Examination of Witnesses (Questions 380
THURSDAY 7 DECEMBER 2000
380. That is what the Child Support Agency said.
(Mr Ransford) That is an interesting test to apply
it to. I am applying it to HiMPs and community plans. I will stick
to my point. There is a lot of experience of doing this. If you
look at strategic planning and land use planning, that works quite
well on a spacial basis across a county area with specific factors
right down to development control at the local area, and people
understand how that fits together. The important thing is to get
the purpose right and understand how it fits together. Chris Town's
example of that is a very good one. It gets particularly confusing,
of course, when you get boundaries not only on this question of
one-tier and two-tier but crossing, so that one health authority
is working with three or four local authorities and conversely
a local authority is working with two or three health authorities.
That strikes me as being even more difficult. The principle of
the over-arching needs of an area are the things that are common
and need work on and can be measured, and then looking specifically
at communities with which people identify, and then down to neighbourhood
level is a way we can hold it all together. All agencies are doing
that. It is a question of aligning that process to make sure you
get more benefit from people working together.
381. We have had examples of regions not being
coterminous with other regions, would you say you make it work
in spite of the structures, rather than the causes?
(Mr Ransford) You can make anything work in spite
of structures. Sometimes we go into structural change without
working out what the benefits are. We live in a world of constant
change. If there is an overriding need for change, for instance
in terms of planning there is almost as many planning initiatives
as the initiatives you talked about for intervention. I do think
we need to make planning more aligned to be clear on what the
major issues are.
382. All of this overcoming of these structural
difficulties is extraordinary expensive on people's time, energy
and everything else. We talked about regeneration strategies,
all the different players have to get together, all wearing different
hats, should it not be streamlined at the top so that life is
simpler at the bottom?
(Mr Ransford) If there was a streamline that worked
better, then certainly. The only gain and the only benefit of
all this work on planning is to get better solutions for the citizens
you are serving. If planning is seen as an end in itself, of course,
you are right that planning must be seen as a dynamic process
to improves people's lives. That is where we come back to the
public health agenda as being an essential driver of that.
383. Do any colleagues have any further questions?
Our discussions today have been very much about structures and
you, more than most, have to address these issues. If we were
starting from scratch, if we came in afresh, what would the structure
be in terms of the ideal, from your point of view?
(Mr Town) The structure of the Health Service and
local government and
Dr Brand: The world!
384. Are you saying there should be a separate
structure for health?
(Mr Ransford) I think there is a very strong case
for geographical coterminousity at regional strategic, and local
strategic partnership level and very local level.
385. Coterminousity of what? You argue for coterminousity,
and clearly you are pushing at an open door, you are assuming
existing structures when you argue for coterminousity. If you
were starting completely afresh without looking at chunks of provisions
that we have now what would you offer as the most appropriate
structure for addressing the issue of public health, defined as
you define it in your evidence?
(Mr Ransford) I still say that the geographical coterminousity
of all of the players is very important.
386. There may be only one player.
(Mr Ransford) If there is only one player, the public
health agenda and what we are trying to achieve in terms of health
and the well-being of the community is what is the important thing,
so everyone would have a similar purpose. You then define whether
or not there needs to be separate agencies, on the basis of how
you deliver that purpose and the specialisms. We talked earlier
in your questioning about particular specific duties that have
to be done, where you need specialist advice and specialist skill.
You cannot throw those away because health would suffer if you
did, and after all they are statutorily based. You define your
agencies from purpose and not try and rig together a purpose out
of agencies and traditions, which, to some extent, we try to do
(Mr Panter) Whatever the structure I think what we
certainly want is a clearer delineation between health service
and health, because one of the biggest constraints is that the
health service in the NHS gets confused with the responsibility
for health, and that is right down through every single level.
387. Would you apply that nationally as well
(Mr Panter) There is a clearer delineation between
health services being one contributor to health but health and
public health being a much broader issue affecting everyone.
(Mr Town) The final issue on that is in terms of health
delivery at a local level. You may have to deny patient choices.
Even in areas where there is coterminousity in terms of where
GP surgeries are located, ie they are within local authority boundaries,
there are significant numbers of patients who do not live in that
area, and that is down to patients having the choice of which
GP they register with at the moment.
(Cllr Stringfellow) I think that is probably the hardest
question because it is really very difficult to look at the future
without trying to think of it in the context of the present. What
I would like to say, if I might, is that we have talked a lot
about structures, we have talked a lot about planning and we have
talked about communities, somehow implicit in that is that we
are, perhaps, in danger of "doing unto..." I have brought
a video along for youbecause I thought it might be a change
from written evidencewhich is a very good example in my
own ward where there was a health project that looked at a number
of things like smoking cessation as something that was really
important, because a lot of people in Medwell smoked a lot, and
such like. Actually what we have learned from it is that people
need to be ready to listen to the messages and they have to have
ownership of the messages. What started out as a perception about
a health education message has resulted in a community gym, which
is free to the people in locality. It is pressing all of the right
buttons in terms of coronary heart diseases and it is overcoming
isolation, and it is overcoming some of the mental health problems
that are very much around in the area. I sometimes think we seek
to define what the issues are without always being sufficiently
careful to listen to what people's needs are as they define them.
Chairman: Are there any final points any of
you want to make. If not, can I thank you all for your very helpful
evidence and coming along today. We are most grateful to you,
thank you very much.