Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by East London and The City Health Authority (PH 54)


  The Health Select Committee has just completed taking written evidence for its latest Inquiry into Public Health. A jolly good thing you might argue. Whilst National Health Policy seems to have ditched the wider public health, you could argue it's a good thing that someone cares. But is that really why they chose to focus on public health? To cynics a review of all the action Zones, HIMPs Public health directors and Minister to boot might be interpreted as an opportunity to signal dissatisfaction with the lot of us. But no, my sources tell me that the intellectual and political thinking behind the choice of subject is that public health was seen as the least controversial of topics they could choose during the heated NHS Plan season!

  Let us then make the charitable assumption that the Select Committee's purpose is potentially beneficent. So what should they make of their primordial soup of tasks? The Committee has been asked to look at interagency working, the role of the Minister of Public Health and Public Health directors, the Health Development Agency, PCG/Ts as well as what sounds like an afterthought: the extent to which current public health policy is reducing health inequalities. Any serious scrutiny of this last objective would require the biggest cross-Government health inequalities impact assessment that had ever been conceived, and so far not yet commissioned.

  To help it through the wood and trees that have died in the name of the endless zoning initiatives and guidance so far received, let us assume that the Select Committee will want to come up with solutions that really do help us tackle health inequalities more effectively than the recent report commissioned by Public Health Minister Yvette Cooper shows. 1 Taking each of the remaining five terms of reference in turn. First: how are the dizzying numbers of Action Zones shaping up? The answer is slowly. The national research commissioned at great expense to answer the questions on their effectiveness is only just underway. Public health programmes to tackle longstanding inequalities take time. The Government acknowledged this was at least a 10 year agenda in its white paper—mostly forgotten now "Our Healthier Nation", and at least a seven year programme for HAZs. But do the cuts in the HAZ Programme budget this year 2 suggest that ministerial fuses on the public health are getting shorter? As far as the effectiveness of interagency co-operation is concerned, this is also the subject of formal evaluation within the HAZs. There are three obvious changes which need to be made. First, we should wait for the findings of the commissioned evaluation before judging. Second, the wisdom of supporting multiple health authority, local borough HAZs needs revisiting. It seems self evident that those HAZs such as Sandwell and Brent—each coterminous with one borough—that have the luxury of focused cross-fertilisation with relatively few organisations, are likely to make most progress. If the different government departments stopped to gather all their "zoning power" together with the intention of making the most of all the initiatives, not only would it help us to mainstream the best of the innovations we are testing, but it would stop the pointless fragmentation of these potentially important programmes into ineffectual silos. The model of a Social Exclusion Unit-type approach bringing these initiatives together across Government would go a long way to demonstrating cross agency commitment to tackling inequalities in health.

  HIMPs are an essential, but missing element of most Community Plans. The Community Plan provides an umbrella for influencing the determinants of health and most HIMPs articulate the health outcomes and inequalities to be tackled. If we were required by a joint Duty of Partnership to integrate and agree these plans, not only would we save paper, we might be closer to focusing on those budgets such as leisure, housing and education which are vital elements of the real health budget. The duty to take into account the findings of Annual Public Health Reports could also be added.

  The work of the Health Development Agency is also under scrutiny. Its work is essentially still at the beginning. Most of us never heard anything from its predecessor in the NHS, so there is only one direction to go.

  Little attention has been paid to the health improvement role of PCGs/Ts yet. First and foremost, there has to be a well resourced drive to support the development of public health capacity in all PCTs. While public health departments and PCGs debate the finer points of the odd 0.2 whole time equivalent of a public health consultant that they would like, who is planning how we develop public health skills among all primary care practitioners? As a GP once said to me: what we need is for every GP to become the public health director of her/his practice population. To embed this in PCT development the Select Committee should recommend three things: development monies to normalise and embed training in practical public health skills through education consortia; joint formal recognition of public health training in general practice and community nursing disciplines and last, but not least, proper implementation of the Public Health White Paper's recommendation to expand multidisciplinary public health. Possibly the most fundamental ingredient to enable PCTs to tackle health inequalities, is that the local authority is the appropriate boundary for a PCT. This would resolve many cross agency nightmares that some PCTs will otherwise face, and increase the chances of proper partnerships with local authorities whose actions have more influence on health than the NHS. Non-coterminous PCTs should not be supported. We received this guidance on Drug Action Teams. We should do the same for PCTs.

  The role of the Minister for Public Health is easy to define: focus on the wider causes of health and leave healthcare to the minister for the NHS. The way to achieve this would either be by making sure that the Secretary of State for Health is just that, with NHS ministerial portfolios below, or by moving the public health portfolio to Downing Street. As for Directors of Public Health, we should all be jointly appointed to the NHS and local authorities we serve. We should have statutory backing—emphasised by the duty of partnership—for this independent advisory role. To do this effectively we will need to be supported by properly trained public health practitioners working at all levels of the system to support health improvement. Ever NHS and local authority organisation should have its named director of Public Health. There is no reason why we cannot be drawn from a multidisciplinary group of qualified practitioners as in academe. If we don't bite the bullet now—the whole public health function could disappear in a puff of further organisational change.

July 2000


  (1)   The Guardian; 12 July 2000.

  (2)  Janet Snell; Health Service Journal; 6 July 2000.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 28 March 2001