Examination of Witnesses (Questions 1296-1299)
11 MARCH 2004
MS MELANIE
JOHNSON MP, MS
IMOGEN SHARP,
MS DANILA
ARMSTRONG AND
DR ADRIENNE
CULLUM
Q1296 Chairman: Good morning. Can I welcome
you to this session of the Committee, and particularly welcome
our Minister and colleagues. This is the first time you have been
to this Committee but you are so popular we are going to have
you back for the next inquiry. Thank you very much for your cooperation
and I would like to thank your officials as well for their cooperation
with this inquiry.. Would you all please introduce yourselves
to the Committee.
Miss Johnson: I am Melanie Johnson.
I am Minister for Public Health and I have wide ranging responsibilities,
but obviously issues around obesity are some of my core issues.
Ms Armstrong: I am Danila Armstrong.
I am from the Department of Health, Health Improvement and Prevention.
Ms Sharp: Imogen Sharp, Head of
Health Improvement and Prevention in the Department.
Dr Cullum: I am also with Health
Improvement and Prevention at the Department of Health.
Q1297 Can I begin by thanking you for
the written submissions that you have given us and for your cooperation.
It has been quite a lengthy inquiry but I think, from our point
of view, a very interesting and useful one. Obviously issues taken
up over the past year are hopefully quite significantly to the
long term benefit of the nation. Can I begin, as it is the first
time you have appeared before this Committee, Minister, by asking
you one or two broad questions about the issue of Public Health.
Having been in the job now for a number of months, can you give
us your view on the appropriateness of the location of the Public
Health function? Some years ago, as you probably know, we looked
at Public Health as a subject of investigation. Because it is
such a wide ranging we had a lot of discussions as to whether
or not it is appropriate for your function to be in the Department
and whether that affords cross-departmental working or might there
be other models? What conclusions have you drawn about this location
issue in the months that you have been doing the job?
Miss Johnson: Without a total
radical overhaul of the whole structure of government—I
am not talking about around the edges on this as it were, particularly
the Civil Service element of it—it would be difficult, in
my view, to locate Public Health better than where it is currently
located within the Department. That is because I think, although
it is a very wide ranging issue, and clearly a lot of departments
have major—in some cases, certainly very significant in
other cases—contribution to play to the development of Public
Health and to many of the issues that fall within the brief, nonetheless
I think it makes very good sense for it to be located with the
Department of Health. It needs a single home rather than to be
dissipated across a wide range of different departments and so
its main single home is with us but we now have a lot of cross-working
going on—I will not go into the detail now, but I am sure
you will want me to go into the detail later on—with other
government departments on a number of the main strands of work.
I only see that development of joint working as something which
will increase with time as we go forward. Also I think it is very
important in terms of leadership that there is a single place
that is connected with the Health Service to a degree. We have
had a service for disease and sickness for a long time; it is
an excellent service and we need that service to go on making
the strides it has been making in the last few years of treating
people and dealing with disease and illness, but what we also
need is very much to focus on Health within that, in that setting,
because if we are ever to combat the growing needs of people for
the NHS in terms of increasing rates of cancer and increasing
rates of coronary heart disease and coming to the subject lying
behind some of that—obesity—then we have actually
got to tackle the Public Health agenda. Therefore I think it makes
good sense for these things to be bound up together.
Q1298 Chairman: It has been apparent
to the Committee in recent months that a significant number of
the important statements being made about the issue of obesity
have been made from outside your Department. Increasingly the
DCMS has been making statements of some significance on the importance
of a strategy to address this. We have had the recent Wanless
Report which has also made some pretty radical points about the
question of Public Health. Do you think in the light of those
developments outside your Department that the debate might increasingly
focus on Public Health being a much wider issue and, if so, what
might the outcome of that debate be?
Miss Johnson: Obviously one of
the things that we want to do is to engage people in very much
that debate that you are setting out in relation to the future
of Public Health through the White Paper process which we launched
recently. The consultation exercise that we are going through
now with discussion is one of the things that will lead to a conclusion
about exactly how this is positioned and taken forward. I think
we have to be relaxed and sensible about the fact that wherever
you put Public Health it would not fit—without some massively
radical re-thinking of the whole structure of Whitehall—into
a single slot comfortably. It makes good sense to recognise the
roles that other government departments play and we have very
strong relationships with DCMS (with both Tessa Jowell and Dick
Caborn; obviously Dick with his sport brief and Tessa overall
with responsibilities in the Department for the promotion of food
and the advertising issues) and also with other government departments,
particularly increasingly with DfES where there is a lot of joint
work going on. We are also working with the Department of Transport
and there are a number of different departments with whom we are
working closely. That is actually going forward in a very positive
way. One key strand of the work is on the physical activity side
of things—the Activity Coordination Team—ACT—work—and
that work is very much focussed on a joint leadership between
ourselves and DCMS. Dick Caborn and I jointly chair the cross-government
team that is doing the development of that work, so that is very
much something we are taking forward together and we are very
relaxed about that sharing of responsibilities.
Q1299 Chairman: We talked so far about
the national location of the Public Health function. Obviously
since the advent of primary care trusts the location of Public
Health has been with them. One of the concerns the Committee has
had both on this Inquiry and when we looked at sexual health,
was that we had a minimal amount of evidence from the Public Health
people at PCT level which certainly, from past experience of contact
in inquiries with Public Health professionals, I found very surprising.
I do not want to make any judgments; I appreciate they have been
through a major restructuring, but are you happy that the Public
Health function as it is currently located is appropriately placed
to be effective on major policy issues such as the one we are
talking about here?
Miss Johnson: Yes, is the answer
to that. However, I think there still needs to be a fuller development
of Public Health at the PCT level. Having said that, there is
a lot of excellent work going on at PCT level and I think, as
you recognised in your comments, actually they are very much a
youngish organisation, they are still getting their feet under
the table. Having been out looking particularly at what is going
on recently on health inequalities in different parts of the country—which
obviously relates quite closely to this topic too—I can
see that some of the work that is going on a PCT level on all
of these topics and allied areas is actually fantastic and they
are providing some excellent leadership in a setting where they
know their communities, they know what sort of response ought
to work and they can actually devise the local solutions, which
is really the consequence of the devolution and shifting the balance
of power at its best as we have envisaged it. I think we just
need to make sure that that best is represented more consistently
across the board than it may be at the moment.
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