Examination of witnesses (Questions 273
THURSDAY 23 NOVEMBER 2000
MORGAN and MS
273. Can I welcome you to the second part of
this session. I am sorry you have had a long wait but it was,
I am sure you would agree, a very interesting session. There is
a fire alarm going on, if we are in any danger we will tell you
but until then we will carry on regardless. Can I ask you to introduce
yourselves to the Committee.
(Professor Parish) Good morning. Maybe I should say
good afternoon actually. I am Richard Parish, I am Chief Executive
of the Health Development Agency.
(Mr Morgan) I am Antony Morgan, I am the Head of Health
Information at the Health Development Agency.
(Ms Buckland) Yve Buckland, I am the Chair of the
Health Development Agency.
(Ms White) I am Patti White. I am a Public Health
Adviser on smoking at the Health Development Agency.
274. Can I thank you for your co-operation with
the inquiry and your presence today. Can I begin by asking a little
about the change that has taken place from the predecessor body,
which you do not mention in your evidence at all which was rather
of interest to us. Can you explain your views on why this change
was brought about? What is your feeling as to the purpose of the
change? Also, I think there is a concern which has been raised
with us about the way in which your budget is not quite what it
was for the predecessor body and will that impact on the work
that you do?
(Ms Buckland) Perhaps I could start because I originally
chaired the Health Education Authority in its last year. When
I was appointed as Chair I think it was fairly clear to everyone,
including those in the field and including people inside the Health
Education Authority, that there perhaps needed to be a change
in its remit. As you know, the Health Education Authority was
largely devoted to public education campaigns. There were a number
of views around about the efficacy of public education campaigns
within an overall strategy for health promotion and their ability
to address health inequalities and from the time the HEA had been
set up there had been a number of changes, alternative bodies
are providing public education campaigns and the new Government,
indeed, wanted itself to very directly own and brand some of the
big campaigns that had been run by the HEA, including things like
immunisation and smoking for example. We engaged in a major process
of consultation with the field and what came through that very
strongly was the feeling that if there was to be a national resource
to help promote and improve health then there needed to be more
of a focus on putting together an evidence base for public health,
supporting the workforce in putting that evidence base into practice,
and in particular looking at health inequalities. Around that
time I think there was a view that there might be two separate
bodies, something like a Health Development Agency and a re-formed
Health Education Authority. As it happened, the view was taken
that there ought to be one body and that, in fact, the HEA would
be closed down and a Health Development Agency opened from the
resources of the HEA we supported this view. The Health Development
Agency is a very different body. But I am sorry if we appear to
have been diffident about our antecedents.
275. I wondered if you were rather ashamed of
it, but bearing in mind you chaired it as well
(Ms Buckland) Not at all. I can only pay tribute to
my colleagues in the HEA, many of whom were absolutely instrumental
in the transition from the HEA to the HDA. Indeed, in its early
stages the HDA has built upon that body of work. Coming on to
the budget, as I said the HDA was to pick up the resources of
the HEA which at its point of closure were about £23 million.
Our current budget is £10.3 million but I have to say this
is our first year. We were only constituted in April, launched
in June and, indeed, we did not get our Business Plan finally
agreed until July. I think we will struggle to spend any more
than our £10.3 million effectively and wisely in this first
year. In our first year there has been a significant investment
in our evidence base. I have to say, however, if we think about
future years, and particularly the important role the Health Development
Agency has in putting the evidence base into practice, then I
think there will need to be access to additional resources or
a rethink of what we are currently doing. Of course, we will also
have to continue to develop the evidence base. It will be important
to raise money from other Government departments for the funding
of some of our work (which picks up on the discussion that public
health should cross other Government departments) and also find
ways to influence other moneys going into regeneration which will
have an impact on public health.
276. I would like to go on from exactly what
you have just mentioned. According to your Corporate Plan, two
of your early priorities will be fruit consumption, particularly
for children, and targeting smoking cessation. Can you give an
idea of exactly how the HDA is going to establish an evidence
base? You have talked about the need to establish it but how are
you going to establish it? What are you going to do?
(Professor Parish) Thank you very much. These are
two of our early priorities, they support both the same lines
and some of the initiatives in the National Plan. If I pick up
on the fruit and vegetable initiative in the first instance and
then my colleague, Patti White, might pick up on the smoking issue.
There will be a number of ways in which we are going to try to
establish the evidence base. Firstly, to look at the feasibility
of establishing an electronic register of the existing research.
There is quite a bit of research about what works in terms of
improving diet generally, less so around the specifics of fruit
and vegetable consumption, particularly with youngsters. Part
of our role, providing we have the resources in future years,
will be to identify the gaps in that research base and to commission
the additional work that might be necessary to fill those gaps.
We are in discussion with the Food Standards Agency to ensure
that we have a joined up approach. We will then be in the business,
of course, of disseminating that evidence base to local planners
and, indeed, advising on the inclusion of that evidence as the
basis for health improvement programme planning and local community
plans where it is necessary. It is perhaps also worth just adding,
if I may briefly, that we have an ongoing evaluation of the National
Healthy School Standard, which includes healthy eating and as
the results of that evaluation become readily available again
we will clearly make those results known to people in the field.
We are specifically involved in evaluating the three pilot sites
for the National School Fruit Scheme for four to six year olds,
again jointly with the Food Standards Agency. There are other
issues as well. I might just briefly mention that we work with
the voluntary sector with an organisation called Sustain to look
at the low income food database, so we have increasingly growing
evidence about the specific issues around food, diet and low income
families. I have tried to give you a bit of a Cook's tour to give
you some indication as to how we might tackle that.
277. Ms White, perhaps you could talk about
the smoking side, that is one of your first initiatives.
(Ms White) Yes, that is right. As the Committee will
know from its recent and excellent inquiry about tobacco, there
is a plethora of information about tobacco so we are not quite
in the position of some other areas of health in that we have
to establish a large database, but it is managing it as well.
If I can give as a concrete example some work that we have recently
produced about looking at smoking cessation guidelines for health
professionals. As you may know, two years ago the Health Education
Authority sponsored a project that looked at the cost effectiveness
and effectiveness of advice to smokers and that was published
in Thorax. Because of the changes in the environment since
then and because there are constantly new papers published, particularly
about the pharmacological treatments for smoking, we have updated
those guidelines. The process of doing that was to commission
that to three internationally recognised experts in the field
who were responsible for the first lot of investigation. But they
have gone further than that because they have an expert panel
that they have consulted with and also 25 professional bodies
in the UK, so they have done the literature review but gone on
to consult more widely with other practitioners and other professionals.
We are taking that piece of work forward into the field right
now by trying to disseminate that information in a series of regional
seminars that we are doing in co-operation with the Department
of Health and the NHS Executive in all the regions of England
to try to promote that information as much as possible.
278. Do you feel confident that you can get
their evidence into practice? Do you think that is what you will
be able to do because one of the big things we have picked up
is there is lots of research on smoking but actually getting that
into practice to change behaviour is the difficult bit? How confident
can you be?
(Ms White) Because the evidence is very compelling,
one of the things is to keep making that case in an articulate
way. One of the things we do know about general practice is even
in England with the very brief advice from general practitioners
to 50 per cent of their smoking patients once a year, after a
year we could have 55,000 ex-smokers in England. If they also
prescribed nicotine replacement therapy or Bupropion that would
give us an additional, say, about 27,000 ex-smokers. The evidence
on the effectiveness and the cost-effectiveness of these things
is very, very compelling. Our obligation is to make that case
as clear as possible and also to make it to the practitioners
that now there is a whole system through the National Health Service
of trying to bring smoking cessation advice at the local level
in a very effective way. Our job is to work with those people
at the local level, with those practitioners, to give them appropriate
279. Do you actually have links with the Department
of Health research programme? Clearly they are doing research
as well, so how are you linked up with them to make sure that
you are not duplicating or missing information?
(Professor Parish) We do link very closely with the
R&D programme with the Department of Health. I might ask my
colleague, Antony Morgan, to refer to that in a moment or two.
If I can just make the link between your earlier question and
the joining up with the R&D work in the Department. I do think
we have to get a lot smarter about pulling the levers for change.
It seems to me that we need to get better at building in the incentives
and rewards to bring about change. So we provide incentives to
encourage the change and then we reward, the money follows the
changes that are made. If I can reflect on some of the earlier
evidence you had this morning, we do need to get a lot better
at defining the indicators for success, building this into the
performance management arrangements that exist and, indeed, holding
people to account for making the necessary changes. We do actually
have a considerable resource out there that is available to enable
us to do this. If I think, for example, of the funding that is
available within the NHS for education and training and professional
development, the NHS spends close to £1.5 billion a year
on professional education and training in some form or another.
Even if we just took one per cent of that, we are talking about
£1.5 million and that could actually make a very significant
change. We have got to get smarter at pulling the levers for change.
Dr Stoate: Actually one per cent is £15