The first concern is the role of PH in the control of communicable diseases. The law currently lags behind the reforms of both the health service and Local Authorities. No one has a duty to control infectious disease. As public health is in the purchaser authority, relationships have also have to be established between them and providers in the form of general practitioners and hospital trusts, in a similar way to what happened before the National Health Service but with one major difference. There now exists a Public Health Laboratory Service, and the microbiologists in these and other laboratories are no longer under the control of local authorities. Although co ordination is possible and occurs in many instances, clear lines of responsibility, accountability and relationship need to be established if proper control and prevention of infectious disease is to be possible.

The second major problem is that usually the only medically qualified executive director of a Health Authority or Board is the Director of Public Health. He or she is able to offer advice and provide knowledge of clinical matters which the other executive and non-executive directors do not have. This is a powerful role. Directors of Public Health now have authority not only in matters concerned with public health, but also in areas of clinical concern in which they are not expert, such as establishing clinical priorities and monitoring services.