Councillors' guide to local authority public health responsibilities

Public health has a long and well established history in local government. Councils have, for many decades, played a central role in shaping the social, economic and environmental conditions that influence health, from housing and sanitation to education, planning and community services. While the organisation of public health functions has changed over time, local government has consistently been a key part of the public health system.

Since 1 April 2013, councils have held statutory responsibility for improving the health of their local populations. That responsibility remains a core function of local government and continues to be central to efforts to improve health outcomes and reduce health inequalities.

The Government’s 10 Year Health Plan, published in July 2025, sets out an agenda structured around three shifts: from hospital to community, from treatment to prevention, and from analogue to digital. Local government has a role across all three areas, particularly through its responsibilities for prevention, early intervention and place based services delivered in homes, schools, workplaces and communities.

This role is further reflected in the Neighbourhood Health Framework, published in March 2026, which sets out expectations for neighbourhood level working across the health and care system. From 2027/28, health and wellbeing boards are identified as having a central role in local neighbourhood health plans, building on their statutory function to bring together partners around shared priorities for population health and wellbeing.

At the same time, the national health system is undergoing significant structural change. NHS England is being abolished, integrated care boards are being reduced in number and scale, and integrated care partnerships are being wound down. In this context, it is important that local government is clear about its statutory responsibilities and how these relate to the evolving NHS landscape.

This guide is intended to support elected members by setting out what councils are legally required to do, the funding arrangements that apply, and how national policy frameworks interact with local decision making.

Councillors have a leadership role in shaping local approaches to health and wellbeing. This guide is intended to support that role.

Councillor Dr Wendy Taylor MBE
Chair
LGA Health and Wellbeing Committee

Under the Health and Social Care Act 2012, local councils in England are legally responsible for delivering public health services. They are required to take appropriate steps to improve the health and wellbeing of their local populations. This transferred responsibility from NHS primary care trusts, which were abolished on 1 April 2013.

In addition, Section 6C of the NHS Act 2006 empowers the Secretary of State to delegate specific public health duties to local authorities. The Secretary of State retains overall responsibility for improving health and addressing health inequalities, but councils are the primary delivery vehicle for the population health functions set out in law.

Who does this apply to?

Public health responsibilities sit with upper tier and unitary local authorities in England: county councils, metropolitan borough councils, London borough councils, and unitary authorities. District councils do not hold the statutory public health function, though they play a crucial role in the wider determinants of health through housing, planning, environmental health and leisure services.

The Director of Public Health

Every upper tier and unitary local authority must appoint a Director of Public Health (DPH). The DPH is a statutory chief officer with a duty to advise the council on all matters relating to the health of the local population. Appointment must be made jointly with the Secretary of State (delegated to the Regional Director of Public Health).

The DPH has a unique dual accountability, to the local authority as an employer and to the professional public health system.

They are required to produce an annual report on the health of the local population, which is the DPH's independent professional document, not a council publication. Councils should give this report appropriate prominence.

Councils receive a ringfenced annual grant from the Department of Health and Social Care (DHSC) to fund their public health functions. The grant is determined under Section 31 of the Local Government Act 2003 and is subject to conditions that restrict its use to public health purposes.

2026/27: Public Health Grant Settlement

In 2026/27, the total public health grant to local authorities in England is £4.404 billion. This represents an increase from £3.884 billion in 2025/26. It is the first multi year public health grant settlement in a decade.

The Government has confirmed final allocations for 2026/27 and provided indicative allocations for 2027/28 and 2028/29. This provides councils with increased certainty for medium term financial planning compared with recent years.

The Government has stated that the consolidated public health grant will be higher in real terms in each year of the current Parliament than it was in 2024/25. Over the three year period covered by the settlement, councils are expected to receive more than £13.4 billion in total through the consolidated, ringfenced public health grant.

Consolidation of funding streams

From April 2026, funding for drug and alcohol treatment and for stop smoking services is consolidated into the main public health grant. Previously, these were provided as separate supplementary grants alongside the core public health grant.

The consolidation brings these funding streams within a single grant, while retaining service specific controls. Councils are able to plan and commission services within this consolidated framework, subject to the applicable ringfencing and reporting requirements.

The grant includes the following ringfences:

• £152.8 million nationally for smoking cessation
• £1.1 billion nationally for drug and alcohol treatment and recovery

Councils are required to track and report expenditure against these ringfenced elements separately.

What the 2026/27 grant includes

The public health grant for 2026/27 covers:

• core public health functions
• smoking cessation services (ringfenced at £152.8 million nationally)
• drug and alcohol treatment and recovery services (ringfenced at £1.1 billion nationally)
• supervised toothbrushing programmes
• notional allocations for the 10 Greater Manchester authorities under business rates retention arrangements (funded separately).

Grant conditions

The ringfenced grant must be used only for the purposes of local authorities' public health functions. Each year, the Chief Executive (or finance director) and Director of Public Health must jointly confirm to DHSC that the grant has been spent in line with the conditions. DHSC undertakes assurance activity to verify this.

Councils may carry over underspend into the following year as a public health reserve, but must continue to apply grant conditions to those funds. DHSC may reduce future grant allocations to councils reporting significant and repeated underspends.

Local authorities are required to commission or provide a set of prescribed public health functions. These are the non-negotiable core of the council's public health duty. They are distinct from the broader health improvement and prevention work that councils do, which is equally important, but discretionary in nature.

Prescribed functions

The regulations set out a range of prescribed functions for which councils must demonstrate activity. These include:

• NHS Health Checks — councils must offer a health check to all eligible adults aged 40 to 74 every five yearsNational child measurement programme — annual weighing and measuring of children in reception and Year 6
• Health visiting services — the healthy child programme for children aged 0 to 5, including five mandated universal health reviews
• School nursing services — the healthy child programme for children aged 5 to 19
• Sexual health services — including open-access sexually transmitted infection (STI) testing and treatment, and contraception provision
• Drug and alcohol treatment and recovery services — an accessible system providing a full range of NICE-compliant interventions
• Smoking cessation services — stop smoking support and treatment
• Oral health improvement programmes — including supervised toothbrushing in high-deprivation areas where appropriate
• Local health protection — councils have a duty to ensure arrangements are in place to respond to health protection incidents and emergencies in their area, working with UKHSA.

Councils also have duties relating to the collection of oral health survey data, contribution to the Public Health Outcomes Framework, and support for NHS commissioning to have a population health focus.

Public health services for children aged 0 to 19

Under the terms of the Health and Social Care Act 2012, upper tier local authorities are responsible for improving the health of their local population. Local authorities are key commissioners and hold an array of statutory duties for children, including:

• promoting the interests of children in the development of health and wellbeing strategies (joining up commissioning plans for clinical and public health services with social care and education to address identified local health and wellbeing needs)
• leading partners and the public to ensure children are safeguarded and their welfare promoted
• driving the high educational achievement of all children
• leading, promoting and creating opportunities for co-operation with partners and parents or carers to improve the wellbeing of young people
• safeguarding and promoting the welfare of looked after children
• providing or commissioning oral health improvement programmes and oral health surveys to improve the health and wellbeing of children and young people (see the NHS Bodies and Local Authorities (Partnership Arrangements, Care Trusts, Public Health and Local Healthwatch) Regulations 2012 (statutory instrument SI3094)
• regulation requires all families with babies to be offered five mandated health visitor reviews before their child reaches two and a half years old.

The early years health reviews are offered to all families with a child aged 0 to five years. However, this is not the extent of the health visiting service offer for families who may also require additional support from the health visiting team, for example a nursery nurse. There are no mandated reviews for school aged children.

However, there are opportunities to develop a framework of reviews based on evidence, intelligence, professional judgement and service user voice which provides opportunities to review health and wellbeing needs, support behaviour change and influence outcomes. This presents opportunities for bringing together a robust approach for improving outcomes for children and young people across both health and local authority led services for children and young people aged 0 to 19.

There's more guidance available online on commissioning health visitors and school nurses for public health services for children aged 0 to 19.

Public health advice to NHS

The Director of Public Health (DPH) is expected to provide the NHS with a public health advice service to inform effective commissioning of healthcare and related matters. Whilst not statutorily required to do so, the DPH will also be well placed both as public health expert and place-based leader to provide constructive challenge, strategic insight, advice and support to the fulfilment of a range of statutory duties of ICS partners.

Their above obligation is complemented by the duty on ICBs to seek advice (under section 14 of the 2006 Act) from appropriate persons on prevention and public health. ICBs also have a statutory responsibility to facilitate and promote research.

DsPH can play a key role in assisting this function by facilitating partnerships with academic institutions across the system to generate evidence-based decision-making.

Non-prescribed functions

Beyond prescribed functions, councils use the public health grant to commission a wide range of services at local discretion, reflecting local needs identified through the Joint Strategic Needs Assessment. These commonly include weight management services, physical activity programmes, mental health and wellbeing support, health inequalities interventions, community development, and prevention support embedded in other council services.

The council's Health and Wellbeing Strategy should set the overarching framework that connects prescribed functions with discretionary investment and the wider determinants of health.

Health and wellbeing boards (HWBs) are statutory committees of upper tier and unitary local authorities. They bring together senior leaders from local government, the NHS, Healthwatch and other partners to improve the health and wellbeing of their local population.

Core functions:

• publishing a Joint Strategic Needs Assessment (JSNA) — a shared picture of current and future health and wellbeing needs across the local area
• producing a Joint Health and Wellbeing Strategy — setting the strategic direction for improving health and reducing inequalities
• promoting integration of health, social care and public health services
• promoting joined-up commissioning and the Better Care Fund.

Membership

The statutory membership of the HWB includes at least one elected council member, the Director of Public Health, the Director of Adult Social Services, the Director of Children's Services, at least one representative of the integrated care board (ICB), and a Healthwatch representative. Many councils have strengthened their HWB by including additional members such as the voluntary and community sector, district councils, and NHS providers.

The NHS is undergoing its most significant structural reorganisation since 2013. Councillors need to understand these changes and their implications for local public health, partnership working, and accountability.

Abolition of NHS England

NHS England — the arm's-length body responsible for overseeing the NHS in England and allocating resources to the system — is being abolished. Its functions will be absorbed into DHSC. This is a major centralisation of NHS oversight and will significantly reduce the scale of NHS management infrastructure at national level.

The implications for local public health include potential changes to how national public health programmes are overseen, how OHID (Office for Health Inequalities and Disparities) operates, and how local partnerships with NHS

England's regional teams function. Councils and DsPH should expect the transition to be disruptive in the short term and should maintain good direct relationships with DHSC officials and regional health leadership.

Integrated care boards — significant reduction in scale

ICBs are being substantially reduced in size, with their staff numbers roughly halved. This will affect the capacity of ICBs to engage with local authorities across the range of partnership responsibilities. Councils should not interpret a quieter ICB as less important relationships — if anything, the reverse may be true, with more strategic engagement required from elected members and DsPH.

Abolition of integrated care partnerships

Integrated care partnerships (ICPs) — the statutory bodies sitting alongside ICBs and bringing together a wider set of system partners — are being abolished. Their function of producing Integrated Care Strategies will need to be absorbed into other forums. In practice, this may strengthen the role of health and wellbeing boards as the primary democratic and statutory forum for health strategy at place level. Councillors should ensure the HWB is positioned to take on this strategic role.

Local government reorganisation (LGR) is creating new unitary authorities across significant parts of England. This has important implications for public health that councillors and officers in affected areas need to understand and plan for carefully.

Public health grant allocations

Where new unitary authorities are created, the public health grant will be allocated to the new authority. How existing grant commitments, commissioned services and public health reserves are handled in the transition period is a matter for the councils involved, in discussion with DHSC. Councils should ensure their DPH is centrally involved in transition planning from the outset, this is not simply a financial or organisational exercise, it is a public health one.

Director of Public Health appointments

New unitary authorities will need to appoint a Director of Public Health. The appointment must be made jointly with the Secretary of State. Shadow authorities and implementation teams should plan early for this requirement and involve DHSC, ADPH and OHID in the process.

Health protection co-terminosity

Effective health protection depends on co-terminous working between local authorities, UKHSA, NHS organisations and other partners. LGR changes to council boundaries need to be carefully managed to maintain the coherence of local health protection arrangements. Councils should ensure UKHSA Health Protection Teams are engaged in LGR transition planning.

Health and wellbeing boards

New unitary authorities will need to establish health and wellbeing boards. This is an opportunity to set up an HWB with clear purpose, strong membership, and a direct link to neighbourhood health planning from day one. It is also an opportunity to avoid some of the structural weaknesses that have affected HWBs in other areas — such as overly large membership, weak links to scrutiny, or an absence of meaningful community voice.

Commissioned services

LGR creates both risks and opportunities for public health commissioned services. Service contracts that cross new authority boundaries will need careful management. There are also opportunities to rationalise commissioning, achieve economies of scale, and design more coherent care pathways. The DPH of any new unitary authority should undertake a service mapping exercise as a priority.

The 10 Year Health Plan

The Government's 10 Year Health Plan for England, published in July 2025, sets out a long-term vision for transforming the NHS and improving population health. It is structured around three major shifts:

• hospital to community: moving more care out of hospitals and into local settings, with neighbourhood teams providing integrated, proactive support
• treatment to prevention: shifting resources and focus upstream to prevent ill health, reduce health inequalities, and support people to live healthier lives for longer
• analogue to digital: making better use of data and digital tools to support community working, identify at-risk individuals, and improve the experience of care.

Local government is central to delivering all three shifts. Prevention cannot happen without councils. Community-based care depends on local authority services, the voluntary sector, and the built environment that councils shape.

Councillors should position their council as a full partner in 10 Year Health Plan delivery, not simply a recipient of NHS decisions.

The Neighbourhood Health Framework

Published in March 2026, the Neighbourhood Health Framework sets out the Government's operating model for neighbourhood health across England. It asks ICBs and local authorities to work together over the next three years to deliver a minimum set of integrated neighbourhood health interventions.

The framework has two implementation stages. In 2026/27, local systems are expected to agree neighbourhood footprints, confirm governance arrangements, and begin pooling resources through the Better Care Fund.

From 2027/28, systems will develop full neighbourhood health plans, developed through health and wellbeing boards and setting out how services are organised at neighbourhood level.

The Government has committed to delivering 250 neighbourhood health centres by 2035, beginning with the most deprived communities. These centres are intended to bring together primary care, community health services, social care and wider support — including employment advice, debt support and stop smoking services — in accessible local settings.

The Public Health Outcomes Framework

The Public Health Outcomes Framework (PHOF) measures progress on improving and protecting health at population level. It provides national and local data on health outcomes across four domains: improving the wider determinants of health; health improvement; health protection; and healthcare and premature mortality. Councils should use PHOF data routinely in scrutiny and strategy, and the DPH can help contextualise local performance within national trends.

The Local Government Outcomes Framework (LGOF)

The Local Government Outcomes Framework (LGOF) provides a national framework for describing and monitoring outcomes related to public health, public health services, and the wider determinants of health within local government.

The framework was developed to support transparency and local accountability rather than performance management. It brings together a set of population level indicators drawn from a range of national data sources, allowing councils and their partners to understand trends over time, compare outcomes between areas, and inform local priority setting.

The LGOF aligns closely with the public health system operating model introduced in 2013 and reflects the breadth of local government’s influence on health improvement, including prevention, early intervention, and action on the wider determinants of health. Indicators span domains such as health improvement, healthcare public health, and health protection, as well as outcomes influenced by housing, employment, education and the environment.

Data underpinning the LGOF is published nationally, primarily through the Office for Health Improvement and Disparities (OHID) public health data profiles. Councils are not required to deliver against individual indicators, and the framework does not create new statutory duties. Instead, it is intended to support evidence based decision making at local level and informed discussion between councils, partners and communities.

In practice, the LGOF is commonly used by councils, health and wellbeing boards, and integrated partners to:

• develop and refresh joint strategic needs assessments (JSNAs)
• inform joint health and wellbeing strategies
• support understanding of inequalities within and between places
• provide context for commissioning and service planning decisions.

The statutory public health functions are important, but they represent only a fraction of the impact local government has on health. The great majority of what determines health — housing quality, employment, education, the built environment, community life, air quality, safety — is directly shaped by decisions councils make every day across all their services.

Health in All Policies

Health in All Policies (HiAP) is an approach that embeds consideration of health and wellbeing impacts into decision-making across all council functions. The DPH and their team can support councillors, portfolio holders and officers to apply a health lens to decisions on planning, transport, economic development, housing, parks and leisure, and community safety.

The LGA offers Health in All Policies workshops and support for councils wishing to strengthen this approach. Contact the LGA Public Health and Prevention team for more information.

Health overview and scrutiny

Health overview and scrutiny committees (HOSCs) have a statutory right to scrutinise the NHS and local authority health functions. In a period of major NHS restructuring, this role is more important than ever. HOSCs should be actively scrutinising ICB plans for NHS reorganisation, neighbourhood health implementation, and the impact of NHS changes on local communities.

Councillors sitting on or chairing a HOSC should be in regular dialogue with the DPH to ensure scrutiny is well-informed and evidence-led.

Addressing health inequalities

England's health inequalities remain stark and persistent. Life expectancy at birth varies by almost ten years between the most and least deprived areas. The public health grant, used effectively, is one of the most powerful tools available to reduce those gaps — but it cannot do it alone. Councils need to use their full range of powers and partnerships, from economic development to housing enforcement to community grant-making, to shift the conditions that drive inequality.

The LGA provides a range of support to councils, DsPH and public health teams to help them deliver their public health responsibilities and drive improvement.

Sector-led improvement

The LGA's public health and prevention improvement offer is funded by DHSC and is based on sector-led improvement principles. Support is requested by the council and tailored to local needs.

To discuss improvement support, Health in All Policies workshops, or any aspect of the LGA's public health offer, contact the LGA Public Health and Prevention team at: [email protected]