MEMORANDUM BY THE DEPARTMENT OF HEALTH PUBLIC
HEALTH (PH1) (contd.)
4. CO -ORDINATION
BETWEEN CENTRAL
GOVERNMENT, LOCAL
GOVERNMENT, AND
HEALTH AUTHORITIES
IN PROMOTING
AND DEVELOPING
PUBLIC HEALTH
4.1 In relatively recent history, public
health issues have often been seen as the preserve of the Department
of Health, but improving public health crosses the whole gamut
of public services. A range of socio-economic factors—for
instance transport, environmental pollution, the availability
of affordable and good quality food, the living and social environment,
and poverty, affects both public health and the health of individuals.
4.2 Accordingly public health is a priority
for the whole government and all central government departments
have a part to play in delivering the action plan to improve health
through implementing existing policies and in assessing the impact
on health of new policies being developed. Specific cross-government
initiatives such as the work of the Social Exclusion Unit and
the action against illegal drugs should also deliver health improvements.
4.3 The challenge for the government in
dealing with these problems was set out in the Saving Lives
White Paper and in Reducing Health Inequalities: An Action
Report. The White Paper targets are part of the Department
of Health's Public Service Agreement. Achieving these targets
means action right across the breadth of government, though.
4.4 For example, the Sure Start programme
will invest £450 million over the next three years in support
for families with children under four in areas of lowest income.
The idea is to draw together all services for the under fours
and their families and provide what local parents want. Parents,
midwives, health visitors, childcare workers, nursery teachers,
community workers, local authorities and health authorities are
coming together to draw up proposals ranging from toy libraries
to health advice. This is an area where improvements should come
through concerted action including NHS staff.
4.5 The Department of Health plays a central
role in delivering the Government's plan of action for health
through the NHS, through wider public health initiatives, and
through education and information. Health improvement is a key
imperative for the NHS and is being integrated into local health
care delivery. Primary Care Groups and Primary Care Trusts will
plan and develop services sensitive to local health needs (see
section 7). The Government's health improvement targets will be
delivered through partnership between national, local and individual
players.
4.6 There are major initiatives to improve
quality, effectiveness and clinical governance in the NHS. The
future impact of National Service Frameworks, National Institute
for Clinical Excellence (NICE) guidelines, the NHS Information
Strategy and the need to assess variations in performance and
health outcome are all priorities that health managers will need
to address alongside day to day pressures of life in the health
service. The demand for public health skills in the health care
arena is rising as a result, and the multidisciplinary nature
of public health is now accepted widely.
National Service Frameworks
4.7 National Service Frameworks (NSFs) were
introduced to raise quality and reduce unacceptable variations
in services. NSFs will set national standards and define service
models for a particular service or care group and put in place
underpinning programmes to support implementation and delivery.
NSFs will also establish performance measures against which progress
within an agreed time-scale will be measured and monitored.
4.8 The rolling programme of NSFs, launched
in April 1998, takes forward the established frameworks on cancer
and paediatric intensive care. The NSF for Mental Health was published
in September 1999, and the NSF for Coronary Heart Disease in March
2000. For the most part, both the CHD and Mental Health NSFs have
been generally well received in the field, and local implementation
teams are taking them forward. The next two NSFs will be for older
people (due in Autumn 2000) and diabetes (due in 2001).
4.9 Each NSF is being developed with the
assistance of an Expert Reference Group that brings together health
and social care professionals, service users and carers, health
and social care managers, partner agencies, and other advocates.
These Expert Reference Groups have adopted an inclusive process
to engage the full range of views including patients and consumers.
The Department of Health provides support to the reference groups
and manages the overall programme.
4.10 The Mental Health NSF focuses
on the mental health of working age adults. It applies to health
and social services, and includes health promotion, assessment
and diagnosis, treatment, rehabilitation and care (including support
to carers), and encompasses primary and specialist care and the
roles of partner agencies. It sets seven standards which include
addressing mental health promotion and the discrimination and
social exclusion associated with mental health problems; effective
services for people with severe mental illness; and support for
individuals who care for people with mental health problems. Local
implementation teams were required to develop a local delivery
plan by April 2000. In the current year the Mental Health Modernisation
Fund has provided £3.7 million to support organisational
and professional development.
4.11 The NSF for Coronary Heart Disease
(CHD) is a radical and far-reaching programme that sets out what
services and standards should be available across the country.
It covers the whole spectrum from prevention of heart disease,
through emergency care, primary and specialist care including
heart surgery, and rehabilitation. The NSF was developed over
nearly two years by an independent group of experts led by Professor
Sir George Alberti, President of the Royal College of Physicians.
It sets 12 national standards for improved prevention, diagnosis
and treatment and goals to secure fair access to high quality
services over a 10-year period. It includes two standards on prevention,
two on preventing CHD in high-risk patients in primary care, and
one on secondary prevention. In addition to immediate priorities
to be achieved in the short-term, included smoking cessation,
NHS and partner agencies are asked to identify areas of inequalities,
undertake health impact assessments, develop policies on smoking,
healthy eating, physical activity, obesity and workplaces and
green transport, and report on them at board level.
Role of the Regional Office
4.12 NHS Executive Regional Offices work
with Government Offices for the Regions, Regional Development
Agencies and Social Care Regions to improve health and reduce
inequalities. In particular they:
(i) support ministers in developing, implementing,
monitoring and evaluating policy on health and health services;
(ii) support ministers in accounting to Parliament
and the public;
(iii) work in partnership across Government
and with others to tackle ill-health and its causes and to improve
social well being;
(iv) manage the performance of the NHS in
promoting and protecting good health;
(v) support the NHS in improving the health
of the population and delivering effective health care;
(vi) develop the capability and skills of
the workforce.
Partnership with local authorities
4.13 Joint working between health and local
authorities is crucial. The Health Act 1999 extended an existing
duty of co-operation from the National Health Service Act 1977
for health and local authorities to work together to secure and
advance the health and welfare of their communities. At the local
level, the public health strategy is being implemented through
the mechanisms in place to deliver The New NHS and Modernising
Local Government. Directors of Public Health are playing a
key role in working with local authorities to make this happen.
4.14 Partnership working in public health
involves all other government departments. For example, many policies
which bear directly and indirectly on public health are the prime
responsibility of the Department of the Environment, Transport
and the Regions (DETR). DETR works closely with the Department
of Health, and with local government in developing solutions to
public health problems.
4.15 In 1999 the former Health Education
Authority, in collaboration with the Department of Health and
DETR, published Making T.H.E Links—Integrating Sustainable
Transport, Health and Environmental Policies: A guide for local
authorities and Health Authorities. This publication, copies
of which are being made available to the Committee, provided an
overview of the links being made by national Government policies
and a framework of action by local authorities and health authorities.
It is a tool for any authority trying to develop shared local
plans that bring together quality-of-life issues, and to co-ordinate
their responses to traffic reduction and health improvement with
other sectors. The guide was widely welcomed and illustrates many
of the partnership activities currently underway around the country.
4.16 The Health Act partnership arrangements
(sections 29 to 31 of the Health Act 1999 and regulations made
under those sections) are designed to address the need to co-ordinate
services to improve the health of the local population. The flexibilities
provided for are:
(i) pooling of funds
NHS bodies and local authorities are allowed to pool
their resources so that the resources lose their health and local
authority identity. This enables resources to be used as flexibly
as possible to respond to need and decisions to be made more quickly
and effectively. Pooled funds are used in a number of situations:
— to enable agencies to work together
more effectively, eg on joint training, or health promotion activities;
— to help drive strategic change and
enable new more responsive services to be developed;
— where packages of care need to be
put together which are different for each individual.
(ii) delegation of functions
NHS bodies and local authorities are allowed to enter
arrangements under which one agency exercises the prescribed functions
of the other. This allows one of the partner bodies to commission
all the services for one group of individuals, whether those services
are health or social services. In addition it allows for one of
the partner bodies to be an integrated provider providing both
health and social care. This enables the partner bodies to ensure
that a coherent and responsive service, or set of services, can
be provided through a single management structure.
(iii) powers to transfer money both
from a local authority to a NHS health body, and from a NHS body
to a local authority. These can help set up new services such
as a joint approach to education on drugs and alcohol or joint
investment in a cycle path to reduce accidents and improve health.
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