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 CCGs, to commission 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 Virgin Care (now 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 May 2021 Wakefield Council awarded a £27m contract to Spectrum Health CIC for the provision of sexual health services for the Wakefield Council area, including clinics, testing, digital and remote services, and advice and education.
In September 2020, Vaccination UK was awarded part of a £29.99m contract for school-aged immunisation services for Birmingham and Solihull, Wolverhampton, Dudley, Walsall and Sandwell (Black Country), Coventry and Warwickshire, and Herefordshire and Worcestershire
In May 2020, a number of not-for-profit organisations were awarded a share of a £14.35m contract by Cambridgeshire County Council and Peterborough County Council for an integrated lifestyle service, bringing together a number of services that focus on promoting the adoption of healthy lifestyle behaviours and the prevention of associated poor health outcomes at universal and individual levels.
In May 2020, Change, Grow, Live Ltd was awarded a £13.44m contract by Barnet Council for an Integrated substance misuse prevention, treatment and recovery service for adults and young people.
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 a multinational company owned by the US Providence Service Corporation, headquartered in Stamford, Connecticut. 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.
A UK-based company, owned by European Lifecare Group A/S, originally focused on the travel vaccination market, with seven clinics around the UK. The company has now moved into vaccinations contracts for the NHS and has contracts in Dudley, Milton Keynes, Wolverhampton and Walsall.
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.
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.