Chapter 1 laid out the challenges of public health together with the intrinsic dilemmas and conflicts involved in making health truly public. The source of those dilemmas is to be found in the fact that public health identifies many sources of ill health in the determinants that are formed in complex social and economic systems. Ill health is the effect of multiple causes. In terms of governmental organisation, this means that a public health body must interact with a wide range of agencies and sectors across government. However, it also means that any such interaction needs to be based on a strong and well-resourced core of public health bodies, at different levels of government, which can identify health problems and formulate effective policies, even when those policies need the cooperation of other departments of state.

In this chapter we look at the history of those core organisations in England between 2013 when Public Health England (PHE) was established by the 2012 Health and Social Care Act, and 2020 when the announcement was made that it was to be abolished. Our aim is to show how the dilemmas and challenges identified in the previous chapter played out during this period. Figure 2.1 summarises the key points in the timeline.

Public Health England

As part of the Lansley reforms affecting the whole health system and not only the NHS, public health was reformed both nationally and locally as set out in a White Paper, ‘Healthy Lives, Healthy People’ (Department of Health, 2010), and subsequently in the Health and Social Care Act 2012. PHE was established as an executive agency to provide national leadership for public health, while locally the lead responsibility for public health returned to local government, where it had been located prior to the 1974 NHS reorganisation. Although separate from the Department of Health (now the Department of Health and Social Care, DHSC) and organised into regional outposts, from the outset PHE lacked the independence accorded to some other national bodies, notably the National Institute for Health and Care Excellence (NICE). As a civil service agency rather than an arm’s-length body, it remained part of the central DHSC.