Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 380 - 387)



  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 now.
  (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 as locally?
  (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 you—because I thought it might be a change from written evidence—which 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.

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