Public health covers services that focus on protecting and improving the health of a population, including vaccinations, health education, school nurses and health visiting. Since 2013 the budget for public health has been separate from that of NHS England and commissioning public health services has been the responsibility of local authorities. The budget for public health has undergone significant cuts since 2013.
Many companies, charities, and not-for-profit companies are now involved with providing public health services, in particular in the area of services to stop smoking, addiction, and health promotion and education. In some areas, councils have teamed up with local NHS commissioners (ICBs) to organise many public health contracts as part of a large community services contract.
There have been two triggers for the privatisation of public health: the 2012 Health and Social Care Act and the change of responsibility for public health services from Clinical Commissioning Groups (CCGs) to local councils.
In April 2013 local councils became responsible for the public health budget and many began the process of putting out to tender public health services that had previously been provided by NHS trusts and GP surgeries. This process resulted in an influx of non-NHS organisations into all areas of public health, including areas that had never seen privatisation previously, such as sexual health services and contraception, vaccinations, school nurses and health visitors.
The 0-19 healthy child programme, a flagship programme in public health services, covering many aspects of preventative health for children, such as vaccination and health visitors, is now the responsibility of local councils. Local councils have put this major public health programme out to tender seeking new providers; in many areas the contract was won by an NHS trust (often they had previously carried out the work), however there was also an influx of private companies.
For example, school vaccination, previously carried out by the NHS, is now also carried out by private companies, such as Vaccinations UK Ltd and HCRG Care. In Bath and North East Somerset and in most of Essex, the 0-19 healthy child programme is run by HCRG Care.
In the area of services for sexual health and contraception, the new contracts from the local council were often won by GP surgeries and NHS community trusts, both of which had previously provided the services, but in some areas private companies won, such as Virgin Care (now HCRG Care) in Teesside, Lincolnshire, Oldham, Rochdale and Bury. In the area of mental health, such as addiction services, many companies and charities won contracts from local councils; more details of privatisation in this area can be found on the Mental Health page.
Of all the areas that fall under the public health banner, smoking cessation, and health promotion and education, has seen the largest influx of non-NHS organisations. Large numbers of charities, not-for-profits, and private companies are contracted to run healthy lifestyle programmes or well-being programmes. An example of such a contract is the four year 'Integrated Public Health & Lifestyle Behaviour Change Service' contract in Rotherham won by Parkwood Healthcare Ltd; the contract worth up to £4.5 million covers a wide range of services, such as adult weight management, alcohol risk screening intervention, a health trainer service, and support to stop smoking.
Recent contracts include:
In January 2024, Wigan Council awarded a seven year contract worth £17.5 million for integrated sexual health services to Locala Community Partnerships CIC.
In January 2024, NHS England South West awarded a five year contract for school aged immunisation services for four areas - Bath and North East Somerset, Swindon and Wiltshire (BSW), Somerset, Cornwall, and Gloucestershire to four suppliers. In BSW the contract worth £5.13 million was awarded to HCRG Care and in Cornwall the contract worth £2.79 million to Kernow Health CIC.
In January 2024, East Sussex Council awarded three year contract for the provision of an Integrated Health and Wellbeing Service worth £6.44 million to Thrive Tribe.
In November 2023, the charity We Are With You was awarded a five year contract worth £42.2 million by Stoke-on-Trent City Council for community drug and alcohol services, including a full range of interventions for children, young people and adults, including detoxification, treatment and recovery.
In November 2023, London Borough of Bromley awarded a five year contract worth £13.7 million to Change Grow Live Ltd to run Bromley substance misuse service.
In October 2023, Nottingham City Council awarded a five year contract worth £102.3 million to Change Grow Live and Framework Housing Association for provision of alcohol and drug treatment and recovery services in Nottingham.
There are a large number of small private companies, charities, and not-for-profit companies involved with public health, many of which are only operating in a small geographical area, therefore it would be impossible to list them all here. This is just a selection, showing the type of organisations involved. To find out what organisations have contracts with your local council for public health, a freedom of information request can be sent.
Ingeus is owned by APM Human Services International Ltd, a company registered in Australia. The company's major business is in employability skills, including programmes to move people from benefits into work and skills-based training and provision of offender rehabilitation programmes. It also has a business in youth services, including providing the National Citizen Service, and in health. In healthcare, Ingeus is the largest provider in England of the National Diabetes Prevention Programme, with contracts that cover over 40% of England and it is also involved in well-being programmes.
Parkwood Healthcare Ltd
This private company is a combination of nursing agency and healthcare consultancy, specialising in healthy lifestyle programmes, public health training, and management consultancy. In addition, the company is closely involved with the Healthwatch organisations around England. Contracts include those with local councils in Leicester, Bexley and Buckinghamshire to deliver Health Trainer Services, involving ‘GetHealthy UK’ teams whose role is to improve the health and well-being of residents and reduce health inequalities across the counties.
Since 2015 Vaccination UK has been commissioned by NHS England to provide school aged immunisations, including Influenza, to numerous counties in England, including the Black Country, Hertfordshire, Herefordshire & Worcestershire, Peterborough, Yorkshire, East Riding, Hull, North & Northeast Lincolnshire and nine boroughs of North East London. Vaccination UK are also commissioned by NHS England in northeast London to provide outbreak response in the event of a vaccine preventable disease outbreak, and to provide the infant BCG programme to newborns in Newham and Tower Hamlets. The company's sister organisation CityDoc runs over 100 private vaccination clinics. The company is owned by Danish company European Lifecare Group A/S.
Solutions4Health is focused on the provision of integrated public health services. The company provides over 30 services to over 100,000 people per year. The company employs over 360 healthcare staff, more than 60% of which have transferred from the NHS.
The company delivers healthcare services to 21 local councils which include integrated lifestyle services, adult and child weight management, children’s lifestyles services in schools, falls prevention, NHS health checks, smoking cessation, clinical services for Tier 3 weight management, new information systems and technology solutions. Contracts include the Children’s 0-19 Health service in Slough which launched on the 1 October 2017; the area's health visitors, school nurses and associated staff were transferred to Solutions4Health.
HCRG Care, previously Virgin Care, is a major player in the provision of community health services. The company has several large contracts for community health: Bath and North East Somerset community health and care; Essex child and family well-being service; and Wiltshire children's community services. All these contracts cover many aspects of public health, including the 0-19 healthy child programme in each area. Outside of these contracts, HCRG Care also has contracts for vaccinations and sexual health services. For full details see our profile of HCRG Care.
Terrence Higgins Trust
The HIV and sexual health charity Terrence Higgins Trust has a number of public health contracts with local councils to provide a range of services associated with testing for sexually transmitted infections and providing sexual health information and advice. The charity provides services in Luton, Brent, Sandwell, Redbridge, Brighton & Hove and many other areas.
Change Grow Live
A charity that specialises in substance misuse and criminal justice intervention projects in England and Wales. All of its funding is provided through contracts with councils.
Locala Health & Wellbeing CIC
Locala is a not-for-profit community healthcare provider that provides a number of NHS and local authority services to care for and support people of all ages. The company provides extensive services in Calderdale, Kirklees and Greater Huddersfield area that come under public health, such as speech and language services, vaccinations, and sexual health, but also community healthcare services.
Public health covers a number of services, including the following:
- Health visitors and school nurses
- Stop smoking services
- Addiction treatment
- Obesity treatment
- Sexual health and contraception
- Health promotion and education
The councils are also responsible for the 0-19 healthy child programme, which covers vaccinations.
Who commissions public health services?
Since 2013, local authorities have been responsible for commissioning all public health services, with the exception of national programmes, such as the National Diabetes Prevention Programme, which is commissioned centrally by NHS England.
Who provides public health services?
Public health services are provided by hospital trusts, GPs, community interest companies, charities and private companies.