ABSTRACT
This chapter looks at the forces that are changing the way people deliver health services. In addition to the white Paper 'Equity and Excellence: Liberating the National Health Service (NHS)' a public health white paper 'Healthy Lives-Healthy People-Our Strategy for Public Health in England' has been published. This needs to be understood as showing the direction of travel for the NHS and how it is adapting to the post credit crunch world of diminished resources. The white paper focuses on the necessity to reduce health inequalities and states clearly that they are part of wider inequalities and are interlinked. It notes the importance of work in reducing health inequalities, to improving education performance and to changing adult lifestyle behaviours and choices. Public health professionals have been disempowered and their skills not sufficiently valued when compared with their counterparts in NHS acute services.
