Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK.
Public Health. 2019 Sep;174:11-17. doi: 10.1016/j.puhe.2019.05.016. Epub 2019 Jun 29.
In England, in 2013, responsibility for some public health (PH) functions transferred from the National Health Service (NHS) to local government. This moved PH from a health-focussed into a broader and more politically oriented context. This article reports on the perceptions of those involved in this transition about how the PH function was changing as it transited to local government.
This is a cross-sectional interview study.
The study included semi-structured interviews with 31 local government councillors, directors and deputy directors of PH, PH team members and members of clinical commissioning groups. Interviews and data analysis were informed by a theoretical framework, COM-B and an inductive and deductive approach was taken to identify relevant themes.
There was a mixed picture of perceived gains and losses for PH. The transition from NHS to local government was seen by some as a 'homecoming', providing the opportunity for PH to have further reach through influence and collaboration with departments like housing, transport and planning. The opportunity to promote evidence-based practice across local government was also seen as a positive aspect of the transition. However, professional roles of PH and individual PH practitioners were perceived to have less influence and autonomy than in the NHS, with some uncertainty about roles within local government. PH practitioners perceived the need to develop other skills to fulfil their roles in local government. Shorter timescales for action and pressure for faster responses were reported to be the reason for less emphasis on using PH evidence to inform policy and decision-making than hitherto in the NHS.
This study illustrates a variety of consequences of transitioning from NHS to local government. There were perceived benefits afforded by proximity to related local government departments but at the costs of reduction in status for PH practitioners and working to a timescale which in some cases reduced drawing on scientific evidence.
2013 年，英国将部分公共卫生（PH）职能从国民保健服务（NHS）转移到地方政府。这使得 PH 从以健康为重点转变为更广泛、更具政治导向的背景。本文报告了参与这一转变的人员对 PH 职能在向地方政府过渡过程中发生变化的看法。
这是一项横断面访谈研究。
本研究包括对 31 名地方政府议员、PH 主任和副主任、PH 团队成员以及临床委托小组的成员进行半结构化访谈。访谈和数据分析以理论框架 COM-B 为依据，并采用归纳和演绎方法确定相关主题。
PH 的得失情况喜忧参半。一些人认为，从 NHS 向地方政府的过渡是一种“回归”，为 PH 提供了通过与住房、交通和规划等部门的影响和合作进一步扩大影响力的机会。在地方政府内推广循证实践的机会也被视为过渡的一个积极方面。然而，PH 的专业角色和个别 PH 从业者的影响力和自主权被认为比 NHS 时要小，对地方政府内的角色也存在一些不确定性。PH 从业者认为有必要发展其他技能来履行他们在地方政府中的角色。据报道，行动的时间框架更短，对更快响应的压力更大，这导致 PH 证据用于为政策和决策提供信息的重视程度低于 NHS 迄今为止的情况。
本研究说明了从 NHS 向地方政府过渡的多种后果。与相关地方政府部门接近带来了好处，但 PH 从业者的地位降低，工作时间框架更短，在某些情况下减少了对科学证据的利用。
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