Public Health and Local Government Reorganisation

No. When a new unitary authority is created, it must make its own statutory appointments, including the DPH. Your existing appointment does not transfer automatically. Shadow or preparing authorities will need to run appointment processes ahead of vesting day. The joint appointment requirement, involving both the local authority and the Secretary of State (currently delegated to the Department of Health and Social Care (DHSC) regional directors of public health (DsPH), applies to all new appointments. This takes time, and planning needs to start well before the shadow authority is formally constituted.

Shadow and preparing authorities have governance responsibilities but do not yet hold the full legal powers of the new council. In practice, existing DsPH in the predecessor authorities will continue in their statutory roles until vesting day. However, shadow/preparing authorities will need to establish how public health advice and leadership will be provided to their emerging structures, and many will want a nominated DPH lead for the transition period. The LGA and the Association of Directors of Public Health (ADPH) advise DsPH to engage early with shadow/preparing authority leaders about this, rather than waiting to be asked.

In some areas, yes. For example, Essex, Norfolk, and Suffolk are each moving to a greater number of unitary authorities than their current upper-tier DPH arrangements, which is likely to require the creation of additional posts.

Shared arrangements are legally permissible and do successfully operate in some areas. However, our view is that shared DPH arrangements should be an exception, not a structural model. Every new unitary authority deserves dedicated public health leadership. Where shared arrangements are proposed, DsPH should satisfy themselves that the governance arrangements are clear, that the statutory independent advocacy function of the DPH role is not compromised, and that adequate public health team capacity exists in each authority to support the role.[

The LGA and ADPH are seeking early clarity on the approach and assurance that reorganisation timing will not result in sudden funding changes for any area. DsPH may wish to begin mapping existing grant-funded services against potential new authority boundaries to help identify any risks or discontinuities at an early stage.

This is one of the most practical immediate challenges. Services commissioned by a county council on behalf of a large geography will often not align neatly with new unitary footprints. Contracts may need to be novated, renegotiated, or re-specified. DsPH should audit their current commissioned service contracts for boundary sensitivity as a priority, and raise any concerns with their section 151 officer and with the shadow authority transition team. 

DsPH should begin reviewing commissioning arrangements at the earliest opportunity. This should include mapping contract end dates, break clauses and renewal points to identify where alignment across future footprints can be achieved, and where extensions or interim arrangements may be necessary to support transition. This is particularly important where areas are entering into new contracts ahead of reorganisation, to avoid locking in misaligned commissioning arrangements that cut across future authority boundaries.

Further advice on LGR and procurement is available in our LGR Toolkit.

The consolidation into a single grant is a structural change to how the money flows, not a boundary-dependent change. However, DsPH in transitioning areas should ensure that their current reporting and spend monitoring arrangements are sufficiently granular that they can demonstrate compliance with grant conditions under both existing and new authority structures. DHSC will expect assurance from both the new authority chief executive and the new DPH, and those relationships need to be in place before vesting day.

HWBs are constituted at upper tier and unitary authority level. When predecessor councils are abolished, their HWBs cease to exist. New unitary authorities must establish new HWBs. This is a significant governance moment: the composition, the terms of reference, the relationship with the ICB, and the strategic focus of the new HWB can all be reset. 

Not necessarily from scratch, but substantially updated. A JSNA is the evidence base for a specific population and geography. Where new unitary boundaries do not map onto existing JSNA geographies, the data picture will need to be reconstructed. DsPH should begin engaging with their local intelligence teams, Office for Health Improvement and Disparities (OHID) regional colleagues, and Integrated Care Board (ICB) partners on what a new JSNA footprint would require. For areas where multiple predecessor JSNAs need to be integrated, this is a significant piece of analytical work.

Several things. First, make yourself known to the transition team leading reorganisation in your area, and ensure public health is represented in transition governance, not just consulted after decisions are made. Second, map your current services, contracts, and team structures against proposed new boundaries, so you have an evidence base for conversations about future capacity. Third, discuss the emerging workforce picture in your region and share with ADPH and the LGA any systemic issues you are encountering. And fourth, start thinking about what you want the public health function in the new authority to look like, because if DsPH do not shape that, someone else will.

Yes, where that is practically possible. The uncertainty is real, and the final footprints in many areas will not be confirmed until later in 2026. DsPH in those areas are in a difficult position, but the answer is engagement, not waiting. Building relationships with all plausible future authority leads is not premature; it is prudent. It also positions public health as a function that understands the transition, rather than one that needs to be carried through it.

Local Government Reorganisation places genuine and competing demands on senior capacity, particularly for Directors of Public Health who hold statutory responsibilities. It is widely recognised across the sector that the greatest risk during LGR is that essential business as usual activity, including prevention, health protection and safeguarding, is unintentionally deprioritised.

The clear expectation is that statutory public health functions and core population health priorities must continue to be protected throughout the transition. Councils that have navigated LGR most effectively have done so by putting in place clear transition governance, delegating appropriately, and being explicit about what must continue uninterrupted. Being realistic about capacity, and acknowledging that not all LGR activity can or should sit with DsPH, is critical to minimising risk to outcomes.

Sector led learning shows that clarity of roles, time limited arrangements, and organisational recognition of pressure points are essential to maintaining delivery alongside reorganisation. 

Workforce uncertainty is one of the most significant challenges associated with LGR, particularly for public health teams whose professional identity and ways of working are closely linked to organisational structures. Supporting staff well through change is not optional; it is fundamental to safeguarding service continuity, quality and population outcomes.

Good practice consistently points to the importance of early, honest and ongoing communication, even where definitive answers are not yet available. Visible leadership from senior officers, strong engagement with HR and organisational development teams, and clear commitment to fairness and transparency help build trust. 

LGR also offers an opportunity to rethink how public health teams are structured, how roles and career pathways are defined, and how specialist skills are best deployed at scale. This opportunity can only be realised if workforce wellbeing, professional integrity and retention are treated as priorities throughout the transition.

More guidance on LGR and workforce issues can be found in our LGR Toolkit.

While LGR is inherently disruptive, it also represents a significant strategic opportunity for public health. New unitary authorities often have stronger and more streamlined governance, providing a powerful platform to embed prevention and Health in All Policies more consistently across the organisation.

Reorganisation allows councils to build health considerations into new constitutions, decision making frameworks, cabinet portfolios and scrutiny arrangements from the outset. Many councils are using this moment to reposition public health as central to place leadership, economic resilience, sustainability and tackling inequalities, rather than as a standalone function.
If approached deliberately, LGR can help normalise health as a shared responsibility across planning, transport, housing, education and economic development, strengthening long term outcomes for communities.

Concerns about commissioning at scale are particularly pronounced for smaller unitaries, where individual public health grant allocations may be insufficient to sustain certain services independently. The shared principle across the sector is that service quality, equity and workforce sustainability must not be compromised by organisational boundaries.

Flexible commissioning approaches, such as joint committees, lead commissioner models, hosted arrangements and pooled budgets, are well established and offer a practical means of maintaining scale and resilience. LGR provides an opportunity to review and rationalise commissioning footprints so they better reflect population needs rather than historic structures.

Effective collaboration between councils, underpinned by clear governance and shared outcomes, is key to ensuring services such as health visiting and specialist provision remain robust and sustainable.