Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

Peckham, Stephen; Gadsby, Erica W.; Jenkins, Linda M.; Coleman, Anna; Bramwell, Donna; Perkins, Neil

doi:10.1080/03003930.2017.1322069

Cited by 10 publications

(11 citation statements)

References 17 publications

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“…It illustrates how responsibility for such services, previously commissioned by PCTs, was split between different agencies. This increased complexity and fragmentation of responsibilities had the potential to disrupt service commissioning 13…”

Section: Introductionmentioning

confidence: 99%

Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening

et al. 2019

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ObjectivesExplore the impact of changes to commissioning introduced in England by the Health and Social Care Act 2012 (HSCA) on cervical screening activity in areas identified empirically as particularly affected organisationally by the reforms.MethodsQualitative followed by quantitative methods. Qualitative: semi-structured interviews (with NHS commissioners, managers, clinicians, senior administrative staff from Clinical Commissioning Groups (CCGs), local authorities, service providers), observations of commissioning meetings in two metropolitan areas of England. Quantitative: triple-difference analysis of national administrative data. Variability in the expected effects of HSCA on commissioning was measured by comparing CCGs working with one local authority with CCGs working with multiple local authorities. To control for unmeasured confounders, differential changes over time in cervical screening rates (among women, 25–64 years) between CCGs more and less likely to have been affected by HSCA commissioning organisational change were compared with another outcome—unassisted birth rates—largely unaffected by HSCA changes.ResultsInterviewees identified that cervical screening commissioning and provision was more complex and ‘fragmented’, with responsibilities less certain, following the HSCA. Interviewees predicted this would reduce cervical screening rates in some areas more than others. Quantitative findings supported these predictions. Areas where CCGs dealt with multiple local authorities experienced a larger decline in cervical screening rates (1.4%) than those dealing with one local authority (1.0%). Over the same period, unassisted deliveries decreased by 1.6% and 2.0%, respectively, in the two groups.ConclusionsArrangements for commissioning and delivering cervical screening were disrupted and made more complex by the HSCA. Areas most affected saw a greater decline in screening rates than others. The fact that this was identified qualitatively and then confirmed quantitatively strengthens this finding. The study suggests large-scale health system reforms may have unintended consequences, and that complex commissioning arrangements may be problematic.

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Section: Introductionmentioning

confidence: 99%

Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening

et al. 2019

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“…Drawing on the initial government White Paper entitled “Healthy lives, healthy people” (HM Government, 2010), the Department of Health (2011) outline the vision for public health in local government, which was described variously as bringing public health “home”, “democratising Public Health” and providing local government with the “freedom to innovate” using the newly provided local funding. Increased aspects of democracy were welcomed as public health commentators described the reforms as an opportunity to bring “health into all policies” (Buck and Gregory, 2013; LGA, 2014a, b; Peckham et al , 2017) and the emphasis on the full “life course approach” (Nuffield Trust, 2011).…”

Section: New Public Management and Austerity: The New Public Health Arrangementsmentioning

confidence: 99%

“…Since the establishment of these reforms, research on the organisational, professional and practical implications of the transfer of public health into LAs has been published across several journals. In the public health literature studies have investigated questions of leadership (Day et al , 2014), public health advocacy and evidence (Brown et al , 2014; Phillips and Green, 2015; Smith and Stewart, 2017; Sanders et al , 2017; Reynolds et al , 2018) and strategic delivery and partnership working in the new context (Caron et al , 2014; Van Der Graaf et al , 2017; Chantler et al , 2019), with some studies in the local government literature having taken up similar questions (Peckham et al , 2017; McGivern et al , 2017). Several studies note that the new system introduces a complex mix of stakeholders, with a range of sometimes competing accountabilities to the local population, to management and to politicians with increasingly “fragmented” structures of performance measurement and reporting (Brown et al , 2014; Phillips and Green, 2015; Chantler et al , 2019).…”

Section: New Public Management and Austerity: The New Public Health Arrangementsmentioning

confidence: 99%

Public health interventions in English local authorities: constructing the facts, (re)imagining the future

Brackley

Tuck

Exworthy

2021

AAAJ

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PurposeThis paper examines the contested value of healthy life and wellbeing in a context of severe austerity, exploring how the value of “Public Health” is constructed through and with material-discursive practices and accounting representations. It seeks to explore the political and ethical implications of constructing the valuable through a shared consensus over the “facts” when addressing complex, multi-agency problems with long time horizons and outcomes that are not always easily quantifiable.Design/methodology/approachThe theorisation, drawing on science and technology studies (STS) scholars and Karen Barad's (2007) agential realism, opens up the analysis to the performativity of both material and discursive practices in the period following a major re-organisation of activity. The study investigates two case authorities in England and the national regulator through interviews, observations and documentary analysis.FindingsThe paper demonstrates the deeply ethical and political entanglements of accounting representations as objectivity, consensus and collective action are constructed and resisted in practice. It goes on to demonstrate the practical challenges of constructing “alternative accounts” and “intelligent accountabilities” through times of austerity towards a shared sense of public value and suggests austerity measures make such aims both more challenging and all the more essential.Originality/valueFew studies in the accounting literature have explored the full complexity of valuation practices in non-market settings, particularly in a public sector context; this paper, therefore, extends familiar conceptual vocabulary of STS inspired research to further explore how value(s), ethics and identity all play a crucial role in making things valuable.

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“…Secondly, research has shown that cultures of evidence use are different in non-health sectors, such as transport, planning and housing, with which public health teams are now expected to work [8]. There have also been large reductions in the ring-fenced public health grant since the transfer [9] and there is evidence that public health practitioners (PHPs) see themselves as having less influence or status in some ways since the transfer [5,7,10].…”

Section: Introductionmentioning

confidence: 99%

“…However, LAs represent a different policy-making environment to the NHS in a number of ways. Firstly, elected politicians are involved in decision-making [ 5 – 7 ], which has the potential to impact on evidence use [ 6 ]. Secondly, research has shown that cultures of evidence use are different in non-health sectors, such as transport, planning and housing, with which public health teams are now expected to work [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Use and value of systematic reviews in English local authority public health: a qualitative study

South

Lorenc

2020

BMC Public Health

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Background: Responsibility for public health in England transferred from the National Health Service to local authorities in 2013, representing a different decision-making environment. Systematic reviews are considered the gold standard of evidence for clinical decision-making but little is known about their use in local government public health. This study aimed to explore the extent to which public health decision-makers in local authorities engage with systematic reviews and how they do so. Methods: Semi-structured interviews were conducted with senior public health practitioners (n = 14) in Yorkshire and the Humber local authorities. Sampling was purposive and involved contacting Directors of Public Health directly and snowballing through key contacts. Face-to-face or telephone interviews were digitally recorded, transcribed verbatim and analysed using the Framework Method. Results: Public health practitioners described using systematic reviews directly in decision-making and engaging with them more widely in a range of ways, often through a personal commitment to professional development. They saw themselves as having a role to advocate for the use of rigorous evidence, including systematic reviews, in the wider local authority. Systematic reviews were highly valued in principle and public health practitioners had relevant skills to find and appraise them. However, the extent of use varied by individual and local authority and was limited by the complexity of decision-making and various barriers. Barriers included that there were a limited number of systematic reviews available on certain public health topics, such as the wider determinants of health, and that the narrow focus of reviews was not reflective of complex public health decisions facing local authorities. Reviews were used alongside a range of other evidence types, including grey literature. The source of evidence was often considered an indicator of quality, with specific organisations, such as Public Health England, NICE and Cochrane, particularly trusted. Conclusions: Research use varies and should be considered within the specific decision-making and political context. There is a need for systematic reviews to be more reflective of the decisions facing local authority public health teams.

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Views of public health leaders in English local authorities – changing perspectives following the transfer of responsibilities from the National Health Service to local government

Cited by 10 publications

References 17 publications

Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening

Exploring the impacts of the 2012 Health and Social Care Act reforms to commissioning on clinical activity in the English NHS: a mixed methods study of cervical screening

Public health interventions in English local authorities: constructing the facts, (re)imagining the future

Use and value of systematic reviews in English local authority public health: a qualitative study

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