a number of reasons, quite apart from the simple need to avoid Anglo-centrism. In the first place, the organisation of public health in the devolved governments provides interesting points of similarity and difference to those in England. If the replacement of PHE took place without any forethought, the same is not true in the other home nations where, in keeping with health care services, there has been great stability of organisation, alongside policy developments. So patterns of structural organisation provide interesting evidence of the various ways in which public health functions can be organised. As we shall see in this chapter, there is no one uniform set of functions that are the responsibility of the public health bodies. Functions that are the responsibility of a public health agency in one of the home nations may be the responsibility of, say, the environment agency of another home nation.

Variation in the home nations in the organisation of public health also potentially poses another challenge to effective public health. If public health requires intersectoral collaboration across government, the conduct of policy in the UK requires collaboration across the governments of the home nations.