DH to have veto over DPH appointments

The document has sparked a debate about the control and independence of the PHS.

July’s health white paper said moving public health functions to councils would “strengthen the local democratic legitimacy of the NHS” and “allow local authorities to take a strategic approach”.

But Alex Scott-Samuel, co-chair of the academic Politics of Health Group, told HSJ he was concerned the PHS would be too closely tied to the DH, undermining local autonomy.

He said: “Central government will for the first time have a veto on director of public health appointments, and will doubtless seek to ensure that directors of public health toe the government line.”

At present, public health directors are appointed by primary care trust boards - in some cases jointly with local authorities.

However, King’s College London honorary professor of public health Alan Maryon-Davis said he was concerned NHS influence over public health would not be sufficient in the future.

He told HSJ shifting public health to local government would weaken public health directors’ ability to influence the commissioning decisions of GPs.

“The risk is that you’ll have a disconnect between the local authorities and the NHS; that’s a big worry,” he said.

Faculty of Public Health vice president John Middleton said that while the planned reforms would create opportunities for public health staff to influence areas such as education and social housing, they should guard against losing their link to the NHS.

Croydon director of public health Peter Brambleby told HSJ public health directors would retain their independence from both the DH and their local authorities through the publication of their annual public health reports, which would “tell it like we see it”.

He argued: “We can challenge spending patterns and policy. I don’t think the new government is a threat to that.”

Dr Brambleby said the government’s plans would further liberate directors of public health to do localised preventative work.

A DH spokesperson said: “It is right that decisions are made locally, and equally appropriate for ministers to retain accountability for the nation’s health and the money spent on it.”