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 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
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
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
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
- 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.