Select Committee on Health Second Report


241. At the outset of this report we set ourselves the task of gauging the extent to which the Secretary of State's pledge to get public health out of the ghetto was likely to be achieved by the policies he has put in place. Our final verdict must be that many of the initiatives have been taken with the best of intentions, but their multiplicity and lack of rigour threatens to undermine them. We have found blurred lines of responsibility leading to disputes over who should have responsibility for the public health function. Nevertheless, we have also found a commitment on the part of Government to put public health higher up the agenda.

242. A number of the key themes emerged throughout the inquiry:

  • the need to achieve balance in health policy between health and health care, upstream and downstream.

We found that the present health policy agenda is heavily dominated by the NHS Plan with its overwhelming concentration on acute care, hospitals and beds, and numbers of doctors and nurses. We accept these are issues of vital importance to the NHS but we think the case for re-balancing health policy is strong.

  • strengthening public health leadership at all levels.

We have described the confusion surrounding the leadership of public health at every level. We call for the Minister for Public Health to be empowered to demonstrate more positive and public leadership for improving health and reducing health inequalities. Stronger leadership at the centre must be matched by stronger leadership at regional, intermediate and local levels.

  • establishing strong partnerships at all levels for a broad-based approach to public health.

We have endorsed the need for partnerships in delivering the public health function. We support a more pro-active role for the NHS in regeneration initiatives, the introduction of joint posts in public health, and a single Community Plan in each locality incorporating the HImP.

  • placing the emphasis on public health practice and implementation rather than on knowledge acquisition for its own sake.

We consider that insufficient attention has been given to the application of knowledge and practice in public health. For too long the public health function has been dominated by a culture, mind set and training scheme which stresses the epidemiology and science of public health, rather than its practice in bringing about change. We hope our recommendations on developing capacity within public health will encourage the development of practitioners at all levels who can implement the theory.

  • avoiding distracting and probably counterproductive reorganisation of structures imposed from the centre while allowing local initiatives to flourish.

We have found a recognition amongst stakeholders that progress in public health must not rely on structures but on processes and incentives, coupled with effective and appropriate performance management arrangements.

  • creating incentives for health improvement activity.

We have found an over-emphasis on top-down targets and performance agreements. Stronger incentives to give health improvement priority for action are essential.

  • building the evidence base in public health.

Knowing what works, why and how, remains a key challenge in ensuring effective implementation of public health policy.

  • learning the lessons from past failures or partial successes in putting health before health care.

We believe it is imperative that the Government learns the lessons of previous policy, particularly with regard to political leadership and commitment, making health improvement a central priority, and ensuring that local government and other partners recognise the importance of their public health role.

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