Health and Social Care Bill

Memorandum submitted by Professor Martin McKee (CBE MD FRCP FFPH FMedSci), Louise Hurst (MSc MFPH), Robert W Aldridge (MSc MBBS MEng), Professor Rosalind Raine (MB PhD FFPH), Jennifer S Mindell (MB PhD FFPH FRCP), Ingrid Wolfe (MB MSc MFPH), and Professor Walter W Holland (CBE MD FRCP FFPH) (HS 115)

1. In an article published by the Lancet (Annex 1) we set out reasoned arguments for an alternative model for Public Health in England that overcomes some of the problems with the current proposals in the Health Social Care Bill, namely:

· the stripping of public health professionals of their ‘independent voice’ to advocate for the health of the population based on evidence

· unnecessary fragmentation of the public health workforce between the Department of Health and local authority

· possible risks to the ‘ring-fenced’ budget

· securing adequate technical support to Directors of Public Health

· practical difficulties for the maintenance of the substantial trading activities of the health protection agency

In the article we outline recent successes of public health and key principles that should underpin a new public health service.

2. Our practical proposals suggest the establishment of a new body, which would still be called ‘Public Health England’ that would build on existing capacity and absorb the entire existing NHS public health workforce. This body would ideally be established within the NHS as a special health authority, although it might be an arm’s length body of the Department of Health. It would be organised at a local, subnational and national level.

Our model would:

· secure the independence of public health advice, which is crucial to build public trust. For example, it has taken many years for public health professionals to regain public trust following the bovine spongiform encephalopathy affair. The importance of public trust has also been well illustrated by the difficulty the last government experienced in convincing parents of the safety of the measles–mumps–rubella vaccine, a challenge that the new government must now take on.

· provide clear lines of accountability with a board of Public Health England, similar to the model proposed for the NHS National Commissioning Board

· provide national support for cross-governmental working to tackle the wider determinants of health as outlined in the Marmot review

· ensure that Public Health England would hold a truly secured ring-fenced budget, reducing the risk of asset stripping

· enable teams to be deployed at a local level to provide strategic leadership for public health. Local teams would work across the domains of public health with the local structures proposed in the Health and Social Care Bill, including Health and Wellbeing Boards and Commissioning Consortia. Flexible deployment of staff will make it possible to secure critical mass of public health expertise to work with local authorities

· provide comparable competitions for medical staff with their clinical counterparts, avoiding the potential damage that could be caused by 2-tier pathway

· enable the Health Protection Agency to continue its trading and research activities, that would be compromised by the present proposals, so threatening key elements of its work.

3. We attach the article that this submission summarises in Annex 1 as further evidence for consideration by the Public Bill Committee on the Health and Social Care Bill 2010-11.

March 2011