Examination of witnesses (Questions 196
- 199)
THURSDAY 23 NOVEMBER 2000
DR PETER
DONNELLY, DR
ROSEMARY GELLER,
PROFESSOR JAMES
MCEWEN,
PROFESSOR SIAN
GRIFFITHS, MR
JOHN NICHOLSON
and MR GEOF
RAYNER
Chairman
196. Colleagues, can I welcome you to this morning's
session of the Committee. Can I begin by welcoming Marion Roe
back to the Committee. We are very pleased to see you and we wish
you well in your work. Can I particularly welcome our witnesses
for this first session this morning. I wonder if you would each
briefly introduce yourselves to the Committee.
(Dr Donnelly) I am Dr Peter Donnelly, Director of
Public Health in Lothian based in Edinburgh and I am President
of the Association of Directors of Public Health.
(Dr Geller) I am Dr Rosemary Geller. I am Director
of Public Health in Shropshire and I am here in the capacity of
Vice President of the Association of Directors of Public Health.
(Professor McEwen) Jim McEwen, President of the Faculty
of Public Health Medicine and also Professor of Public Health
at the University of Glasgow.
(Professor Griffiths) I am Sian Griffiths. I am Vice
President of the Faculty and I am Director of Public Health in
Oxfordshire, currently on part-time secondment to the DETR.
(Mr Nicholson) Dr John Nicholson, Chief Executive
of the UK Public Health Association.
(Mr Rayner) I am Dr Geof Rayner and I am the Chairman
of the UK Public Health Association.
197. Thank you very much. Can I begin by exploring
some of the areas that we touched on last week. You may have been
made aware of the areas that we covered in last week's session.
Can I ask, first of all, for your views on the location of the
Minister for Public Heath. You will be aware that there has been
some discussion about whether that role is properly located within
the Department of Health or whether it should be a much more wide-ranging
role. I was interested in the evidence from the UKPHA where you
said: "Enhancing the role of a Minister for Public Health,
so as to be independent of existing of Departments and with responsibility
for overseeing progress across Government, might enable local
initiatives to become more effective." I am interested in
that point because, as you may be aware, the current Public Health
Minister has said that detaching her role from the Department
of Health would be silly and not something that she would support.
Can you say a bit more about what your reasons are for arguing
that that change might take place?
(Mr Rayner) I think it is about power and visibility.
We are pushing this argument because we think that public health
needs to have a far stronger and wider and more visible remit.
It needs to be more visible right across government. It needs
to continue to have the support of the Department of Health, but
because the Minister is linked to the Department of Health and
perhaps, in terms of the pecking order of ministries, the Department
does not have that power, we think there needs to be a major sea
change in terms of that position. So while we do not want to cut
off the linkages with the Department, it is really about what
power, what visibility, and what responsibilities that Minister
has.
198. Do I detect from the point of view of your
Association that you have a wider concern that one of the problems
we have with public health at the present time is the domination
of the medical model, and that medical model perhaps also applies
within the Department of Health to the detriment of addressing
the wider issues that you are suggesting we should look at?
(Mr Rayner) My colleague, John, will come in in a
moment. I criticise the word "domination". Let us talk
about the limitations of the medical model, let us talk about
other models, social and economic and so on. Will the medical
model by itself put public health in its rightful place? The answer
is no. There are limits because, if you like, public health and
public health medicine are constrained within the Department of
Health and even people within public health medicine background
are constrained from moving on a wider field. That is our concern.
It is not a denigration of any particular specialty or way of
thinking.
(Mr Nicholson) I think health is wider than the NHS
alone and wider than health care, and I think the contributions
of local government and the voluntary sector are essential and
the contributions of other government departments are essential.
When the Minister said, I think quite understandably, that she
wanted her own position to be in the Department of Health, that
is because that is where resources currently are, that is where
some status and power resides, and she has been endeavouring to
get the NHS to take the promotion of health seriously. I do not
think I would wish to undermine that. However, in order to step
ahead of that and get the serious commitment of the other government
departments, it does seem to us essential that some other mechanism
is found, as we have said, to enhance that role. Some suggestions
have been made of a Health Unit similar to the Social Exclusion
Unit which could have the same Prime Ministerial support and Cabinet
support and so on, and I think we would like to see some Cabinet
role or Cabinet linkage to whatever position was given to a Minister
for Public Health. That is the reasoning.
199. Do any of the other witnesses have a different
view or would you support this argument?
(Professor Griffiths) I think we absolutely support
the comment that the medical model is a limitation. It is not
about domination, it is a limitation, and we would also support
Cabinet level involvement in public health, In our submission
we raise the thought of a Public Health Advisory Group, if not
another unit, which would allow senior people in the field to
ensure that the public health profile was maintained across government.
I think the feeling at the moment is that, by putting the post
into the Department of Health, there are severe limitations. So
it is not so much about where the role needs to sit, it is about
what powers it is to have and how government works together to
promote public health given that public health is a cross-governmental
issue and not just a health issue.
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