Supplementary memorandum by The NHS Alliance
of the Management of Infectious Diseases
The NHS Alliance believes that there should
be a single co-ordinating body which has overall authority for
investigating any epidemic whatever the source of the infection.
We would like to suggest that this should probably be the Public
Health Laboratory Service.
2. What Role do you think NHS Direct could
have in Public Health?
The NHS Alliance view is that any health agency
which has front line contact with the public has a responsibility
for both informing and educating the public. This is particularly
true of NHS Direct which has been established to manage demand
in the NHS through triage. NHS Direct has also established a role
in the promotion of self care through the publication of a self
help manual which covers the 20 commonest conditions giving rise
to contact with NHS Direct. This is an important public health
role because it enables people to take better care of themselves.
In addition to this role, there is the potential
now that NHS Direct has linked with NHS Patient Information Services
for NHS Direct to take a lead role in public health campaigns
about topical concerns such as flu in winter and exposure to sun
and the risks of skin cancer in summer. Providing people with
information when they are suffering the consequences of a particular
condition is an effective way of changing future behaviour.
3. Can the Success of the Back to Sleep Campaign
The NHS Alliance view is that the Back to Sleep
campaign was successful because sudden infant death was a major
worry for new parents; it offered a simple remedy which was easy
to follow; the message was broadcast widely; the health visiting
service was in place and able to reach the target population quickly
and comprehensively. Behavioural changes such as changing your
diet or taking more exercise are much more complex. By and large
people know what they should eat, they also know that they should
take more exercise. Motivating people to change then depends on
the perceived threat of not changing and the perceived difficulty
of making the change. In the case of diet and exercise the perceived
threat is low and the perceived difficulty of changing established
habits is high. Different and more sophisticated approaches are
4. At What Level do you Think HimPs Should
Operate; Ought they to be Formally Merged with the Committee Plan?
The NHS Alliance view is that if HimPs are going
to be implemented they need to be locally developed and owned
at the level of PCGs and PCTs. At present there are some risks
that they become sterile strategy documents produced by Health
Authorities which have not effectively engaged with the front
line primary care workforce or with local communities. Community
planning at local level was established for very similar reasons:
Local Authorities produced policy documents in Town Halls and
Civic Centres but implementation of policy at local level, particularly
in areas of social disadvantage, was always problematic. Community
Plans by operating at a smaller more local level have greater
opportunities to engage with local people and to ensure that policies
and priorities address real local needs.
The risk of merging HimPs and Community Plans
is that both become more bureaucratic. The other way forward would
be to enact a statutory duty for HimPs and Community Plans to
liaise and to co-ordinate. The major barrier to effective liaison
is often due to continuing poor working relationships between
health and local authorities. In Newcastle we have three PCGs,
which will merge to become a single PCT in April 2001, while at
the same time maintaining a locality structure. In parallel with
this development and without any discussion with local health
services, the local authority has established seven community
planning areas with very little relationship to the PCT localities.
This is clearly a missed opportunity and a duty of consultation
on both sides would have been helpful.