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Commissioning Public Health Services

Commissioning Public Health Services: the impact of the health reforms on access, health inequalities and innovation in service provision

This research project (2015-2017) was funded through the NIHR Policy Research Programme and led by Durham University. PI: Linda Marks; Co-Investigators: David Hunter, Shelina Visram (previously Durham University and currently Institute of Health and Society (IHS), Newcastle University); Anne Mason, University of York, Howard Davis, Coventry University and Joanne Smithson, Voluntary Organisations’ Network North East; and Research Associates: Llinos Mary Jehu, previously Durham University and Dan Liu, University of York.

In April 2013, major public health reforms came into force in England: local authorities were given new responsibilities for promoting, protecting and improving the health of their populations. Public health teams were relocated from the NHS and local authorities received a public health budget, transferred from the NHS and intended for public health purposes. The reforms reaffirmed the role of local authorities in influencing social factors with an impact on health and health equity and were intended to promote innovation and local responsiveness in a context of democratic accountability.

This project evaluated the impact of the reforms through three interrelated workstreams. Workstream 1 investigated how the public health budget was spent over time while Workstream 2 explored innovation in how preventive services are being provided, remodelled or targeted and how local communities are involved. Crucially, success of the reforms depends on public health-related changes in mainstream local authority services, and this was investigated in Workstream 3.

Methods included surveys to provide a national overview, data analysis of spend and health outcomes and in-depth studies of ten local authorities.

Research outputs will contribute to effective public health commissioning for the public health budget and across local authority services. The project complies fully with procedures for preserving anonymity of participants and for data governance.

A project External Advisory Group was convened, spanning policy and practice partners at national and local levels, including representation from the Society of Local Authority Chief Executives, Public Health England, NHS England, Healthwatch England, the Local Government Association and the charitable sector.

Meet the Research Team

Linda Marks

Linda Marks, Principal Investigator

Linda Marks was Senior Research Fellow at the Centre for Public Policy and Health from 2001-2017. Her background is in medical sociology, health policy analysis and the organisation of primary care. She was a Non-Executive Director of NHS Darlington from 2007-11 and acted as adviser to WHO European Region on their public health action plan, approved by Member States in September 2012.

Linda's previous experience includes a ten year association with the King's Fund, where she was a Fellow in Health Policy Analysis. Her research interests include governance, priority-setting, public health policy and inequalities in health. Her most recent book ‘Governance, Commissioning and Public Health’ was commissioned by Policy Press and published in July 2014. Linda was also co-investigator for a NIHR School for Public Health Research-funded study on prioritising public health investment. 

David Hunter

David Hunter, Co-Investigator

David Hunter was professor of health policy and management, and director of the Centre for Public Policy and Health at Durham University from 2001-2017. He is known internationally for his work on health system reform, complex systems, and leadership in health, as well as being as non-executive director of NICE and deputy director of Fuse (UKCRC Centre for Translational Research in Public health). David has been involved in several NIHR, DH and ESRC-funded projects, including studies on transformational change in health systems, public health partnerships and world class commissioning. David is currently Professor at IHS, Newcastle University.

Llinos Mary Jehu

Llinos Mary Jehu, Former Postdoctoral Research Associate, Durham University

Llinos Mary Jehu returned to research in 2010, receiving a PhD from Bangor University where she considered the involvement of lay people in the development and delivery of the Strategy for Older People: asking why some people become involved, why others choose not to and why some are unable to have their voice heard. Llinos moved to Durham from Robert Gordon University where she was a Research Assistant for a study considering peer-mentoring as an intervention for persistent low back pain. Before returning to academia, Llinos spent much of her career within the public, voluntary and community sectors and has a strong interest in partnership approaches to policy planning and service development. She obtained an MPhil from Cardiff Business School in 1990, researching statutory-voluntary sector coordination of services for adults with disabilities. Llinos is now a Research Fellow in the School of Social Policy, University of Birmingham. 

Shelina Visram

Shelina Visram, Co-Investigator, Durham University

Shelina Visram was previously Associate Professor in the Centre for Public Policy and Health, Durham University. She has expertise on health inequalities, asset-based approaches and lifestyle interventions, and is experienced in service evaluation and qualitative research. She held an NIHR doctoral research fellowship award and was Co-I on an NIHR HTA evidence synthesis on the effectiveness of different types of health-related lifestyle advisor. Shelina is an associate member of Fuse and a fellow of the Wolfson Research Institute for Health and Wellbeing.‌ She is currently Senior Lecturer at IHS, Newcastle University.

Staff Photo for Anne Mason

Anne Mason, Co-Investigator, Senior Research Fellow, University of York

Anne Mason is a senior research fellow at the Centre for Health Economics, University of York, and is co-director of ESHCRU.

Current research includes evaluating the effects of GP care on outcomes for people with serious mental illness (HS&DR Project - 13/54/40) and on admissions to hospital and to long-term care for people with dementia; a project led by Durham University investigating the impacts of the public health reforms; and a study on efficiency, cost and quality of mental health provision (funded by the Health Foundation).

Dan Liu staff photo

, Research Fellow, University of York

Dan Liu is a Research Fellow at the Centre for Health Economics, University of York. She joined the team in 2015. She holds a Master Degree in Economics from Shanghai University of Finance and Economics and a PhD in Economics from DEFAP Graduate School in Public Economics, which is jointly founded by Catholic University of Milan and University of Milano-Biccoca. She has experience working at the World Health Organization.Dan’s research interests include: health reforms; healthcare system and providers’ quality and competition; impact of public policy on health and behaviour; incentives in public health.

Joanne Smithson

Joanne Smithson, freelance Policy, Partnerships and Engagement advisor and an experienced leader and senior manager in the public and voluntary & community sectors

Joanne is a freelance Policy, Partnerships and Engagement advisor and an experienced leader and senior manager in the public and voluntary & community sectors.

In addition to her work on this Public Health research, Joanne manages a portfolio career. Her primary role is project manager for an AHSN funded research project, Improving Patient Pathways for Persistent Physical Symptoms, learning more about how people with CFS/ME, Fibromyalgia and IBS experience local health and Care Services.

Joanne also works as an Associate with VONNE (the Voluntary Organisations’ Network North East) supporting their work on Health and Social Care, and with Aspire Development as a leadership and management development trainer.

Howard Davis

Howard Davis, previously Executive Deputy Director, Centre for Communities & Social Justice, Coventry University and Professor of Social and Local Policy.

Howard has a strong background in local government and has had a long involvement in a large number of projects advising on and/or evaluating the modernisation and improvement of public services – commissioned by both national and local governments. He also has many years of experience of international working with particular reference to improving the delivery of local and public services. He has served as a member of the Coventry Health & Wellbeing Board and a variety of transformation, programme and partnership boards.

For further information and updates regarding this study please contact: 


External Advisory Group

Terms of Reference for the PRP Project External Advisory Group

The External Advisory Group (EAG) for the project provided independent comment and advice in regard to the progress of the study throughout its duration and suggested ways in which research outputs might be disseminated throughout the local government community and other organisations to maximise their value and impact. Members of the EAG, and their affiliations at the time of the project, were as follows


Rob Bellingham, Director of Commissioning (Greater Manchester) NHS England

Gerard Crofton-Martin, Head of Network Oversight and Support, Healthwatch England

Dr Jo Farrar, Chief Executive, Bath and North East Somerset Council Policy spokesperson on community wellbeing, Society of Local Authority Chief Executives (SOLACE)

Professor Peter Kelly, Director of Public Health, Stockton-on-Tees Borough Council

Dr Roberta Marshall, Centre Director, North East, Public Health England

David Pye, Lead Analyst, Research and Information Team, Local Government Association

Bev Wears, Service Development Manager (North) British Lung Foundation

Research Outputs/Presentations

Final Report

Commissioning Public Health Services Executive Summary (PDF , 410kb)

Commissioning-Public-Health-Services final report Dec 2017 (PDF , 3,287kb)


  • Jehu L, Visram S, Marks L, Hunter D, Davis H, Mason A, Liu D, Smithson J. Directors of public health as 'a protected species': qualitative study of the changing role of public health professionals in England following the 2013 reforms. Journal of Public Health 2017;doi:10.1093/pubmed/ fdx154. Download from OUP
  • Mason A, Liu D, Marks L, Davis H, Hunter D, Jehu LM, Visram S, Smithson J. Local authority commissioning of NHS Health Checks: A regression analysis of the first three years. Health Policy 2018;doi:10.1016/j.healthpol.2018.07.010. Download from ScienceDirect

Research Outputs

Presentations from the CPHS National Conference: King’s Manor, York, 28 June 2017

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