This chapter looks at the forces that are changing the way we deliver health services and will pay particular attention to the two white papers on health ‘Equity and Excellence: Liberating the NHS’ which deals with health service reforms, and ‘Healthy Lives-Healthy People-Our Strategy for Public Health in England’3 which focuses on public health and will initiate the biggest change in this area for many decades. Whilst there is a long history of white papers on health which sound radical and call for drastic change, their effects are normally watered down in the implementation and the result is tinkering rather than wholesale change. However, the combination of the desire for change in the delivery of public services shown

1 Equity and excellence: Liberating the NHS Department of Health July 2010. 2 Laurance, J. (2010) ‘NHS Ordered to Find Massive Savings’, Independent, March

by the coalition government, as revealed in the big society agenda, allied to a severe lack of funds to enable ‘carry on as usual’ policies, means this is unlikely to be the case this time. We have an unusual coalescence of desire for change, allied to a financial imperative of deliverance with reduced funds, which means that we should expect radical changes in the way the health sector is run and how services are delivered with much greater weight given to public health in achieving health outcomes.