Public Health - Health Committee Contents

1  Introduction

1.  Since the publication of the White Paper Equity and Excellence: Liberating the NHS in July 2010, the Government has been engaged in the largest reorganisation for many years of the commissioning and provision of healthcare services by the NHS. At the same time, the Government has also been pursuing the most far-reaching reform of the public health system for a generation.

2.  This situation is perhaps indicative of the way that public health (the promotion and protection of health, and the prevention of ill health)[2] has long tended to be overshadowed in the minds of both the public and politicians by healthcare (the treatment of illness and injury). Yet public health was a priority of governments and local authorities long before the state took responsibility for the provision of universal and comprehensive healthcare services. And, since the creation of the NHS, it has been the policy of successive governments to ensure that, as far as possible, people stay well and so avoid the need to use those healthcare services in the first place. More recently, the combating of health inequalities has also been the explicit policy of successive governments.

3.  It is arguably more important now than ever - with a growing and ageing population, continued health inequalities, and constrained public finances - to ensure that public health is accorded the full priority that it deserves. Yet, while the broad outlines of the Government's proposed changes have been widely welcomed, significant concerns have been raised - not least within the public health field itself - about the risks posed by several key details of implementation.

4.  With these considerations in mind, the Health Committee resolved to look at the planned public health reforms. We agreed the following terms of reference for our inquiry on 10 May 2011:

Public health is a vital, but too often neglected, aspect of the National Health Service. The current constraints on public finances make it more important than ever to limit and reduce the overall demand for NHS services by the public health goals of preventing disease, prolonging life and promoting health. At the same time, the aim of reducing health inequalities becomes ever more pressing as the burden of ill health falls in an increasingly disproportionate way on the poorest, as well as on other disadvantaged social groups.

It is also particularly important to review this topic at this time given that the Government is proposing major changes to the organisation of public health services, as part of its wider plans for reform of the NHS. These changes, which are being legislated for in the Health and Social Care Bill, were originally welcomed by those in the field but have subsequently become highly contentious. The Committee believes it is important that these plans be effectively scrutinised not least because of the importance of public health in ensuring that health services are commissioned effectively.

In its inquiry, the Committee will consider:

  • the creation of Public Health England within the Department of Health;
  • the abolition of the Health Protection Agency and the National Treatment Agency for Substance Misuse;
  • the public health role of the Secretary of State;
  • the future role of local government in public health (including arrangements for the appointment of Directors of Public Health; and the role of Health and Wellbeing Boards, Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies);
  • arrangements for public health involvement in the commissioning of NHS services;
  • arrangements for commissioning public health services;
  • the future of the Public Health Observatories;
  • the structure and purpose of the Public Health Outcomes Framework;
  • arrangements for funding public health services (including the Health Premium);
  • the future of the public health workforce (including the regulation of public health professionals); and
  • how the Government is responding to the Marmot Review on health inequalities.

In addition, our inquiry has touched on the Government's approach to health improvement at the national level; we have looked particularly at "nudging"; the "ladder of intervention" and the Public Health Responsibility deal (with particular reference to alcohol).

5.  During the course of our inquiry, 192 memoranda of written evidence were received and five evidence sessions were held. Oral evidence was taken from: academic experts on public health; the Faculty of Public Health; the UK Public Health Association; the Royal Society for Public Health; the Health Protection Agency; the National Treatment Agency for Substance Misuse; the National Transition Director for Public Health Observatories, Professor Brian Ferguson; the UK Association of Cancer Registries; the Local Government Group; the NHS Confederation; the Association of Directors of Public Health; the British Medical Association; the Marmot Review Team; the Behavioural Insights Team at the Cabinet Office; the Alcohol Health Alliance; Diageo Great Britain Limited; the advertising industry; the Chief Medical Officer, Professor Dame Sally C Davies DBE; officials of the Department of Health; the Chair of the Department of Health Working Group on Information and Intelligence for Public Health, Professor John Newton; the author of the Review of the Regulation of Public Health Professionals, Dr Gabriel Scally; and the Parliamentary Under-Secretary of State for Public Health, Anne Milton MP.

2   The UK Faculty of Public Health defines public health as "The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society" -  Back

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© Parliamentary copyright 2011
Prepared 2 November 2011