Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Society of Health Education and Health Promotion Specialists (PH 55)


  SHEPS is the professional society for health promotion and health education specialists in the United Kingdom. The Society was formed in 1982 with the aim of advancing Health Education and promotion, building on the work of the Society of Health Education Officers, the Guild of Health Education Officers and the Association of Area Health Education Officers.

  The Society claims a "professional voice for Health Promotion":

  "It provides a national forum through which expertise and experience can be shared and the issues and interests of those in the field given support within a national perspective."

  SHEPS claims a democratic structure organised through a system of local branches and special interest groups, which nominate representatives to a UK Executive council.

  SHEPS offers its membership professional guidance through its Code of Conduct and Principles of Practice. It assesses first degree of postgraduate courses nationwide to inform members of the suitability of professional development opportunities and evaluates and develops professional issues to promote the profile of the specialism. SHEPS also produces a range of authoritative publications. SHEPS is influential in public health policy and active in developing collaborative initiatives with other public and professional health bodies. SHEPS not only protects and represents its members but also provides a national voice on social economic and environmental matters affecting health (membership form 2000).

  Given this remit and the networking through branches, which allows SHEPS to offer evidence on policy and practice as experienced across the UK, we are well placed to contribute to debate on all aspects of public health.


  1.  There is a need to explicitly acknowledge the range of public health functions and to recognise the varied contributions made to public health by a diversity of sectors, professionals and volunteers.

  2.  Performance management indicators for public health in all health authorities, NHS trusts, PCGs and PCTs and across other sectors need to be developed. These can build on a solid base of quality assurance programmes already in circulation, including work developed by SHEPS. These programmes acknowledge the importance of process measures, particularly in relation to partnership working. (See attached papers on Quality and Health Improvement Programmes).

  3.  Performance management needs to be "joined up", a process not helped by the plethora of separate initiatives (HAZs, EAZs etc) targeting health and well being. A recent example of the impact of separate performance management is the Coronary Heart Disease National Service Framework which has significant implications for local authorities but has not been included in their performance management framework.

  4.  Local public health teams should be created, on a multi-agency and multi-disciplinary basis to bring together public health policy and planning alongside public health and health promotion practice. Again, these can build on the positive experiences developed in health promotion practice in interagency work. The move to join up community plans is supported as a means to bring together multi-agency work, training and development around community needs.

  5.  There should be greater investment in public health education at all levels and available to a wide range of professional groups. This should build on a shared understanding of the principles made explicit by the Ottawa Charter (WHO 1986) and be developed and delivered by multidisciplinary educators. (See Multidisciplinary Public Health Discussion Paper.) Programmes of education and training will need to recognise the existing skills of those already active in the Public Health arena and the existing academic qualifications which already prepare practitioners for effective and ethical practice (notably the Post Graduate Programmes in Health Promotion). They can also draw on significant academic achievement in Health Promotion in the UK and on the knowledge and experience of reputable academics in this field.

  6.  There should be investment in developing leadership capacity and public health education amongst members of PCG and PCT boards. This should be part of a strategic review of current public health skills and of the workforce currently available to support strategic approaches within all settings. Recognition of the various roles and functions of all within the wider Public Health Field must be reflected in equality in terms of pay and conditions.

  7.  The position of Director of Public Health should be open to any professional group. Criteria for this and other leadership roles should be developed in partnership with relevant professional bodies. The issues of accreditation and of "parity" across current public health practitioners will need urgent attention. SHEPS awaits with interest the report on the development of standards for Public Health Specialists (SHEPS is an active participant in the Advisory Committee led by Sir Kenneth Calman) and the soon to be circulated draft criteria for such posts from the NHSE. In addition, every PCG and PCT should create a post responsible for leading public health practice in primary care (in addition to the PCT Board level public health specialist post). This post holder should be responsible for developing the social health agenda of the PCT and the community at large.

  In addition to the brief evidence offered below, I have attached recent SHEPS papers which are relevant to the debate on public health:

    —  Code of Practice.

    —  Discussion paper on Multidisciplinary Public Health.

    —  Health Improvement Programmes.

    —  A Quality Framework for Health Promotion.

    —  Response to the All Party Inquiry into Health Improvement Programmes.


  The evidence offered for SHEPS comments was gathered through:

    —  discussion within and between branches;

    —  development of briefing papers for SHEPS members by Executive Council and others; and

    —  consideration of and response to the various initiatives and programmes focusing on Public Health across the UK.

  1.  The co-ordination between multitude of public health schemes and initiatives at all levels is weak. There is a lack of clarity about roles, functions and direction and a lack of a strategic framework which incorporates public health work across all sectors.

  2.  Fragmentation of public health is, in general, increased rather than otherwise, by the variety of models of primary care actioned across the UK. Some of the primary care developments have, contrary to expectation, heralded a return to individualistic "health education", rather than holistic health promotion based on a socio-ecological model of health.

  3.  The renewed focus on public health has caused some disquiet amongst health promotion specialists as they espouse the principles of:

    Empowerment, Participation and Interagency work (see Code of Conduct).

  Many report these principles are eroded by some public health developments which look for "quick fixes" and are funded and organised on a short-term basis (see Code of Conduct on sustainability). There is also concern expressed about the continued dominance of the "medical model" in public health practice.

  4.  There has been negative impact on professional status from recent changes within public health and health promotion infrastructures. Practitioners skilled in strategic approaches to health promotion report being reallocated to "health education" work using models and approaches which have been proved ineffectual and which are not holistic.

  5.  Some aspects of current policy have exacerbated these difficulties. While the White Paper Saving Lives Our Healthier Nation (and the other policies developed in the devolved countries) identifies the need to improve the health of the worst off in society many of the targets in these and related strategic documents (Regional Strategic Frameworks, for example) focus on disease and risk targets and not on the wider actions required to address inequalities.


  Health Promotion Specialists work at all levels and within all sectors on public health issues. SHEPS looks forward to representing these specialists and to continue to contribute to the debate on healthy public policy and practice. It works closely with a variety of other bodies, including fellow public health professionals and others, such as the UKPHA, to promote effective, participative and meaningful health improvement across the UK.

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