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- Author or Editor: David J. Hunter x
As in the case of other parts of the UK wider health system, it has been a turbulent time for public health since 2010. Not only has the function undergone major structural and cultural change following its return to local government from the NHS, where it had been located since 1974, but it has had to confront new challenges in public health arising from lifestyle behaviours and a widening health gap between social groups. All of this has occurred during a period of unprecedented financial austerity affecting public services in general but local government in particular. This chapter reviews the state of public health in the lead up to the changes announced by the Coalition government in 2010. It then summarises the reforms before offering an interim assessment of their impact. Finally, it discusses the evidence to date concerning the reforms and speculates on likely prospects in the years ahead.
This chapter highlights the need for partnership working, which has been a long-standing objective of health and social policy. For many years, the National Health Service (NHS) and local authorities have been attempting to deal with ‘wicked issues’. Issues such as homelessness, disaffection of young people, and the ageing society that have complex multiple causes require joined-up approaches by the statutory and third sectors at national and local levels. In 2012, at the time when Public Health responsibilities were transferred from the NHS to local authorities, health and wellbeing boards (HWBs) were established in England. With few exceptions, HWBs punch below their weight and are not the powerful system leaders that were hoped for. Evidence of their value and impact is negligible, with poor-performance indicators, and the difficulties in overcoming deep-seated departmentalism and a silo approach prevalent in government and public services, leaving ‘wicked issues’ as deep-seated as ever.
It is impossible to understand the devastating impact of the COVID-19 virus across the UK involving significant loss of life, and the government’s much criticised response to it, without applying the lens of a sociopolitical perspective.
A substantial body of evidence exists to show that the virus has had a disproportionate impact on poor communities, and on care homes, reflecting widening health inequalities and the effects of deep public spending cuts since 2010.
This chapter explores many of the core cleavages in health policy, reflecting political and ethical tensions over the balance to be struck, and negotiated, across personal and collective responsibility, across public and private interests, and between the rights of the community and personal freedoms.
Adopting a sociopolitical perspective allows us to identify and explore a range of factors which, taken together, help explain where the government’s handling of COVID-19 has been found wanting.
Three particular policy failures, and the political choices leading up to them, are explored. These comprise the persistence of a command and control approach to handling the crisis, the policy of austerity introduced by the Coalition government in 2010, and the heavy reliance on outsourcing activities to the private sector and management consultants. An agenda for reform going forward is presented to conclude this chapter.
Chapter 6 describes the changing context for partnership working in public health following the UK coalition government’s plans for returning lead responsibility for public health in England to local government while also creating a new agency, Public Health England, to provide support and national system leadership. The changes, contained in the Health and Social Care Act 2012 and introduced in April 2013, reinforce the importance of partnership working while introducing new partnership forms that are yet to be tested and evaluated. The new health policy landscape is described and an interim assessment of progress provided.
In the light of the research presented and the public health changes underway in England, assesses the future prospects for public health partnerships which will become more complex and challenging. This chapter argues for a different approach which emphasizes the importance of relationships and suggests the need for less attention being given to structures and order. Partnerships in future need to be much more flexible and task oriented, engaging with those who can effect change on the frontline. The public health challenges facing society have few obvious or clear-cut solutions. Partnerships need to experiment and take risks to find out what works and why. If this requires being a little messy in how the work gets done then that may be desirable. The chapter offers some learning points for effective partnership working.
Partnership working is central to British public policy. Few challenges facing government can be tackled successfully without working across boundaries and in partnership. Public health issues are particularly complex in this respect and yet little is known about public health partnerships. The research reported in this book seeks to go some way to closing the knowledge gap employing the notion of a public health system to explore the issues raised. The book brings the discussion up-to-date by examining the evolving public health system in England and the major changes introduced in April 2013. These have introduced new partnership forms that remain to be tested. Our research offers useful insights and learning points.
This chapter discusses the various theories and concepts of partnership working and explores what partnership working is, the opportunities and barriers to working in partnership, and the various modes of governance underpinning partnerships. It argues that a networked approach to the governance of partnerships is needed based upon systems thinking to tackle the complex ‘wicked issues’ found in public health.
The chapter reports on the findings of a systematic review of the impact of partnership working on public health, and considers whether these partnerships have delivered better health outcomes for local/target populations. It finds that there is little evidence that partnerships have produced better health outcomes for local/target populations or reduced health inequalities.
This chapter presents the research findings, through qualitative research, derived from the views of senior practitioners and their perceptions of the effectiveness and efficacy of public health partnerships. Interviewees include: Directors of Public Health, Directors of Commissioning, Councillors, and other senior public health practitioners.
This chapter presents qualitative research findings of the views of frontline practitioners and service users of public health partnerships in four selected tracer issues. The topics examined include: the benefits and barriers to partnership working, the effectiveness of partnerships in providing a more seamless service for users, and what is needed to improve services for users through the aegis of partnership working.