APPENDIX 7
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.
|
