Friday, 15 February 2013

Public Health in Local Government, 2001-2012

This is another in our series where researchers planning to use the archive outline their projects. This guest post is by Martin Gorsky of the London School of Hygiene and Tropical Medicine.

Public Health in Local Government, 2001-2012: web representations and practices

Background The Health and Social Care Act of 2012 has introduced a major restructuring of the National Health Service (NHS).  As part of this process public health duties have been removed from NHS bodies to become part of local government. The Department of Health (DH) describes the initiative as reviving 'a long and proud history' by 'returning public health home'. That history includes not only the great achievements of Victorian sanitary reform, but also the early NHS, because in Bevan's original design public health departments were based in local authorities, where they remained until the NHS reorganisation of 1974. Policy-makers see exciting opportunities for public health to further its goals within the local government setting. They hope that by being more closely connected to local peoples' needs and living environments, health professionals will be able to develop better programmes and to tackle inequalities. This, they believe, should work better than 'one size fits all' policies.

Historiography  What might the recent history of public health in local government tell us about the opportunities and challenges ahead?  There is already a limited body of work examining the changes of 1974 from a national perspective, which argues that various problems had arisen.  Post-war public health 'lost its way', lacking a clear philosophy and rationale at a time of rapidly changing health needs.  It was also sidelined by other professional groups, delivering patchy services and failing to link effectively with the NHS.  There is also a more recent history which is as yet unexamined.  Since 2001, and gaining official force in 2006, the DH has championed the joint appointments of Directors of Public Health (DPH), to straddle both NHS primary care trusts and local authorities.  The activities of these new appointees may give some interesting clues as to whether the structural and philosophical challenges of the earlier period retain their force or can be overcome.

Aim  The project will therefore aim to identify the web presence of these joint appointment DPHs during the period from 2001 up until the passage of the recent Act.  By reading these texts it will ask:
a. whether a coherent rationale for public health in a local government setting is discernible
b. what practices of joint working between NHS and local government are reported, and how the benefits of integration are represented.

Martin Gorsky
Centre for History in Public Health, LSHTM