Memorandum by Amicus (Health Sector) (WP
98)
1.1 Amicus (health sector) welcomes the
opportunity to submit evidence to the Health Select Committee
related to Choosing Health the Government's Public Health
White Paper.
1.2 Amicus (health sector) represents over
80,000 employees within the NHS. Within its membership are a number
of professions sections including The Community Practitioners
and Health Visitors Association, The Medical Practitioners Union,
Mental Health Nurses Association, Sexual Health Advisors Association
and Guild of Healthcare Pharmacists.
Whether the proposals will enable the Government
to achieve its public health goals?
2.1 The roots of this document are in an
individualistic approach to health. The problem is seen as being
that people do not make the right choices. We reject this victim
blaming approach. People should make choices where they can, but
often the only choices it will be possible for them to make are
those they can make collectively. There is no mention in the White
Paper about how the Government defines communities, as these are
very diverse and complex. Often the rational choice for each individual
in isolation may aggregate into a state that none of them would
have chosen. Moreover we believe in the duty of governments to
protect citizens from serious harm. Like Nye Bevan we believe
that liberty is the freedom to choose, not merely the absence
of constraint. It is necessary to address the barriers to healthy
choices rather than just to proclaim an individual responsibility.
We welcome the fact that the White Paper seems to have adopted
this analysis. But it has often fallen short of pursuing it.
2.2 Amicus (health sector) are pleased to
see that the Government has achieved a dovetailing across between
the White paper and the Children's National Service Framework.
However, within the White Paper there is little mention of Governance
or Local Strategic Partnerships.
2.3 Amicus (health sector) are also delighted
to see the commitment to modernise and promote school-nursing
services and we look forward to working with government to achieve
this.
2.4 The inclusion of mental health is also
very welcome however the implementation is still somewhat vague.
2.5 We are disappointed that the Government
has not put a greater emphasis on older people within the White
Paper. Given the demographic shift in the age profile, it would
seem shortsighted not to invest more in strategies that are aimed
at older people.
Whether the proposals are appropriate, will be
effective and whether they represent value for money?
3.1 Amicus (health sector) are also disappointed
that the Government have not has not been more assertive in its
action on obesity and in particular the impact on children. Amicus
(Health Sector) fully endorses The Children's Food Bill campaign
co-ordinated by Sustain: the alliance for better food and farming
and Sustains current submission to this enquiry. The Government
needs to go further than strengthening the voluntary codes on
food advertising to children and a strong consideration in relation
to standards for school meals.
3.2 Amicus (health sector) are concerned
that there is an assumption that that providing communities with
high quality information will automatically lead to people making
healthier choices but there can be a number of barriers, which
impact on those, who are often, most disadvantaged including those
with visual, language and learning difficulties or those where
English is not their first language.
3.3 Amicus (health sector) would also urge
that if the tobacco trade is to decline then action must be taken
by Government to protect the workers and communities dependent
on that trade.
3.4 The promotion of exercise involves more
than just an assertion of the responsibility of the individual.
Amicus (Health Sector) feel the Government has missed many opportunities
here. It is important to promote public policies aimed at making
it easier for people to choose to exercise for example:
— Developing safe cycle networks.
— Vastly improving the scope for using
cycles in combination with trains as in the case of the successful
Californian initiative by Cal Train.
— Developing aesthetically attractive
walking networks with safe convenient crossings over major roads
(there is evidence that people will regard walking as an option
for longer distances if the networks are aesthetically attractive).
— Encouraging employers to encourage
walking and cycling.
— Developing "green gym"
projects which have the double advantage of promoting exercise
and improving the environment.
— Promoting decentralised public services
so that people can walk to public services.
— Preserving public footpaths, instead
of seeing them as security hazards.
— Extending open space in the inner
city by using earth sheltered buildings and roof gardens when
redeveloping brownfield sites.
Whether the necessary public health infrastructure
and mechanisms exist to ensure that the proposals will be implemented
and goals achieved?
4.1 Amicus (health sector) welcomes the
White Paper's acceptance of occupational health as a public health
issue. But we urge for it to go farther. Around a third of inequalities
in health arise from work, which is not surprising since people
spend about a third of their waking lives at work. Occupational
health services should be universally available and the Medical
Practitioner's Union has produced detailed proposals for this.
We envisage that they should be funded by employers, provided
or licensed or commissioned by a public body (the HSE and local
NHS Trusts and PCTs have roles here—the HSE for large industry
wide services, NHS Trusts for services marketed to individual
large and medium size workplaces and PCTs for group services for
small and medium size enterprises grouped on a geographical basis).
They should be jointly controlled by employers, trade unions and
local communities.
4.2 Nationally the Minister for Public Health
should be leading cross-governmental strategies. The emphasis
should be on developing healthy public policy. There must be a
continued commitment to integrated working between government
departments so that the broader determinants of health are tackled
at both national and regional levels. There needs to be increased
support for and reinforcement of cross-government targets. Instead
the post has been reduced to Parliamentary Secretary, far too
junior to play such a role, and has been allocated work coordinating
certain healthcare programmes that have a preventive element.
In this way the great step forward that Labour promised in 1997
has been neutered. Indeed the post in not significantly different
from the one that Julia Cumberlege held in the Conservative Government.
The Minister for Public Health must be seen as a powerful force
with access to Cabinet.
4.3 Public health organisation at local
level must:
— Operate to local government boundaries
at least where single tier local government is in place (it is
more difficult in two tier areas).
— Empower the Director of Public Health
to be a significant authoritative figure.
— Recognise the professional nature
of the relationship of public health professionals to a population.
— Be led by an organisation which has
public health goals at its forefront and does not see them as
secondary to other more important corporate goals.
— Have money to bargain with.
— Have adequate capacity. The specialist
public health workforce capacity in the NHS and beyond is wholly
inadequate to the challenges faced. Many primary care trusts still
have single-handed DsPH. This must be addressed to enable delivery
by public health practitioners and the wider workforce in and
beyond the NHS.
4.4 Amicus (health sector) are also concerned
that that Primary Care Trust commissioning function is now going
to practice base based commissioning as this poses real issues
for certain minority groups within the community such as the homeless
and travellers.
4.5 We are delighted with the Government's
move on Extended Schools as there is a body of evidence (world
wide) that demonstrates the impact that extended schools can have
in reducing health inequalities, if a socio-economic approach
is taken, and it is not solely driven by education. However as
we are not starting with a level playing field an issue of concern
must be; to what extent are all schools able to sustain the extended
school model? It is clear that larger schools with good facilities
and external areas will be able to offer local communities a range
of activities. But there are many schools, particularly in inner
city, deprived areas, which due to space and the general fabric
of their buildings are struggling to provide the educational provision
for their pupils let alone for the community. The inverse care
law will prevail, in that those who have will have more.
February 2005
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