HC 1048-III Health CommitteeWritten evidence from Northgate Public Services (PH 183)

Introduction

1. Northgate Public Services warmly welcomes the opportunity to submit evidence to the Health Select Committee’s inquiry in to public health. Ensuring good health is a key aspect of creating a more equal society and ensuring that the life chances of all citizens are improved.

2. Our submission builds on the previous responses we have made to the Healthy Communities, Healthy Lives consultations and focuses on the areas where we believe that the Government’s approach to public health requires further development.

General Comment

3. We firmly believe that, if we are to improve and support wellbeing in our communities, local government and active local communities should be at the heart of a new approach to public health. Local authorities are well placed to take a view on the health of their communities and understand local need, we therefore welcome an extension of their role.

4. However, the level of resources available to local authorities for their new responsibilities is still unclear. The Government has accepted in its consultation on commissioning that the figure of £4 billion is subject to substantial revision. We believe that there is a strong need for greater clarity about the weighting on the public health allocations for local authorities.

5. We also welcome the creation of Public Health England with its focus on empowering local communities to improve health while also maintaining a national view. If it is to do so effectively, it is important for this new body to foster a close relationship with the National Health Service at a national level and also with local authorities at a local level. Yet, we believe that there remain a number of unresolved issues around the proposed approach to partnership working at both a national and local level. We discuss these issues in more detail below.

6. The Government says that it wants to reach out to address the root causes of poor health and wellbeing. To achieve this, we believe that a reduction of health inequalities must be the central driver behind the Government's approach. We have previously called on the Government to make a reduction of health inequality a key focus of the Health and Social Care Bill by focusing on the social determinants of health. Without such an approach, we fear many of the Government’s plans around health may be blunted by the persistent root causes of poor health in our communities. To tackle this will require a holistic approach to health improvement which considers the wider social determinants of health by joining up services in the locality such as education, employment and housing.

7. Information also has a major role to play in the new approach to public health. High quality information will give people and professionals more control over the direction of healthcare and help shift the central emphasis to one of well-being and improving the health of our communities. Information will also be key to promoting an active citizen approach whereby individuals become fully involved in the decision making process around their own healthcare.

8. We discuss all of these issues in more detail below and make a number of recommendations which, we believe, will help to enhance the Government’s public health vision and make it a reality.

Specific comment

Local Authorities

9. As we have already identified, we warmly welcome an extended role for local authorities in public health, however, we believe that the transfer of public health responsibilities to local government will be restricted by the proposed ring-fencing of the budget.

10. The Government has not yet confirmed what conditions it should impose on local authorities and what level of resources will be available. It is important that the Government provides greater clarity around this issue so that local authorities can prepare for their new responsibilities.

Partnership working

11. As we have mentioned already, if public health is to be improved, there will need to be close partnership working between Public Health England and the NHS at a national level, and between local authorities, Directors of Public Health and GP consortia at a local level.

12. We have previously outlined some concerns about a lack of clarity around partnership working. The Government is proposing to split public health functions between Tier 1 local and Public Health England. It is essential that there is a clear duty for Tier 1 authorities to work in effective coordination with Tier 2 local authorities who have responsibility for health protection work to ensure more joined up working.

13. There also needs to be greater clarity of the relationship between the Secretary of State and local authorities. While the Government wishes to establish greater localism, it also proposes new powers and duties for the Secretary of State, in effect, greater centralisation of powers.

14. Clause 14 of the Health and Social Care Bill provides for the Secretary of State to specify the particular public health services, facilities or other steps that one, several or all upper tier local authorities must provide or take. While this regulation would be subject to Parliamentary approval, it does appear to be at odds with a localism agenda. It would be useful, in our view, for the Bill to clarify in what circumstances such provisions may apply and to consider whether this is in fact necessary.

15. Similarly, Clause 26 of the Bill provides that the Secretary of State may require an upper tier local authority to take certain action where they consider that a Director of Public Health, to be transferred to the employ of the local authority under the new arrangements, has failed or may be failing to carry out certain aspects of their responsibilities. We believe that this clause as currently drafted is at odds with the localism agenda that the Government wishes to pursue.

16. In developing public health strategies it is critical that health and social care strategies are aligned along with broader strategies addressing the wider social determinants of health. We welcome the proposals for minimum membership of the boards, but we think that it is essential that community organisations and the not for profit sector are also brought into the process. This would help to maximise the opportunities for developing an active citizen approach by ensuring that organisations which closely represent the interests of local citizens are able to influence the process.

Health Inequality

18. We firmly believe that the best investment in public health will be that which addresses inequality as its central concern and focuses on outcomes. This approach should maximise the opportunities and life chances for disadvantaged individuals and communities, thereby minimising cost.

19. Sir Michael Marmot’s review Fair Society, Healthy Lives shows that dramatic health inequalities remain a dominant part of our lives. For example, in the wealthiest part of London—a ward in Kensington and Chelsea—a man can expect to live to 88 years of age, while a few kilometres away in Tottenham Green—one of the capital’s poorer wards - male life expectancy is 71. Such inequalities are apparent across all regions.

20. The review also highlights the costs that such inequalities can cause. It estimates that health inequalities cost the economy £31–33 billion every year through loss of productivity, £20–32 billion in lost taxes and higher welfare payments, and £5.5 billion through additional costs to the NHS, economy and society.

21. Health inequalities are not inevitable and can be significantly reduced through coordinated national and local action involving communities. They stem from avoidable inequalities in society such as income, education, employment and neighbourhood circumstances. We therefore believe that any local approach must be one that involves and includes local people in the design and delivery of services, and in their assessment.

22. In order to tackle health inequalities effectively, there must also be closer integration of services. This should involve health and social care, but also wider services in the locality such as education, employment and housing so that the wider social determinants of health can be addressed. Without such an approach, we fear that many of the Government’s proposals may be blunted by the persistent root causes of poor health.

The Information Revolution

23. Information has an integral part to play, not only in supporting and improving performance and choice, but also in transforming our approach to healthcare. The use of high quality information would help to give people and professionals more control over the direction of healthcare and shift the central emphasis to one of well-being and improving the health of our communities.

24. If the Government’s information revolution is to be successful, it is also essential that individuals are able to access the information that will empower them to be active citizens, taking more responsibility for their own wellbeing and that of their families.

25. In developing the right approach to information on public health, we believe that it is critical for social care and health care information to be closely integrated. At the same time, if the overall health of society is to be improved, it is essential that information on public health is linked to as many as possible of the external factors influencing health (such as educational attainment, benefit claims, crime and access to healthy food choices). There should also be coordination between the information collected at a local authority level so that public health information more accurately informs data about the population’s health. This will ensure that the social determinants of health are taken into account by commissioners and enable individuals to assess the risks associated with their lifestyle choice and community more generally.

26. It is for this reason that we believe local authorities, given their public health responsibility and wider view of local issues, are ideally placed to take a leading role on the provision of information relating to the health of their local communities. We take the view, however, that Government has a central role in setting the applicable framework for public health and for coordinating an effective evidence base at a national level. The Information Centre has previously had a role to play in ensuring the quality and standard of data and we believe that its experience in doing so should be key to informing the Government’s approach in the future.

Conclusion

27. We welcome the Government’s overall vision of public health, however, there are a number of areas where we believe further development is required if the new approach is to be a success.

28. Particularly, we believe that more clarity must be provided about the role of local authorities and the nature of partnership working at both a national and local level. This is to ensure that all parties are fully prepared to take on their new duties.

29. At the same time, it is essential that the key driver behind the new approach to public health is a focus on the reduction in health inequalities. Without this, many of the Government’s wider plans around healthy may be blunted in implementation by the persistent root causes of poor health.

30. Finally, we believe that information has a key role to play in directing the new public health agenda and also in encouraging active citizens who become fully involved in the decisions and management of their own health.

June 2011

Prepared 28th November 2011