Guidance

Directors of public health in local government: roles, responsibilities and context

Updated 29 June 2023

Applies to England

This guidance sets out both the statutory and non-statutory elements of the local authority director of public health role. It seeks to promote understanding of this vital role and the ways it operates at the heart of effective arrangements to improve and protect the public’s health. It also sets out arrangements for appointing directors of public health, along with information on their corporate and professional accountability.

Prepared by the Department of Health and Social Care (DHSC), this guidance is written in collaboration with the Local Government Association (LGA), the Association of Directors of Public Health (ADPH), the Faculty of Public Health (FPH), NHS England (NHSE) and the UK Health Security Agency (UKHSA).

This guidance replaces the 2020 publication ‘Directors of public health in local government: roles, responsibilities and context’, and has been updated to reflect changes to the health and care system, including those resulting from the Health and Care Act 2022. It is published under section 73A(7) of the National Health Service Act 2006 (the 2006 Act) as guidance to which local authorities must have regard. 

Introduction

Effective action to improve and protect the public’s health is critical to our nation’s health and wellbeing, as clearly shown by experience of the COVID-19 pandemic. Directors of public health (DsPH) and their teams demonstrated a unique combination of leadership and expertise to support their communities and act as the local public health lynchpin within the broader pandemic response.

The public health system in England empowers local government to lead on major health issues that affect local populations. This enables a strategic approach tailored to local health needs and to address the determinants of health and health inequalities. DsPH will continue to play a key role as we face ongoing and new challenges, including action to increase healthy life expectancy, tackle health disparities and protect our communities from communicable and non-communicable diseases and other threats to health.

To support a local government-led approach to better public health, every local authority with public health responsibilities must, jointly with the Secretary of State (SoS) for Health and Social Care, appoint a specialist director of public health (DPH). The DPH is a statutory chief officer of their authority, accountable for the delivery of public health responsibilities, and the principal adviser on all health matters to elected members and officers, with a front-line leadership role spanning all 3 domains of public health – health improvement, health protection and healthcare public health. The DPH also has a vital system leadership role, working closely with place-based organisations in efforts to secure better public health.

These roles will continue to be crucial to place-based strategies and plans, and to co-ordinated system-wide action following the creation of integrated care systems (ICSs). The Health and Care Act 2022 establishes integrated care boards (ICBs), which are required to take account of joint local health and wellbeing strategies in which the DPH has a key role in design and/or sponsorship. Additionally, the act requires the creation of integrated care partnerships (ICPs) as a joint committee of ICBs and its partner local authorities, and production of an integrated care strategy responding to local needs assessments.

In turn, ICBs must have regard to that strategy in exercising their functions, including when drawing up their 5-year forward plans. Within a revised legislative framework that supports integration and collaboration, we expect DsPH to play a key leadership role in ICSs. In particular, DsPH will provide expertise and guidance on how system partners should work together to improve the public’s health, address health and care inequalities and fulfil statutory duties as set out in this guidance.

The role of the director of public health

This section outlines fundamental aspects of the DPH role as an influential system leader with oversight and expertise across all determinants of health within local authorities, the NHS and other sectors and agencies. It highlights the DPH role in the local context, including in influencing ICS strategies and plans in a complex system with a wide range of stakeholders, to influence and facilitate change in the interests of better health for local people.    

Please also refer to the guidance on the DsPH role, published by the Association of Directors of Public Health, for more information outlining the enduring essential characteristics of the role, including required qualities and skills. 

The DPH should:  

• be an independent advocate for the health of the population and provide leadership for its improvement and protection, and, as a statutory chief officer of the local authority, lead on advancing their authority’s public health objectives
• be the person to whom local authority elected members and senior officers look for expertise and advice on public health issues, from improving and protecting local people’s health through to outbreaks of disease and emergency preparedness, and access to health services
• provide the local public with expert, objective advice on health matters
• lead work to improve local population health by understanding the factors that determine health and ill health, and how to change behaviour and promote health and wellbeing in ways that also reduce health inequalities
• play a key role on the Health and Wellbeing Board, advise on and contribute to the development of joint strategic needs assessments and joint local health and wellbeing strategies, and promote commissioning of appropriate services accordingly
• promote action across the life course, working together with local authority colleagues working on matters such as planning, housing, transport and the environment as well as the director of children’s services and the director of adult social services. They should play a comprehensive role in their authority’s action to meet the needs of vulnerable adults and children - for example, by linking effectively with the local safeguarding arrangements - and engage with wider civil society partners in improving the health and wellbeing of the local population
• contribute to and influence the work of NHS commissioners, providers and other ICS partners, helping to lead a whole systems approach to public health across the public and private sector to improve health and care outcomes and experiences across the whole population. This includes providing appropriate challenge to arrangements for screening and immunisation programmes, advocating for an emphasis on reducing health inequalities and improving access for underserved groups. It will be important to work collaboratively with local, regional and national public health colleagues, including those working in the NHS and UKHSA, to promote effective, efficient and equitable healthcare
• work through local resilience forums and local health resilience partnerships to ensure effective and tested plans are in place for the wider health sector to protect the local population from risks to its health. The DPH should be assured that planning and arrangements to protect the health of the communities they serve are robust and are implemented appropriately to local health needs, capturing major communicable disease risks, major incidents involving a health sector response and that there is adequate capacity from relevant partner agencies to plan for and respond to health-related emergencies. The DPH should be able to escalate any concerns as necessary with the appropriate partner organisations, including the NHS and UKHSA. The DPH should provide assurance that all organisations involved in health protection co-operate and work together, including agreeing funding, roles and responsibilities and operational elements of response to incidents and outbreaks
• work with UKHSA and the NHS through the ICP to include health protection in their integrated care strategy, to deliver improved outcomes and to reduce health inequalities. Arrangements should include:
  • infection and prevention control within health and care settings
  • reducing vaccine-preventable diseases
  • prevention activities related to hazards such as needle exchanges for blood-borne viruses
  • commissioning of services for response to health protection hazards (such as testing, vaccination and prophylaxis) and to tackle locally and nationally agreed health protection priorities as well as emergency preparedness, resilience and response across all hazards
• work with local sectors, such as education, employment, and criminal justice partners and police and crime commissioners (PCCs) to promote safer communities. There are a range of natural areas for collaboration between DsPH and PCCs. These areas include but are not limited to the commissioning of drugs and alcohol services, mental health, adverse childhood experiences, violence against women and girls including domestic abuse, illicit tobacco, and developing a ‘public health approach’ to crime and disorder. DsPH are well placed to work with PCCs on addressing wider determinants (for example, improving the public environment through appropriate licensing), and other health-related issues, such as input into refugee health challenges in conjunction with local health protection teams and NHS colleagues
• take responsibility for the oversight of their authority’s public health services, with professional responsibility and accountability for these services’ effectiveness, availability and value for money. This includes ensuring the authority’s public health grant (for those authorities in receipt of the grant) has been spent in accordance with the conditions set and complying with the year-end statement of assurance as set out in the relevant annual grant circular. Guidance on reporting and categorisation of spend is available to local authorities in the Service Reporting Code of Practice (SeRCOP)

Statutory functions of the director of public health

This section describes the legal duties of the DPH, as a statutory chief officer of their local authority, a status conferred by section 2(6)(zb) of the Local Government and Housing Act 1989. A number of the DPH’s specific responsibilities and duties arise directly from acts of Parliament, mainly the National Health Service Act 2006 (as amended), the Health and Social Care Act 2012 (the 2012 Act), and related regulations. Some of these duties are closely defined but most allow for local discretion in how they are delivered.

In general, the statutory responsibilities of the DPH are designed to match exactly the corporate public health duties of their local authority. The exception is the annual report on the health of the local population: the DPH has a duty to write an independent report, whereas the local authority’s duty is to publish it (under section 73B(5) and (6) of the 2006 Act). The content and structure of the report may be decided locally.  

Section 73A(1) of the 2006 Act gives the DPH responsibility for: 

• all of their local authority’s duties to take steps to improve the health of the people in its area
• any of the SoS’s health protection or health improvement functions delegated to local authorities, either by arrangement or under regulations. These include services mandated by regulations made under section 6C of the 2006 Act, and functions exercised in pursuance of joint working and delegation arrangements, or other prescribed arrangements, made with another body by virtue of sections 65Z5 or 75 of the 2006 Act
• exercising their local authority’s functions in planning for, and responding to, emergencies that present a risk to the public’s health

• their local authority’s role in co-operating with the police, the probation service and the prison service to assess the risks posed by violent or sexual offenders

• such other public health functions as the SoS specifies in regulations, including services prescribed under section 6C of the 2006 Act and under dental public health powers under 111 of the 2006 Act, as amended

As well as the core functions listed above under section 73A(1) of the 2006 Act, various acts and regulations give the DPH some more specific responsibilities:  

• DsPH must have a place on their local health and wellbeing board (section 194(2)(d) of the 2012 Act)
• through regulations made under section 73A(1) of the 2006 Act, responsibility for their local authority’s public health response as a responsible authority under the Licensing Act 2003, such as making representations about licensing applications (a function given to local authorities by sections 5(3), 13(4), 69(4) and 172B(4) of the Licensing Act 2003, as amended by Schedule 5 of the 2012 Act)
• if the local authority provides or commissions a maternity or child health clinic, then regulations made under section 73A(1) also give DsPH responsibility for providing Healthy Start vitamins (a function conferred on local authorities by the Healthy Start Scheme and Welfare Food (Amendment) Regulations 2005, as amended)

The DPH is also expected to lead or oversee activity under the statutory requirement placed on the local authority (under section 6C regulations) to provide the NHS with a public health advice service to inform effective commissioning of healthcare and related matters. Whereas this duty previously referred to provision of advice to clinical commissioning groups (CCGs), regulations have been updated so that this duty now requires provision of a public health advice service to the relevant integrated care board(s) (ICBs). 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 new section 14Z38 of the 2006 Act) from appropriate persons on prevention and public health. ICBs also have a new 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.

Additional guidance on delivering a quality public health function is also available, jointly issued by the FPH, ADPH, LGA and NHSE: Delivering a quality public health function in integrated care boards.

Corporate and professional accountability

Corporate accountability

DsPH are politically restricted posts under section 2 of the Local Government and Housing Act 1989. They share the same kind of corporate duties and responsibilities as other senior staff. To discharge their responsibility to their authority and in law, and deliver real improvements in the public’s health, the DPH needs both an overview of the authority’s activity and the necessary degree of influence over it.  

In practice, this will usually mean that the DPH is a standing member of their local authority’s most senior corporate management team. In cases where the DPH is not a member of this team, they need the right access to the Chief Executive and elected members to influence and enable a contribution to decision-making. Membership of this team should be determined locally. All local authorities should ensure direct accountability, and direct access, between the DPH and the local authority Chief Executive (or other head of paid service) and other elected members for the exercise of the local authority’s public health responsibilities.

Each local authority with a shared DPH should ensure roles, responsibilities and working arrangements are clearly defined and agreed on a sustainable basis with the other local authorities the DPH works for. Similarly, where several DsPH cover a single commissioning organisation (ICP or ICB), there should be locally determined agreement as to how input is managed to align approaches and to avoid role conflict.

Professional accountability

Regulation and registration

DsPH should be registered specialists in public health. They may come from different professional backgrounds. Those with medical and dental backgrounds are registered with and regulated by the General Medical Council (GMC) or the General Dental Council (GDC). Those with other professional backgrounds are registered with and regulated by the UK Public Health Register (UKPHR). Standards of competence, education and experience to enter any of the specialist registers are set by the Faculty of Public Health (FPH). In most cases these are identical, regardless of which body the specialist is registered with. The Secretary of State will not regard an applicant for a DPH post as suitable unless they have the appropriate registration.  

To assure themselves of the continuing competence of their DPH, local authorities should ensure that they:  

• undertake a continuing professional development (CPD) programme that meets the requirements of the FPH or other equivalent professional body
• undertake appropriate annual professional appraisal to ensure revalidation and fitness to practise
• maintain a programme of personal professional development to ensure competence in professional delivery. This programme should include all training and development needs identified by both management and professional appraisal processes

Revalidation

Revalidation is the process by which registered specialists in public health, including DsPH, are required to demonstrate to the relevant specialist register that their skills are up to date and that they are fit to retain their licence to practise. The requirements for revalidation for the GMC and UKPHR vary but are broadly equivalent. The GMC and UKPHR publish guidance on their revalidation processes.  

GMC registrants require a designated body and responsible officer for the purposes of revalidation. UKHSA, DHSC (including the Office for Health Improvement and Disparities (OHID)) and NHSE are the designated bodies for registrants they employ directly.  

It is expected that DHSC (including OHID) will become the designated body for local government employed registrants during 2023.

The UKPHR directly revalidates its registrants (in other words, no designated body is needed). GDC registrants, not otherwise registered with UKPHR, must meet strengthened CPD requirements to maintain GDC registration.  

The role of responsible officers

The Medical Profession (Responsible Officer) Regulations 2010 (as amended in 2013) apply to DsPH who are GMC registrants. Each designated body for the purposes of regulations is required to appoint a responsible officer.  

Responsible officers help to evaluate doctors’ fitness to practise and monitor their conduct and performance in the context of compliance with the elements of good medical practice as prescribed by the GMC. The role of the responsible officer is to discharge the duties of the designated body in supporting doctors to maintain and improve the quality of service they deliver, and to protect patients and citizens in those cases where doctors fall below the high standards set for them.

The responsible officer:  

• makes recommendations to the GMC about the fitness to practise of doctors
• assures the quality of professional appraisals
• ensures that recommendations are informed by clinical governance information provided by the employing organisation, and other key stakeholders, where appropriate
• provides support and advice to employers and appraisers where professional concerns have been identified, in liaison with GMC and GDC when appropriate

Professional appraisal and continuing professional development

Local authorities should assure themselves that all public health professionals have sufficient time and resource to maintain their portfolios of professional public health competence, participate in annual professional appraisal and that those with suitable experience and training are supported and enabled to appraise others in the public health system.  

Continuing professional development (CPD) is a contractual entitlement for directors in local government employed on medical and dental contracts. To comply with the FPH minimum standards for CPD, all faculty members must either submit a satisfactory CPD return annually or have been formally exempted by the FPH from this requirement. CPD undertaken should be linked to a personal development plan agreed through their professional appraisal. The UKPHR expects all its registrants to participate in CPD, preferably as part of a formal scheme operated by a professional body.  

Personal development plans should include recommendations made as a result of both management and professional appraisal. This ensures that CPD activities are suitably aligned to the needs of the employing body, and the professional development requirements of the individual. 

Appointing directors of public health

The local authority and SoS must jointly appoint the DPH (under section 73A(1) of the 2006 Act), with the latter normally delegating the function to a senior DHSC official (currently the relevant regional director for OHID).  

The SoS will not normally intervene in decisions about matters such as the role or position of DsPH within local authorities but must intervene – and ultimately may refuse to agree a joint appointment – if the SoS has reason to believe that a local authority’s proposed appointment would be contrary to the SoS’s general duties under the 2006 Act.  

Requirements for DPH appointments

Please also refer to the FPH website which describes the recruitment process for senior public health appointments in further detail with links to supporting guidance for employers, advisors and assessors. 

Local authorities recruiting a DPH should:  

• design a job description that includes specialist public health leadership and an appropriate span of responsibility for improving and protecting health, advising on health services and ensuring that the impact on health is considered in the development and implementation of all policies, and make every effort to agree the job description with the FPH and the SoS’s representative
• manage the recruitment and selection process and set up an advisory appointments committee (ACC) to make recommendations on the appointment to the leader of the local authority

It is good practice for the ACC (see National Health Service (Appointments of Consultants) Regulations 1996, as amended) to be chaired by a locally elected member of the local authority. It should also include:  

• an external professional assessor, appointed after consultation with the FPH, which maintains a list of appropriately trained individuals
• the chief executive or other head of paid service of the appointing local authority (or their nominated deputy)
• the relevant OHID regional director, or another senior professionally qualified member of DHSC acting on behalf of the SoS
• senior local NHS representation, for example, an ICB board member. The OHID regional director can usually fill this role given their joint DHSC-NHS appointment
• in the case of appointments to posts which have teaching or research commitments, a professional member nominated after consultation with the relevant university

As envisaged in regulations, in exceptional situations where a local authority needs to appoint a short-term interim or locum DPH, it may be appropriate to modify elements of this process. In these cases, the advice of the OHID regional director and faculty advisor should be sought from the outset of the interim recruitment.

The role of the Secretary of State and DHSC

The relationship of the SoS and the local authority in the joint appointment process is one of equals. The role of the SoS is to provide additional assurance of the DPH’s competency. This means that officials acting on behalf of the SoS should be involved in all stages of the process, including providing the necessary support enabling local authorities to identify and appoint a DPH suited to their organisational need. They will advise the SoS on whether:  

• the recruitment and selection processes were robust
• the local authority’s preferred candidate has the necessary technical, professional and strategic leadership skills and experience to perform the role – proven by their specialist competence, qualifications and professional registration

To provide this assurance, officials acting on behalf of the SoS will:  

• agree a job description with the local authority and the FPH that fits with the responsibilities of the DPH and sets out the necessary technical and professional skills required
• offer advice in relation to the recruitment and selection process, including the appointment of FPH assessors
• participate in the local advisory appointment committee
• ensure the interests of the SoS are taken into account in circumstances where the designated DsPH responsibilities are carried out by an officer with other broad responsibilities

OHID regional directors will work with local authorities in any area where there is a DPH vacancy to ensure a robust and transparent appointment process is established and a timescale for recruitment and appointment agreed. This should be completed within 3 months of a post becoming vacant.  

If the OHID regional director has concerns about the process or their involvement in it, they will seek to resolve these concerns through negotiation with the local authority. It is important that the interaction between the OHID regional director and/or the local authority is based on dialogue, collaboration and agreement.  

The local authority has the primary role in recruiting people who will be under contract to it. However, there are clear joint considerations in processes for appointing a DPH. If, at the end of this procedure, the SoS is not satisfied that an appropriate recruitment process has taken place and that the local authority preferred candidate has the necessary skills for the role, they will write to the lead member and chief executive of the council setting out in full the reasons for not agreeing the appointment and proposing steps to resolve the situation.  

Under section 73A of the 2006 Act: 

• the SoS can direct a local authority to review the DPH’s performance (section 73A(4)), to consider taking particular steps, and to report back if the local authority believes that a DPH is not properly carrying out any SoS function that has been delegated to the local authority. This power does not extend to the DPH’s performance of the local authority’s own health improvement duties
• a local authority must consult the SoS before dismissing its DPH (section 73A(6)). The authority may still suspend its DPH from duty (following its standard rules and procedures) and the SoS cannot veto its final decision on dismissal. An authority proposing dismissal for any reason should contact an OHID regional director for advice on how to proceed with the consultation. OHID will normally provide the SoS’s formal response within a maximum of 28 days