HC 1048-III Health CommitteeWritten evidence from Platform 51 (PH 149)

Summary

Platform 51 is concerned that the Government’s Public Health plans have not given sufficient attention to women’s health.

It is our view that providing girls and women with quality, appropriate, and gender-specific health services can help to reduce health inequalities. Women’s voluntary and community sector (VCS) organisations provide a range of integrated, holistic, needs-based services which promote girls’ and women’s health and wellbeing. They also “add value” to existing health services by acting as a referral agent, and through reaching and representing the most marginalised women.

The role of the VCS should be better embedded in Public Health plans. This includes through the gathering of evidence, helping to inform local health priorities, and in producing joint strategic needs assessments (JSNAs).

All bodies and individuals involved in promoting public health must have a full understanding of gender and health inequalities in order to develop the right priorities, commission appropriate services, and hear the voices of girls and women. There should be strategies, guidance and training to support this.

Public Health evidence and the Outcomes Framework must reflect girls’ and women’s particular health concerns, be able to be disaggregated by all the protected equality characteristics (Equality Act 2010), and be monitored for performance.

Platform 51 is unconvinced that a health premium is the right way to allocate resources. In our view, public health funding should be targeted to areas of high need and not withdrawn from areas that do not appear to be performing as well as others.

We would like to see greater attention given to The Marmot Review’s recommendation to ensure a healthy standard of living for all, and to address the correlation between income and health.

Introduction

1. Platform 51 supports girls and women as they take control of their lives. Girls and women are at the heart of all we do. Our activities, services and campaigns are about things women need and want. We give them a platform to have their say and challenge discrimination. We want a world where women are in control of their own lives.

2. Platform 51 welcomes the Health Committee’s enquiry into Public Health and the opportunity to submit this evidence. We welcome the Government’s stated commitment to the prevention of poor health, to taking a life course approach to health, and to looking at the wider determinants of poor health.

3. We are concerned, however, that the Government’s Public Health White Paper, Healthy Lives, Healthy People, did not give any specific attention to women’s health, despite the Department of Health previously publishing documents and strategies which recognise the health differences between men and women. From our work with girls and women, Platform 51 knows that the cumulative effects of women’s disadvantage can have significant impacts on their health, and this must be considered in future Public Health arrangements.

Girls’ and Women’s Health

4. Many of the social factors associated with poor health are of particular concern to women, particularly: poverty and debt; violence and abuse; unemployment, underemployment and low pay; and mental health problems. Due to the longer durations of poor health that women experience, their health and social care needs exceed that of men in each social class and area. While women can expect to live longer than men, they are also more likely to spend more years in poor health or with a disability.

5. Women’s voluntary and community sector (VCS) organisations work on a wide range of issues that affect girls’ and women’s health and wellbeing, including: gender stereotyping; self esteem; violence and abuse; poverty; unemployment; offending; pregnancy and parenthood, including teenage pregnancy; drugs and alcohol; asylum and immigration; and physical and mental health problems.

6. Platform 51’s own work supports the Government’s ambitions for good public health outcomes in a range of ways:

(a)helping girls’ and women’s build self-esteem and confidence, increasing their choices, opportunities and personal responsibility;

(b)building women’s resilience to poor health, promoting healthy behaviours, preventing health problems from arising or worsening, and tackling the root causes of poor health;

(c)working with women around key transition points in their lives, when things can go wrong and have a damaging affect on their lives;

(d)supporting mothers, including teenage parents, to give their children the best start in life; and

(e)and supporting women into meaningful volunteering and job opportunities, moving them on from the bottom rung of low-skilled and low-paid work.

7. Providing girls and women with quality, appropriate, and gender-specific health services can help to reduce health inequalities. As a report from the National Mental Health Development Unit found, “local voluntary sector women’s centres have a clear and important role in engaging women and fostering well-being, particularly women who are marginalised.” The work done by women’s organisations is estimated to save the state millions of pounds each year, through improving women’s prospects and preventing problems from arising or worsening. Without them, women would have a greater need for health services to address their acute problems, which could have been prevented in the first place.

8. For example, women-only services have an important role to play in promoting positive mental health in women. Platform 51 is very concerned by the extent of low level mental health problems, including stress and depression, amongst girls and women. Our recent report showed that in England and Wales, 63% of girls and women have been affected by mental health problems of some kind – the equivalent of 15.2 million girls and women. Of the 2,000 women we polled for our recent report into women’s mental health and wellbeing, 82% felt it was important to have access to women-only services. Women-only space is particularly important for women who have experienced abuse or isolation as they can feel unsafe in mixed settings.

9. The women’s VCS also contribute “added value” to existing health services and public health by acting as a referral agency, both in to and out of the health system, through reaching and representing some of the most marginalised women who either do not engage with health services or who do so chaotically, and by providing integrated, holistic, needs-based support.

Public Health England

10. Public Health England (PHE) must ensure that it is using the full range of evidence available to inform its health priorities, including that which best captures the broader social and personal barriers to good health. Platform 51 is concerned that current evidence does not always reflect the experiences and lives of the girls and women we work with, and that gender is often not fully considered in health research. Qualitative evidence and information gathered by VCS organisations, who are often not involved in setting health priorities despite their role in contributing to them, should be included in this.

11. Where research does not exist, or where local organisations can not be called upon to help provide this information, PHE, local authorities and health and wellbeing boards should commission research that addresses the gaps, particularly around gender and health inequalities, access to services, and appropriate gendered responses to health.

12. All research must be disaggregated by all the protected equality characteristics as set out in the Equality Act (2010). PHE must also oversee how local areas are gathering data to ensure a consistent and thorough response to Public Health evidence across the country.

The future role of local government in public health

13. To comply with their obligations in the Equality Act (2010) and to effectively commission services to support girls’ and women’s health, the women’s VCS must have representation on the relevant health bodies, including health and wellbeing boards, GP consortia, the NHS Commissioning Board, and Public Health England. These bodies must also actively engage with the women’s VCS, as service providers, as referral agencies, and as patient advocates. Boards will need clear guidance and governance to do this, which must be applied consistently. Part of the ring-fenced public health funding should be allocated to engaging with, and commissioning, VCS organisations.

14. Directors of Public Health need to understand gender and health inequalities in order to take the strategic lead in meeting the health needs of both women and men in their area. It is important that they fully understand what services the women’s VCS can offer, as well as the added-value these services bring. They should find ways of enabling specialist organisations, who may not have experience of working with health services, to become an equal and trusted partner.

15. The VCS must be involved in producing joint strategic needs assessments (JSNAs) to ensure a full picture of local health needs. The production of JSNAs should be jointly owned by the statutory sector, the VCS and local communities, and should ensure that all the protected characteristics are represented, including the voices and experiences of girls and women.

Public health and the commissioning of NHS services

16. Platform 51 recognises welcome extending existing arrangements so that a wider range of providers can deliver public health services. We know from our work that many socially excluded girls and women do not readily access their GP, or feel they do not receive an appropriate service when they do. As commissioners, GPs must understand the role of the women’s VCS in contributing towards public health outcomes and commission them accordingly.

17. GP consortia will need given clear guidance on how to work with VCS organisations. In Platform 51’s experience, where we have good relationships with local health services, we are better able to support the public health of the wider community. By referring girls and women on to us, GPs are better able to contribute to improving the wider health outcomes of their area.

18. Each GP consortia should set out a policy and strategy for addressing women’s health. We look forward to seeing plans set out for meeting legal requirements under the Equality duty to tackle discrimination and gender inequality, as outlined in the department of health’s working paper on the GP Commissioning Consortia.

19. To be able to mainstream a gendered approach in primary health, GP training and education must include the gender differences in health outcomes and inequalities, as well as the different ways in which women and men access and interact with services.

20. The NHS Commissioning Board (NHSCB) should work with local authorities to support the women’s VCS to build the links they need to engage with health bodies, including GP consortia. They should provide GPs with guidance, training and support on how best to engage with the sector, as well as to understand the added-value the sector can offer.

21. Platform 51 would like to see further information about how local people will be able to hold their GPs and GP consortia to account. There must be active engagement with local communities, and particular efforts to engage with the most marginalised, to ensure their voices are heard and health services are improved. The NHSCB and PHE should monitor NHS and GP consortia performance and hold them to account where are not achieving appropriate standards and meeting equality objectives.

Commissioning public health services

22. Local authorities, health and wellbeing boards and GP consortia must work together to map the services available in their areas so they can build a clear picture of existing provision, identify gaps, and understand what organisations could be commissioned to deliver services which promote public health. Health commissioners should ensure that women-only services are provided as part of a core range of support for girls and women.

23. Local areas must take responsibility to ensure that girls and women are involved in the design, delivery and evaluation of public health services to ensure they meet their needs. All health services should be young people friendly, and pass You’re Welcome standards.

24. Girls and women must know what services are available to them. The Department of Health should establish a service which provides Information, Advice and Guidance (IAG) to enable girls and women to make appropriate choices about their health and wellbeing and enable a range of providers, including the VCS.

25. Platform 51 believes that there will be some minority or specialist services that may need to be commissioned by the NHS Commissioning Board and Public Health England, rather than by GP consortia or health and wellbeing boards, to ensure that they are not missed out entirely and to avoid public health being dominated by majority concerns.

The Public Health Outcomes Framework

26. The Outcomes Framework must contain measures which relate to a range of areas, including health, housing, education, welfare and employment. Platform 51 would like to see a set of indicators arrived at which reflect girls’ and women’s particular health concerns, and which will result in better services and health outcomes.

27. In our previous responses we stressed that we did not want to see so small a set of indicators arrived at that they become ineffective at reflecting a true picture of an area’s health. Indicators should be joined up to create key indicator themes, including: experiences of violence; quality of the environment; housing and the quality of neighbourhoods; the labour market; education; offending; and economic indicators.

28. The Framework must use indicators that are meaningful to all partners to ensure collective agreement and effective joint-working. All local bodies which play a part in improving health must jointly agree and share health and wellbeing priorities through the health and wellbeing board. Performance and improvements across the Framework must be monitored.

29. Platform 51 is concerned that the Framework currently gives insufficient attention to the role of the VCS and is not clear enough on the role it can play in local partnerships. We would like to see VCS engagement made clear in plans for local delivery to ensure that this involvement is embedded from the outset.

30. We are concerned that as it currently stands, the Framework does not go far enough to reflect or address inequality in health across equality characteristics. All public health data must be able to be disaggregated by equality characteristics in order to deliver the most appropriate services, and to monitor health inequalities. For more on our concerns around an appropriate public health evidence base, please see paragraphs 10-12.

31. We would like to see the Framework measure inequalities in access and experiences of health services. Girls and women often tell us they have poor experiences of health services which can be inaccessible, unfriendly and not appropriate for their needs. As a result, many have little confidence in them, and so do not access services at all, which can have significant longer term consequences for their overall health.

Arrangements for funding public health services

32. Platform 51 welcomes the attention given to public health, but we are concerned that the funding allocated is not sufficient. As the Marmot Review found, only 4% of NHS funding is spent on prevention, and the estimated £4 billion that will cover public health services, of the approximately £100 billion NHS budget, goes no further to redressing this. Current and forthcoming spending cuts will place a significant strain on vital public and VCS services that contribute to public health in a number of ways. In addition to a reduction in services, the loss of staff, knowledge and expertise will further compromise public health.

33. Platform 51 is unconvinced that a health premium is the right way to allocate resources. In our view, public health funding should be targeted to areas of high need and not withdrawn from areas that do not appear to be performing as well as others. This could be for a variety of reasons, including increasing unemployment rates, poor educational attainment and reductions in welfare payments, all of which would be out of the direct control of Directors of Public Health.

34. We are concerned that a health premium could result in some areas doing better than others, and funding continually going to those which have already improved upon their outcomes. Reducing funding from deprived areas like these will result in worse outcomes for people in those areas. This method may also provide a perverse incentive to create JSNAs around indicators which are easier to measure or reduce. It may mean that wider factors not included in the framework are ignored entirely. Creating areas which have increasingly better services while others have funding removed or reduced, may mean that people who have the facility to will travel to areas that have better services, creating pockets of deprivation and poorer services.

The Marmot Review on health inequalities

35. Platform 51 was particularly supportive of the attention The Marmot Review gave to income, and welcomed the recommendation to develop standards for minimum income for healthy living.

36. Women are at greater risk of poverty, are more likely to suffer recurrent and longer spells in poverty, and are the main managers and shock absorbers of family poverty. Around two-thirds of low-paid jobs are held by women, so the National Minimum Wage is a key tool for lifting girls and women out of poverty, as well as tackling the gender pay gap. Evidence also shows that benefits paid directly to women substantially improve the health of them and their children.

37. Platform 51 is concerned that, whilst recognising the evidence put forward by The Marmot Review, Healthy Lives, Healthy People did not take seriously enough the Review’s recommendation to ensure a healthy standard of living for all, or to address the correlation between income and health and would like to see this given more consideration.

June 2011