Public health and local government: reflections on the 10-year NHS Health plan

The Government’s Fit for the Future: 10-Year Health Plan for England sets out a transformative vision for healthcare, shifting from a hospital-centric model to a community-based, preventative system. This reorientation aims to manage rising demand, improve health outcomes, and ensure the NHS’s long-term sustainability.

At the heart of the plan is the creation of a Neighbourhood Health Service, designed to deliver integrated, personalised care within local communities. This model reduces reliance on hospitals by offering services closer to home and places strong emphasis on prevention, early intervention, and digital tools. The NHS App is expected to become a central platform for booking appointments, accessing care plans, and communicating with healthcare professionals.

The plan also references the broader social determinants of health—such as housing, employment, and education—through closer collaboration between the NHS and local authorities. Public health teams will work with schools, community organisations, and local partners to create healthier environments and promote healthier lifestyles.

Local government is positioned as a key partner in this transformation. Integrated Care Boards (ICBs) will be aligned with strategic authorities to ensure health planning is coordinated with wider social and economic strategies. Local authorities will co-develop Neighbourhood Health Plans tailored to local needs.

The plan outlines targeted action on several major public health challenges. On air quality, it commits to working with local authorities to reduce pollution in high-risk areas, recognising its impact on respiratory and cardiovascular health. In tackling HIV, the plan supports the goal of ending new transmissions by 2030 through expanded testing, access to PrEP, and community outreach. To address obesity, it proposes a whole-systems approach involving schools, local food environments, retailers and active travel initiatives, alongside support for weight management services.

The government also renews its commitment to reducing tobacco use, aiming for a smoke-free generation by 2030. This includes measures such as raising the age of sale, expanding smoking cessation services, and restricting youth access to vaping products. On alcohol, the plan supports local licensing reforms, improved treatment pathways, and public awareness campaigns to reduce alcohol-related harm. it stops short of endorsing or even discussing minimum unit pricing (MUP) as a policy tool.

This omission is notable, as MUP has been implemented in Scotland and Wales and is supported by many public health experts as an effective measure to reduce harmful drinking, particularly among high-risk groups.

A renewed focus is placed on health visitors, recognising their critical role in early years development and family health. The plan includes investment in expanding the health visiting workforce and integrating their services more closely with community health teams.

Health and Wellbeing Boards (HWBs) are also referenced as part of the local governance infrastructure supporting the delivery of place-based health strategies. HWBs are expected to contribute to joint strategic needs assessments and help align the work of ICBs with local authority priorities. However, the plan does not propose any significant reform or expansion of HWBs’ powers, leaving their role largely advisory. This has led to concerns that the plan misses an opportunity to strengthen HWBs as vehicles for local accountability and integration.

Mayors are also acknowledged as important actors in the new health landscape. While mayors are acknowledged as important actors in the new health landscape, the plan does not propose any formal transfer of public health powers to mayoral offices. Instead, it supports a model of collaborative governance, where mayors work alongside local authorities, ICBs, and Health and Wellbeing Boards to improve population health outcomes.

Importantly, the plan does not propose shifting public health services back to the NHS. Instead, it reinforces the post-2013 model in which local authorities retain responsibility for public health, while promoting stronger collaboration with NHS bodies. Public health functions such as health improvement, health protection, and population health intelligence remain under local government leadership, supported by joint planning mechanisms and integrated funding streams.

The plan also expresses a broad ambition to improve life expectancy and narrow the gap between the most and least deprived communities. It frames prevention, digital access, and community-based care as key levers for addressing health inequalities. However, it does not provide a detailed roadmap for how these goals will be achieved, nor does it outline how progress will be measured or how resources will be targeted toward the most disadvantaged populations.

Despite its ambition, the plan has drawn mixed reactions. The Faculty of Public Health (FPH) has welcomed the emphasis on prevention but raised concerns about funding clarity and workforce capacity. The Association of Directors of Public Health (ADPH) has warned that the digital-first approach could widen health inequalities if not carefully managed, and the Royal Society for Public Health (RSPH) has noted that past efforts to shift resources toward prevention have often faltered due to short-term pressures.

Yet, for all its strengths, the plan leaves several critical areas of public health underdeveloped or unaddressed. It lacks a comprehensive workforce strategy for public health professionals beyond health visitors, with little mention of roles such as environmental health officers or public health analysts. Mental health prevention is not robustly addressed, with limited focus on upstream interventions in schools, workplaces, or housing. While digital transformation is a key theme, the plan does not fully explore how structural inequalities—such as racism, disability, or geographic deprivation—impact health outcomes, nor does it provide a clear equity framework.

Environmental health and climate change receive minimal attention beyond air quality, despite growing evidence of their impact on population health. Broader sexual health services, including STI testing and contraception access, are largely absent. The plan also lacks detail on how public health data and surveillance systems will be modernised or integrated with NHS data—an essential component of effective prevention. Furthermore, while the plan promotes community-based care, it does not outline how communities themselves will be empowered to shape services through co-production or participatory approaches.