Select Committee on Health Appendices to the Minutes of Evidence


Supplementary memorandum by The NHS Alliance (PH 81A)

1.   Co-ordination 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 be Replicated?

  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 probably needed.

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.

February 2001

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