Memorandum by the Association of Directors
of Public Health (WP 41)
GENERAL COMMENTS
The ADsPH broadly welcomes the White Paper on
Choosing Health. We note however that the focus is very much on
lifestyles and individual choices which, while important, also
misses much of public health. There are three domains of public
health practice which incorporate health improvement, health protection
and heath services. Health Improvement does include promoting
healthy lifestyle but also needs to address the importance of
the underlying determinants of health (including poverty, educational
attainment, housing and social networks). The White Paper also
omits mention of health protection and preventive programmes such
as immunisation and screening and much of the public health contribution
of health services. The implication of this partial view of public
health will affect the ability of the Government to achieve its
public health goals. We understand the Governments wish to focus
on choice as part of its system reform agenda but we would seek
recognition that this does not encapsulate a rounded public health
analysis of contemporary public health challenges.
To ensure effective implementation you need
public health programmes, which address all three domains of public
health practice. Public health programmes need to address the
problems (eg heart disease) in terms of promoting and protecting
health, preventing disease, diagnosis, treatment and care. Each
programme will need a strategy which identifies the role of national,
regional and local partnerships. It is this conceptual framework
that will assist the Select Committees appraisal of whether the
infrastructure and mechanisms proposed in the delivery plan are
fit for purpose.
SPECIFIC ISSUES
— We welcome the emphasis in the White
Paper on Directors of Public Health Annual Reports being submitted
to the LSPs and Local Authority partners who will be expected
to issue a formal response to the recommendations. The annual
report needs to be a statutory responsibility and DsPH be given
the resources to produce effective reports and follow through
via local partnerships on a year on year basis.
— Sufficient resources must mean increasing
public health capacity so PCTs are all able to recruit a DPH and
those in post don't find themselves exposed as single handed specialists.
Since Shifting the Balance this has been a common experience of
our members in England.
— We also support the development of
joint appointments between the PCT DPH and the partner Local Authority.
Often these arrangements are notional with little resource being
made available to the DPH in the local government sector and no
clear corporate position. There are however a number of successful
examples of effective joint appointments and these are usually
where there is a unitary authority and the boundaries of both
organisations are coterminous.
— The ADsPH recognise that for many
PCTs the lack of coterminosity makes the development of effective
LSPs problematic. It also makes joint appointments impossible.
If there is to be more organisational changes in the NHS or Local
Government then moving toward shared populations should be a priority.
— Since 1974 the issue of the location
of public health leadership within either the NHS or local government
has been debated in a sometimes divisive way. There is clearly
a need for the local NHS and local government to demonstrate the
duty of partnership as the lead statutory bodies for public health.
Joint appointments and the development of effective LSPs will
be critical.
— We welcome the development of Local
Area Agreements and the explicit linking of national PSA targets
with local PSA target delivery. Clearly getting greater clarity,
consistency and synergy from the centre to the locality via central/local
government and the NHS will make the delivery of the White Paper
goals more likely.
— The question of political and civil
service leadership for public health needs review. We recognise
that the Health Select Committee has looked at the Minister for
Public Health post and its seniority and position in the DH before.
In view of the fact that so much of the White Paper and Public
Health requires cross government working that consideration be
given again to create a Cabinet level post who could provide the
leadership across government. The current junior level Ministerial
post in the DH is not a good signal of the priority given to Public
Health challenges.
CONCLUSION
The ADsPH have a long history of representing
Public Health Directors in statutory organisations since the middle
of the 19th century. We recognise the need to influence government
policies at national, regional and local levels. We hope that
the Health Select Committee will urge the Government to ensure
that at each level of the public health system there is sufficient
public health capacity and that the leadership is positioned corporately
to have optimal impact on government at each level and through
the NHS.
January 2005
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