Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Public Health Directorate Bradford Health Authority (PH 12)

  We would like to make the following points to the inquiry:

    —  it seems illogical and impractical to consider public health policy for the UK in isolation from its European and global partners. It has been estimated that only about 25 per cent of public health issues (World Health Organisation) fall within the jurisdiction or sole influence of the UK Government acting alone;

    —  if different models of how the health of the public could be protected, promoted and improved through organised efforts of society are being considered, there are a number of excellent models in Europe and other parts of the world that could be drawn upon. Direct experience of colleagues in Northern European countries such as Denmark and Sweden indicate there is much good practice to be drawn from, but countries in parts of the developing world can also teach us a lot about public health practice;

    —  the fact that the vast majority of public health specialists (non-medical and medical) are employed within an NHS until recently concerned almost exclusively with health services for the treatment of ill health, has led to an increasing domination of the public health agenda by medical and clinical issues to the detriment of a focus on the "underlying determinants of health". Besides skewing the agenda towards the clinical public health issues it has created both unnecessary structural barriers and "barriers of perception" reducing other partners' ability to recognise their contribution to tackling the many complex issues that influence public health. There needs to be consideration of broadening the employment base to develop recognised public health specialist roles within Local Authorities and other partner agencies, as well as within the health service;

    —  we have particular concerns about the capacity of Primary Care Groups and Trusts to deliver the public health/health improvement agenda. Despite efforts to support PCGs/Ts from Health Authority Public Health Departments and a willingness by many PCGs/Ts to respond to the challenge of improving the health of their populations (including contributing funding to public health specialist posts), structures are yet to be put in place for most PCTs. Skills are in short supply and PCGs/Ts have a huge agenda encompassing all aspects of health and health care. Some unambiguous and challenging performance measures for PCTs around public health and health improvement need to be introduced which will guide PCGs/Ts and ensure they give priority to the health of their population. Unless PCGs/PCTs are supported to embrace fully the public health model it will be harder to access resources for health improvement. PCTs will also require strong Public Health professional advice given a degree of independence to speak up for the health of the public (such as the DPH of a Health Authority has through their Annual Report);

    —  we feel that what is meant by the term "health inequalities" needs to be more clearly and rigorously defined and the actions needed to tackle the various types of inequalities must be carefully distinguished. Our experience shows that "health inequalities" can so easily be interpreted just to mean improving access to services or the need to deliver consistent and high quality services. Of course these are very important challenges and make a critical contribution to improving the public health and tackling inequalities but they represent a very partial picture and arguably form a lesser contribution than action needed to combat some of the lifestyle, socio-economic and environmental factors that lie behind the major health inequalities. These more rigorous definitions would help engage LA and other partners more easily and support the arguments for targeting resources into areas of greatest need;

    —  we would like to see the Secretary of State for Health being seen as the Minister for the "Health of the public" with Junior Ministers balancing equally the "health" and "health service" portfolios; and

    —  with the burgeoning pace of developments in medical technologies additional pressures on NHS resources are being increasingly felt as the health care consumer unsurprisingly and in many cases rightly expects to have access to new treatments. This has the potential to heighten the competition for resources between the prevention and treatment "ends" of the service. This will require determination on behalf of the Government, HAs and PCGs/PCTs to argue for, protect and properly resource long-term health improvement measures.

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