Examination of Witnesses (Question Numbers
Professor Dame Sally C Davies DBE,
Chief Medical Officer, Department of Health, Anita Marsland
MBE, Transition Managing Director, Public Health England,
Department of Health, Professor David R Harper CBE, Director
General, Health Improvement and Protection, Department of Health,
and Professor John Newton
12 July 2011
Q289 Chair: Good
morning. Thank you very much for coming along this morning. Welcome
in particular to Dame Sally Davies, the new CMO, on your first
appearance before the Committee in your new role. I apologise
for keeping you waiting. We have a bit of a backlog of reports
building up that we are trying to get out and we have been discussing
those as well as preparing ourselves for this session.
Could I begin by asking you to introduce yourselves and the particular areas of departmental responsibility that you come from?
As you know, I am Sally Davies, the new Chief Medical Officer.
I am also the Chief Scientific Adviser to the Department and I
hold the R&D portfolio, which I had previously managed as
Director General. As Chief Medical OfficerI have actually
brought the job description in case you wanted to get right into
the detailsI am the principal medical adviser to the Government
to advise on health and the population's health. I am both independent
as well as part of the Government. In that role I attend the Cabinet
SubCommittee on Public Healththe only official who
doesand I am clearly the advocate for the public's health
crossGovernment and generally.
In the job description I have been given a new role,
as professional head of the public health profession, and as we
develop our plans, I have to make sure they are all right. While
I am no longer the professional head of the whole medical profession,
we take the view that the leaders of the medical profession are
collective and multiple and that it does not rest with one person.
I will be writing an annual report, which is independent, and
continuing in that way. I will stop at that point and pass over
to Professor John Newton.
Good morning. My name is John Newton. I am the Regional Director
of Public Health for South Central and I chair the Working Group
on Information and Intelligence, which I believe is of interest
to the Committee. Thank you.
I am Anita Marsland. I am Transition Managing Director for Public
I am David Harper. I am the Director General for Health Improvement
and Protection within the Department of Health. I am also the
Department's Chief Scientist and Head of Profession for scientists.
Q290 Chair: Thank
you very much. Could I begin by asking Dame Sally a question about
the role of the CMO as a result of the changes the Government
proposes in the structure of public health in England. How do
you see the role of the CMO changing in the context of the proposals
as they have developed over the last twelve months compared with
the historic role of the CMO in public health issues?
Historically, the CMO straddled health care and public health,
whereas now I see the NHS Medical Director as playing the lead
role for the health care part. As CMO, I will play very much the
lead role and be the senior doctor for public health. That plays
out in a number of ways. I am going to set upI have not
yet because it is unclear to me the best way to do ita
public health advisory committee that will advise me, and through
me, Ministers. It will have the function, relating to Public Health
England, of keeping an eye on it, challenging it and doing deep
dives, if necessary. Therefore, it will be looking at public health
and advising. As Public Health England will not have a nonexecutive
board, this CMO advisory committee becomes particularly important
in its challenge and monitoring functions.
As to the important role of the annual report, I
see it as being in two parts: one, a quite oldfashioned
one about the state of the public's health and the data that need
to be out there for transparency and for everyone to use, and
another doing an indepth review of an area that matters.
I am considering doing infection as the first and getting experts
to contribute to that in a way that antique CMOs didbut
not the last one. I think they would be antique now anyway, if
they are still alive.
Then there is the role of leadership: externally
showing that this matters to me, to the Government, to everyone
and trying to make the linkages; and inside the Department and
Government advising, chivvying and pullingdoing what we
Q291 Chair: In
your introduction you drew out the fact that you were the head
of the public health profession rather than the medical profession
more generally. Do you, therefore, see the role of the CMO now
as almost a director of Public Health England?
No. It is not an executive role. There will be a chief executive
reporting to the Permanent Secretary. It is a serious advisory
and challenge role. It is written down as advisory and I have
put in the "challenge" as well.
Q292 Chair: The
classic three domains of public health include health care public
health and the question is how far you interpret the role of the
CMO, as you have defined it, allowing you to get into health care
questions as opposed to prevention and health protection?
Being me, I am reserving my right to range widely, but there is
a limit to what one person can do. My role is to make sure the
public health profession play that out. In the Government's response
to the Future Forum they accepted that the public health third
pillar would be delivered by Public Health England and out of
local authorities, and we are working on how to do that. If there
were concerns that came to my attention, or to your attention
and you remitted them to me, clearly I would pick them up. Infection
is an example. We have infection in the NHS, we have infection
broadly in the community and we have infectious threats. That
is why I thought I would try using infection as the first expert
report to show that I am going to reach into every area on certain
issues if I need to.
Q293 Chair: Infection
is a classic health domainpreventionarguably. Suppose,
for example, there were concerns aboutan issue very rarely
out of the headlinescancer outcomes and the delivery of
cancer outcomes in different parts of the health care delivery
system. Would that be something, as CMO, you would follow up as
part of health care public health, or would you say that is now
defined elsewhere in the system?
The executive role would sit with the National Commissioning Board
and the medical director there. Clearly, if I was concerned, I
would be asking questions, throwing a light on it and advising
about the science and what might be considered, but the executive
role is in the Commissioning Board.
Q294 Chair: Thank
you. Can I move the spotlight to Anita Marsland to understand
what is proposed now in terms of the structures for Public Health
England? We have moved from it being a core function of the Department
to it being an Executive agency. The question in many people's
minds is what that means in practice. What is the degree of independence
implied by an Executive agency? Some people have said that it
ought to be a special health authority. It becomes a bit of an
anorak issue, if you are not careful, about "Why an Executive
agency rather than a special health authority?" and "What
are the implications of the choice?"
I will take the Committee through the development of thinking
on this. Ministers have been very clear about the importance of
a clear line of sight between them and the front line when it
comes to health protection issues. This is akin to the defence
of the realm. We look to central Government to defend us against
threats which we, as individuals or communities, are not well
placed to tackle. That is why Ministers have taken the view that
a nondepartmental public body like the HPA, however responsivewe
would agree with the proposition that the Health Protection Agency
is very responsiveis less fit for purpose than an organisation
that is part of the Department.
However, we have heard a consistent message and concern
that that was going too far. We believe that locating Public Health
England completely within the Department would risk compromising
the attributes of scientific excellence and independence that
we depend upon. Executive agency, therefore, in the Ministers'
view, is a sensible compromise. Executive agencies are part of
the home Department but have an operational distinctiveness. Such
status would allow Public Health England to build and maintain
a distinctive identity but within the Department. Also, it will
support the ability of scientists in Public Health England to
give expert independent scientific advice and make it easier for
PHE to continue earning significant sums from external sources,
as the HPA does at present, as I am sure the Committee is aware.
Shall I go on to "Why not a special health authority?"
Chair: Go on, yes.
I would refer you to my previous answer in part, that Ministers
have of course been very clear about the importance of the clear
line of sight. It is also important to recognise, though, that
Ministers have taken the view across the system that the freedom
to set up special health authorities has been overused and that
the lifespan of any such body should be strictly time limited
and subject to review.
Q295 Chair: I
am less interested, personally, in the precise structure than
I am in the principle that Public Health England is seen to be,
and wins public confidence as, an independent voice that speaks
truth unto power.
That is terribly important, and is why I am happy we are going
to have an agency rather than incorporate it into the Department.
If you think about the MHRA, it is seen internationally as a model
and functioning independently. Most people do not even know that
it is an Executive agency. We will have to work hard with the
scientists, but as Chief Scientific Adviser, it is one of my roles
to guarantee the independence and to get them talking about what
they are doing to power and to mediate where necessary.
Q296 Chair: Not
necessarily speaking truth in private.
I hope they will speak truth in private.
Chair: That is not what
That is important. When it is needed, we will have to speak
truth publicly if it is not heard, yes. I would prefer to have
the uncomfortable stuff discussed.
Q297 Valerie Vaz: Do
you see Public Health England, in this new structure, as part
of the NHS? For instance, will there be joint appointments or
will it be jointly appointed?
It is going to be separate from the NHS but will work very closely
with the NHS.
Q298 Valerie Vaz: Is
it still part of the NHS?
It is funded by the same vote that funds the NHS, so it is part
of the health bit, but what we are trying to do is give a much
bigger emphasis to public health and prevention than we have ever
given it before.
Do you want to pick up on the links across?
You have said what I would have said, Sally. I think that is clear.
Q299 Valerie Vaz: Is
it joint appointments or jointly appointed?
Do you mean of the director of public health?
Valerie Vaz: Yes.
It is jointly appointed.
That is between Public Health England and the local authorities.
Q300 Valerie Vaz: That
is not what the Secretary of State said last week.
Directors of public health in local authorities will be jointly
appointed between Public Health England and local authorities
so the NHS will work through the local Health and Wellbeing Boards
at the local level. At the national level there will be working
between PHE and the National Commissioning Board and we are looking
at our subnational hubs to try to make sure they not only
match with the DCLG resilience stuff but that the Commissioning
Board and Public Health England are, ideally, colocated
and work very closely together. We are working to make them very
close to each other. We cannot let the NHS walk away from public
health. They are a key part of it.
Q301 Chair: When
you say "colocated with the Commissioning Board,"
that raises another question in our minds about the nature of
the structure that Public Health England intends to have below
the national level. The Commissioning Board is itself developing
its ideas about offices outside Richmond House. Is that a conversation
that is going on in parallel with PHE and is it the implication
that wherever the Commissioning Board had an office PHE would
have a presence?
I will let Anita give you the detail, but yes, of course it is
a conversation we are having together. Not every office will be
colocated, but where significant amounts of activity are
going on, if we can, we will. However, that does not mean that
at the end, it will be like that.
Thank you. We are not proposing a regional structure but we will
align the hubs that we create for Public Health England with the
DCLG resilience hubs and with the NHS Commissioning Board. As
far as possible, we will look to the same geography. That may
not always be necessary or appropriate, but it will be our starting
point. We are not able to say anything definitively today about
that as we are still working on it, but we feel very strongly
that alignment is important.
As an existing regional director of public health, of course I
have a view on this. The important thing is that Public Health
England can interact with a variety of bodies. No single arrangement
is likely to dovetail perfectly with all of them, so we need flexible
national coverage that allows us to work effectively with all
the other organisations we need to work with.
Q302 Rosie Cooper: Can
I jump in and ask a question? All these reorganisations are supposed
to make life easier. Is this better or worse than where you have
been? Is this simpler or more complex than where you have been?
What are the real upfront advantages of yet another mess?
I believe, for public health, that when we get to the end of this
it will be better.
Q303 Rosie Cooper: When
will we get to the end of it?
We expect to have Public Health England up and running from 2013.
We are looking to appoint a chief executive for it this autumn.
They will be able to do shadow running so it should start at a
run. At the moment there are lots of very good bits, but they
are rather separate. By creating Public Health England in the
way we envisage, we are bringing it together. We will get efficiency
savings, which we need, and we should get a much better information,
intelligence and surveillance system. John is leading on that
and can talk to you about it. I do believe it will be better.
Q304 Rosie Cooper: You
are involved in it. You are all professing independence and yet
you are all part of it. I hear you, but I do not know whether
the public out there will actually buy this "I am part of
the health department, but I am independent" line that everyone
I think I am the only person who sits here with an independent
role, as it happens. My colleagues are civil servants. If I thought
it was wrong, I would say so. I think we will end up with a better
system. I believe that or I would not be doing this.
Q305 Chair: Could
you elaborate for the Committee what you think are the three or
four key improvements that come from this process?
The efficiencies in the delivery of services by bringing them
together, the increased focus on health improvement and behaviour
by bringing it together, the wins from putting local public health
into local authorities, back where it came from, and
Q306 Rosie Cooper:
With no money.
Chair: We will come to
that, Rosie. Let us do it one by one.
They are going to have a budget.
Oh, dear, you kind of interrupted me.
Rosie Cooper: I am sorry.
Chair: Savings, integration,
Yes. As I had a heavy winter with flu, I also saw how having the
disparate bits made for complications and slowness. It worked
fine, but if we get a really nasty E.coli or something, I would
like it to work better. I believeI am trying to make surewe
are designing a system that will work better.
Q307 Valerie Vaz: This
is an opportune time to talk about what is happening now. You
are talking about your hopes for the future and where it is going
to go. We are all quite confused because we don't know either,
even though we have had various people in front of us. Could you
elaborate on or give us a snapshot of what is happening on the
ground now? Where do you see the transition? How is it going to
get to this wonderful new structure that you are hoping will work
I am determined it will work well. I will start with Anita and
then hand over to John.
Obviously we are working on all the dimensions of this reform,
which is complex. Starting with the local system, the regional
directors of public health have the lead for putting together
transition plans in their areas, working with directors of public
health and the wider public health community and local government
to ensure that there is a smooth transition into local government.
Progress is variable thus far around the country, but what we
are seeing is a real appetite for that transition. That is working
well. The other aspect, of course, is establishing the new national
organisation with its hub structure. We are working with key stakeholders
to design that organisation. There is lots of activity at the
It is really important that we involve people who
are part of the system in designing it, but also the public, and
we are engaging with as many people from as far and wide as possible
in that discussion. I am going around the country with some of
my colleagues talking to as many local authorities as possible
because it is equally important to them what Public Health England
is like for the local system because they are so interrelated.
There is a lot happening. There is a lot of discussion and debate
and a lot of energy and enthusiasm. I believe we have the right
people involved in those discussions.
Can you talk about the pathfinders?
Q308 Valerie Vaz: I
am still not clear what the transition is and what is happening.
You are talking to lots of people, but where is it? It has only
recently been announced that we are going to have Public Health
England so the structure can't be clear in your minds. What is
the morale like out there? Do we have a work force? What is happening
to all the data in terms of health inequalities? What is happening
to all of that? Are they doing no work or are they just talking?
I will invite John to comment. It is variable, as I have said,
but I think morale is improving. It has been a difficult period
If I could answer one of your earlier questions, there is a huge
potential benefit in having a national integrated public health
service. There is no doubt about that. There is huge benefit in
the transfer of health leadership to local authorities, but like
any change, there is good and bad. Some people are seeing more
of the good and some people are seeing less of the good. We are
seeing a mixed picture in terms of morale.
What are we doing? There are two jobs. Whether you
are talking about Public Health England or the local system, there
is a continuity job to be done. We are trying to find out exactly
what we are doing at the moment. It is not easy working out what
everyone is doing in the primary care trusts and in other areas.
So there is a continuity job. What are we doing? How do we make
sure that the good things carry on? That is the point you made
about the inequalities data and so on.
Then there is the opportunity job. We are doing
all this for a purpose. We must make sure we realise the opportunity
in having local councillors involved in health strategy and so
on and, at national level, realise the opportunity in bringing
together disparate organisations whose mission is determined by
which ICD chapter they are responsible for. I am talking about
the classification of diseases. You have the Health Protection
Agency doing infections, Cancer Registries doing cancers and Public
Health Observatories doing some of the other things. In some areas,
like childhood accidents, we have very little activity. Here is
the opportunity to bring that together and take a rational view
of what the public health priorities are for the population, how
we use our resources most effectively to address those and then
follow that through in a properly founded structure. That is my
quick summary of the task. If you wanted to know more about any
of those elements, I am sure we could elaborate.
Chair: Mr Tredinnick wants
to follow up on some of the local stuff.
Q309 David Tredinnick: We
may well be getting into some of these points, Chair, through
you, later on. I am sure you will have a chance to elaborate.
I want to focus on local government and the directors of public
healththe new arrangementsbecause, of course, up
until 1974, as we are all aware, public health was the responsibility
of local government. Now the proposals are for Public Health England
to share that with the higher echelons of local government, including
I would like to ask, first, a question about the
Department's memorandum which says that Directors of Public Health
"will be qualified in the specialty of public health (which
includes those from both medical and nonmedical backgrounds."
Does this mean that there will now be a statutory requirement
for them to be appropriately qualified?
I had better answer that. The Government has not yet decided.
It is still under debate. The profession feel very strongly that
there should be statutory regulation. The debate centres on the
costeffectiveness of that, and I know you are addressing
it in your next session.
What we are clear about is that the director of public
health in local authorities will be appointed jointly by the local
authority and Public Health England and will, therefore, be an
appropriately qualified and certified persona professional.
Q310 David Tredinnick: What
if there is a disagreement between the local authority and Public
Health England about the appointment? How will that be dealt with?
Do you mean at the appointments committee?
Q311 David Tredinnick: Yes.
Are you going to have guidelines for that?
I have seen many appointments committees where there have been
disagreements and we have always resolved them.
Q312 David Tredinnick: Fine.
Often the third party walks through the middle.
David Tredinnick: Thank
But it will be an appropriately qualified person.
Q313 Chair: It
is a dual key.
Q314 David Tredinnick: The
memorandum says that the Government is "working with local
government to ensure that there is maximum flexibility" to
ensure directors of public health continue to be independent advocates
for population health. What form exactly will that flexibility
take and will councils be free to decide how flexible they are?
The democratic accountability of local authorities is a strength
of the new system, not a weakness. We would expect directors of
public health to be senior officers and to have the same corporate
responsibilities as any other senior officer. The Bill gives them
clear duties that they would be expected to undertake in a professional,
impartial and objective way. The Bill also gives the director
of public health a duty to produce an annual report on the health
of the local population and, importantly, the local authority
to publish that report. Finally, before dismissing a director
of public health, local authorities would have to consult the
Secretary of State. All together, that gives quite a bit of independence
in terms of their voice.
Q315 David Tredinnick: I
put it to you that the key issue is the seniority of the public
health officer and whether they report directly to the chief executive
or whether they are going to be an underling somewhere, buried
in the infrastructure. Can you explain to us how directors of
public health are accountable to you as the Chief Medical Officer?
How will that fit in with their accountability to local authorities
and to Public Health England in the new system?
People are formally accountable to their employers. DPHs will
be accountable in the local authority to the chief executive.
We expect them to have chief officer status with a direct line
of accountability to the chief executive. Thus, their accountability
to me is a professional accountability that will be exercised
through Public Health England in general, but, clearly, if there
are issues, I may have to step in.
Q316 David Tredinnick: We
have a dual reporting system here, reporting to you and reporting
to the council.
It is not unusual in health that doctors are part of a formal
structure for accountability, and so we should be, but also have
professional responsible lines.
Q317 David Tredinnick: Thank
you. I have one other question. What work is the Department undertaking
to ensure continuity of the public health work force in the transition
to local government's new public health role, please?
As David Nicholson made clear in his most recent letters to
NHS colleagues, there is a clear expectation that sufficient resources
are retained within the system to enable critical public health
functions to be delivered. The NHS is itself in the process of
completing a people and function migration map to make local decisions
about the nature and shape of their work force. The regional directors
of public health, as I mentioned earlier, are actively supporting
those local transition plans and charged with managing the transition
Q318 David Tredinnick: You
have been looking at these, obviously, with great care. Is there
anything that particularly worries you in your portfolio at the
It is complex, and we certainly have to be careful that our colleagues
in public health continue to feel valued and are supported through
the process. It is our responsibility to ensure that clear processes
are put in place so that they can continue with their roles, their
professional development and their ambition, for the very reasons
that brought them into the jobs that they do. To that end, we
are in the process of producing a concordat with local government
to guide some of that transition so that they feel more secure
in their profession and roles going into the future. We are producing
an HR transition framework as well to further support the whole
of the public health system. While those things are clearly very
high on my agenda, we have processes in place to manage them and
I am confident that we can. I am sure we will be successful.
Perhaps it would be helpful to tell you that I addressed the Faculty
of Public Health last week500 public health practitionersand
I expected low morale. Actually, people were really up for it,
but the concern they hadit was a general concern and they
made me well aware of itwas whether there would be jobs
for the public health specialists that we are training at the
moment. I was not aware that there was this concern and I went
back to the Department about it. There is quite a bit of work
going on about that and I believe that by the end of the week
I will have a report on how we are going to handle it. Clearly
we cannot be training doctors or other public health professionals
and not finding jobs for them. We need them. The fact I did not
know does not mean the team did not know and work had not been
ongoing, but that was the biggest concern the profession gave
me in Birmingham at the Faculty.
Q319 Valerie Vaz: Will
there be jobs for them?
I am assured that we should have jobs for them. David Nicholson,
in one of his letters, has specifically alluded to thistrainees
should have jobs. I am waiting for the report. Having been apprised
of the issue, I am now looking into it.
Q320 Rosie Cooper: Can
I pursue that a little more? The whole health service is in a
complete state of flux or disarray. As to PCTs, doctors and nurses,
nobody knows if they have a job. But you are able to say here
today that if you are a public health professional doctor David
Nicholson is going to guarantee your job. Is that what you are
No, I did not say that. I was talking about the trainees who are
Rosie Cooper: I can be
a trainee doctor or nurse and not be sure I am getting a job,
but if I am a trainee public health doctor, I am going to get
I would see what you have said as an exaggeration, speaking as
a medical practitioner. I come from the hospital sector, which
is not changing its structures significantly. We are training
doctors and nurses and we have jobs for the vast majority of them,
if not all of them. I can only talk to you about public health
Q321 Rosie Cooper: Can
I tell you that there are loads of people out there listening
to youin your independent statustelling us that
as far as you are concerned, we do not have a problem; that people
are not going to be losing their jobs all over the place and that
you do not know there are nurses and doctors out there who are
going to lose their jobs? As the leading medical doctor, are you
really saying that to me?
You are overinterpreting what I am saying. We are in a time
of austerity; there is a reduction of 30% on management costs
and that will mean losses of jobs, and as we change the structures
of care across the whole of the NHS to more integrated pathways
and things, people's jobs and opportunities will change. I do
not think that the NHS has bottomed out what that means for all
the staff. I definitely do not know what it means for all the
Q322 Rosie Cooper: But
you do know what it means for public health doctors.
I am responsible for public health.
Q323 Rosie Cooper: They
are assured of jobs.
I am apprised of a concern that we have a number of trainees coming
through who think there may not be jobs. I am told that we should
be able to look after this. I have not promised it yet. We are
looking into it and I hope it will be all right. If we train any
professional for public health or health they are a precious resource
for this country.
Q324 Chair: Before
we leave it, I would like to come back to one of the answers Anita
Marsland gave David Tredinnick, which I think was that it was
the Government's policy that every director of public health should
be a chief officer of the local authority, should be accountable
to the chief executive and should not be accountable to any other
senior officer of a local authority. Given the concerns that have
been expressed about this among public health professionals, if
that is what you said, it is a very important announcement. Have
I heard you correctly or am I overinterpreting? I am not
seeking to do so.
Maybe a slight
I think you are overinterpreting. We expect this, but we
cannot mandate it, as I understand it, into local authorities.
By being strong about the expectation, we would hope that this
will happen across
Q325 Chair: I
am going to push you further, in that case. I accept that you,
as an independent CMO or as departmental officials, cannot mandate
it, but the House of Commons can and the Government has to be
clear whether it thinks this should happen and it should be part
of the structure or whether it is simply left as a matter for
local discretion. There is a clear policy choice to be made. Which
choice is the Government going to make?
The policy paper that will be published later this week should
make that clear.
Chair: Thank you.
Q326 Mr Sharma: You
talked earlier about trainees who would possibly have jobs. How
many trainees are there?
I do not have those figures. That is the report I expect to have
at the end of the week.
Chair: Rosie, you wanted
to ask about funding, if I can remind you.
Q327 Rosie Cooper: I
do. The public health White Paper said the total annual public
health budget is likely to be over £4 million. I wonder whether
people on the panel might shed some light on where that figure
was magicked from? Also, what areas of spending is it intended
should be funded from the ringfenced public health budget,
at local and national level? I would like to come back on that
It is £4 billion. I am not sure if I heard you correctly.
Did you say £4 million or £4 billion? It is £4
Rosie Cooper: I meant
£4 billion if I said £4 million.
I understand. We said in the White Paper published at the end
of November that estimates at that stage would suggest it would
be £4 billion, or over £4 billion. The figure was taken
from a number of sources, not least from money that is currently
spent in national programmes and budgets from those arm's length
bodies that would be coming togetheror the functions of
those bodies that would be coming togetherto form Public
Health England. The part that we have found most difficult is
to tease out the local spend on public health because, of course,
different parts of the system currently classify spend in different
ways. That is a part of what we are still working on. Those three
elements, essentially, went together to form the over £4
You have mentioned ring fencing, and it is probably
helpful to clarify the different types of ring fencing. Within
the total spend for health, there is an element of ring fencing
along the lines of £4 billion plus. There is also a ring
fencing that is referred to, which I think is the one you are
alluding to, that goes out to local authorities essentially to
be spent on those health improvement activitiesthe commissioning
activitieslaid out fairly clearly in one of the papers
that we consulted upon alongside the White Paper on public health.
All of this is work in progress.
Some of the work will be mandated from the Secretary
of State. Much of it will be framed around the outcomes framework
that we are currently working on. There will be outcomes
that are considered so important at national level that local
authorities will deliver them through their own means. We are
not saying how things should be delivered, but we are saying what,
at national level, we consider important, in the context, say,
of inequalities. How do we get this reduction in health inequalities
that we are all agreed we should be looking for and that Michael
Marmot has been closely involved with for many years now? Those
are the sorts of activities that will be included within the local
authority ringfenced part of the budget. Thus, there will
be the local authority-determined activities, there will be the
activities related to the outcomes framework and there will be
a number of mandated services that the Secretary of State feels
have to be delivered because of that national importance.
Q328 Rosie Cooper: Do
you believe local authorities will have sufficient resources to
be able to comply with all those signals and signposts they are
That is absolutely the objective. The objective at this stage
is to determine what is currently spent and to match that with
the priorities that I have alluded to. We are not completely there
yet because the elements that I have not mentionedwe might
want to discuss them laterare of course around health protection.
I have focused on health improvement. Without overcomplicating
a very complex landscape, other areas would be expected to be
funded out of this ringfenced budget. However, much of the
interestwhat we have gleaned through the consultation process,
through the listening exerciseis around health improvement
activities where there will be a commissioning role, particularly
for local authorities.
Q329 Rosie Cooper: Most
people would find this all very, very nebulous, but can I ask
you a question about the concerns that I and a number of people
have, that local authorities might redesignate some of their existing
activities as public health activities? In fact, we have had people
give evidence who suggested that making roads 20 miles per hour
zones around schools is a public health activity.
That is a risk that we have been made aware of over recent time.
It is something that we need to take into account. The very fact
that this is being described as "ring fenced" signals
the intention. What we need to do over the next few months is
work very closely with our key partners to make sure that the
sort of risk that you have just alluded to
Q330 Rosie Cooper: Forgive
me. It is down to you to make sure it does not happen. It would
be an outrage if public health finances could be moved in that
way. I would really like to ask Anitabecause, Anita, you
know from your previous life how easy this would behow
do you see it? Not that, "We hope we would make sure it did
not happen," but that we
I am sorry, at the risk of interrupting, I did not say "hope".
I said "our intention" was, and that is what we are
working on. We will be working and already have worked extensively
with local authorities and others. Part of the challenge is to
identify areas within local authority remits that are legitimately
public health. There will be areas of transportnot the
one that you identified, which is, I think, a very clear examplewhere
we would not expect the ringfenced budget to be paid. However,
you might well find that there are areas on housing, on redevelopment
and on other areas of transport, such as cycling and walking,
that could legitimately be funded using some of that ringfenced
Could John come in?
From my experience of working at the moment with local authorities
in the transition, most of the ringfenced budget that will
come across to local authorities is currently spent on quite specific
items, if you break it downthings like drug treatment services
and smoking cessationand it would be quite difficult to
take that money and use it for some of these more general projects.
In fact, the NHS spends relatively little on the sort of infrastructure
projects that we think local authorities will really want to address.
The real win is the strategic and advocacy role of public health
embedded in local authorities. That is what we think will make
the big difference, not the spend of the specific budgets.
Q331 Rosie Cooper: I
absolutely understand the strategic part, but that will go into
things like the ideas and the evaluation. The evolution of this
will be associated with Health and Wellbeing Boards, but they
are powerless. The question I have not yet asked you, is this.
I have, as will most people, a problem with the fact that the
strategic idea is extremely good but local authoritiescouncilsare
under huge pressure to deliver services to the elderly that they
have to deliver and, where they are not required, they are reducing
the entitlement of people with moderate needs. They are only dealing
with people with severe and critical needs.
My experience of going round speaking to local authoritiesI
was talking to the leader of Southampton last weekis that
they really welcome the presence of the director of public health
on their management boards and they are using that opportunity
to look again. Absolutely. Southampton is a good example of where
they are making substantial cuts. However, they see public health
as something different they can do strategically. In fact, all
the arguments around public health getting upstream are that unless
you invest in public health they will not be able to make their
Q332 Rosie Cooper: I
understand that. That is where the strategic point is good, but
the reality is that we are here today. We have to get to 2013
and beyond and I think there are serious hiccups on that journey.
I do not see any real signposts from the Department of Health
that they are dealing with the "now". Without going
into much detailI can give you an example todayLiverpool
City Council, when a person goes from a residential home to a
nursing home, is, in essence, making a family pay an extra £100odd
for nursing care that is free. They are making the family pay.
If they are doing that now, and that is totally outwith the rules,
what fun they are going to have with this lot.
We are designing an outcomes frameworkwe have consulted
on itwhich will be used to judge the outcomes, because
we are trying not to tell local authorities how they should do
their business, and, of course, there will be the health premium,
particularly aimed at health inequalities. Would one of you pick
up on that?
If I may I will go back to your point that I should know from
my previous experience. My previous experience was working in
Knowsley where we did join up the system. We did that over nine
years ago. We found that we were able to reduce health inequalities
and that there was much more ownership about some of those very
difficult decisions. They are always very difficult decisions
and, arguably, even more difficult now than previously. In that
authority there was the real strength of working together. We
did have a Health and Wellbeing Board all those years ago and
we gave it teeth locally. The benefit of this reform is that the
Health and Wellbeing Boards will be given teeth.
Q333 Rosie Cooper: What
teeth are they? Can we see any? Can you tell me what those teeth
Now their powers are strengthened in terms of being able to challenge
the clinical commissioning groups
Chair: If we are going
all through Health and Wellbeing Boards, we will never finish
Q334 Rosie Cooper: No,
absolutely. I cannot see any teeth that are worth their bite coming
out of those powers. They can recommend, talk and do this and
that, but they do not have a vote, a power or a veto. What use
is all that?
They can challenge the clinical commissioning groups in terms
of their plans, which will be very helpful. Having experience
of working in the system where people genuinely did come togetherthey
did not always agree about things but they came togetherthe
Health and Wellbeing Boards certainly provide opportunity for
that debate in some areas where it has not been the case thus
Q335 Rosie Cooper: I
totally agree that it is an area where debate will take place,
but not very much more. Can I very quickly finish by coming back
and talking about how local authorities may circumvent your intention?
You said you were intending to stop it. My question to you would
be: how would you actually prevent them doing it? Also, I have
a general question about the extent to which public health is
subject to cuts in NHS management and administration. We now know
that public health doctors or trainees will not be threatened,
but everybody else is. What effect is that having on public health
As to the first part about how we can stop it happening, a number
of points have been made already, such as having the director
of public health in the right place within the senior structure
in the local authority. That will be critical because the director
of public health will be the person whose responsibility it is
to ensure delivery of those sorts of outcomes that I referred
to earlier, but also to produce, on a statutory basis, a report
on the health of their population. These are, together, the sorts
of things that should help reduce that risk. Over the next two
to three months, working towards the autumn, we will be continuing
to do this work and in a number of other areas as well around
outcomes, around the commissioning lines, the budgetary lines
and the health premium that the CMO mentioned earlier. Working
with local authorities and with our key partners, we would expect
to be able to manage that risk. Of course, that is in the future.
That is our intent. That is where we are now and we have quite
a lot of work to do to be able to deliver that.
Q336 Rosie Cooper:
Okay. What about cuts in NHS management and administration and
how that affects public health today?
The general principle that I know you will be very familiar with
is that front-line services, as far as possible, are protected.
As far as the rest of the administration is concerned, the whole
system is subject, over the next three-year period, 201415,
to a cut of the order of a third. That will apply equally
Q337 Rosie Cooper: Except
I will have to come back on this.
That will apply to the administration of Public Health England
and the public health system as well.
I will know, by the end of the week, the size of the problem.
I will do my very best for those trainees because it is my responsibility
and it is a waste of public money not to use them. I cannot guarantee
people a job. Some of them might not be up to it, of course. I
sincerely hope, if they are trained, that they are.
Chair: These are the joys
of debate in the House of Commons. We have been going 700 years
and we have not got to the conclusion yet. We go on to public
Q338 Mr Sharma: The
Department is still working on the details of the public health
outcomes framework, but are you able to indicate how the Department
is working to refine the framework in response to the various
concerns that have been expressed about it?
Yes, certainly. There are a number of responses that you are alluding
to through the consultation on the document that was published
alongside or just after the public health White Paper. There was
a great deal of support for the general approach. One of the key
responsesa number have respondedsaid that they would
like to see an alignment of the three outcomes frameworks: public
health, the NHS and social care. That is something we are very
mindful of and we are working towards getting as much alignment
as is appropriate but recognising that they are there to do different
The other strong element of the response was the
need to focus on health inequalities. These run right through
four of the domains that were consulted upon. The fifth domain
is health protection and resilience, and we can talk about that
separately. Much of what was said was about choosing the right
indicators. We included, therefore, in our consultation document,
a number of indicators, but they were only ever there to act illustratively
and to prompt discussion. As you rightly said, over the next few
months, as with the funding and commissioning issues, we are going
to be working and engaging with a range of key partners to develop
our thinking on the right indicators. We are not there yet.
Q339 David Tredinnick: I
would like to mention the domains. My understanding is that there
was a consultation document published in December last year which
proposed this outcomes framework and the divisions into domains.
I would like to focus on what I have down as domain 3, health
improvementhelping people to live healthy lifestyles, making
healthy choices and reducing health inequalities, for example,
by reducing smoking rates and increasing physical activity rates.
Over the years I have chaired the Complementary and Alternative
Medicine Group here, and have been an officer of it for about
20 years, and I have been part of the Food and Health Forum, but
I am not going down that route today, Chairman. I would suggest
to you that the key issue here is diet and food consumption. If
you really want to improve people's general well-being you need
them to cut back on fat consumption, probably meat consumption
and to eat more vegetables. This is something that you need to
put up there right at the top of the agenda. I would like you
all to comment on that, please.
You are absolutely right. The science is quite clear; the major
cause of obesity and the consequential diseases relating to it
is our diet. Physical activity plays a role in our health outcomes
but a much smaller role in our overall size. Because it does play
a role in our health outcomes, on Monday I launched the four UK
CMO's physical activity guidelines. We do believe that diet is
important and the Change4Life campaign and the Responsibility
Deal have addressed that quite a bit. It is, again, one of the
ways that local authorities can play a role: how they look at
the provision of fruit and vegetables in their localities and
their shops and how the whole system works locally. We would agree
with you that it is very important.
Yes, that is absolutely right. We know that diet is probably the
second biggest cause of health inequalities. There was a recent
study published showing that in people who do not smoke, obesity
is the next biggest cause of health inequalities, so it is very
important. It emphasises, again, the importance of an approach
to public health that crosses all sectors of society. If you want
to influence people's diet, the most effective way is through
education. I would point to the work of the School Food Trust,
for example, in trying to change children's food culture. There
is evidence about how that could be done and there are a number
of projects that have illustrated that.
If you are going to tackle something as fundamental
as what we eat, you have to take a rootandbranch approach.
That is the sort of thing that is easier to do if you are in a
larger organisation that can, frankly, punch a heavier weight
with all the big partners that you have to deal with, which is
an argument for Public Health England. You will see where I am
going with this. The other argument is for local authorities who,
of course, have such a big role in education.
Coming back to your original point about the outcomes
framework, if it does not cover diet and the consequences of diet,
it will not be a public health outcomes framework.
Q340 David Tredinnick:
From listening to professors of nutrition over a period of time,
it seems pretty clear that those who change their diet then get
improvements in the functioning of the body; their arteries clean
themselves out gradually over time and their metabolism speeds
up. That is why I think this is so important.
Chair: Good advice at
the beginning of the summer recess.
I have a very quick comment to follow up the points that have
been made. The outcomes framework is a very important part of
the new public health system. It is, though, only one part and
I think you have already mentioned the Responsibility Deal. Within
that there are specific pledges, as you will well know, about
reducing salt, reducing trans-fats and increasing physical activity.
With the outcomes framework itself, there are, under this particular
domain, indicatorsfor the momentfor further discussion
about increasing the number of people of healthy weight. Thus,
it is absolutely embedded in the total approach that we are taking,
but well recognised.
Q341 Valerie Vaz: You
mentioned an advisory group. Who will you have on this advisory
group? Are you going to have food manufacturers or alcohol producers
on it? Who are you having on your advisory board?
The reason I have not set it up, as I said earlier, was because
we have not finally decided that between all of us. That is a
new idea to me. I had not thought of having food manufacturers
and everything on it. I wonder whether you would advise me to.
Q342 Valerie Vaz:
I am sorry, do you want me to do your job? I am very happy to
do that. Shall we swap?
No. I am just interested in the provenance of your question.
Q343 Valerie Vaz: I
am asking you a simple question: who are you going to have as
your advisory group? We have heard that there are some people
who have influence at the Department of Health who should not
be part of it. I am wondering who you have on it. It is a simple,
straightforward question. Please do not be defensive about what
No, I wasn't. I was interested in your advice.
Q344 Valerie Vaz: This
is about public money. You referred to the fact that we are in
austerity measures, but nobody asked for this reorganisation and
there was a way to evolve all this restructuring very simply.
The morale of people in the NHS is at rock bottom, I feel, given
the evidence. We have heard from all four of you and it is extraordinary
that nobody knows what is going on. It is quite scary because
it is a third of the budget and all four of you sit here and say,
"I don't know what is happening," and, "We don't
know what is happening next week." It is no offence to you.
Chair: Let us get back
to the membership of the advisory group.
Q345 Valerie Vaz: Professor
Davies threw the question back at me. You are here to answer our
questions. It was just a simple, straightforward question: who
are you going to have on your advisory group? You have taken the
decision to pick on infection when there are a huge number of
other issues you could have picked on and it seems simple and
straightforward for someone at the top of public health to pick
something like that.
Clearly there will be both academics, who bring one sort of expertise,
and practitioners there. I am sorry if it was not proper protocol
to ask your advice. Further than that, we have not decided. I
want to make it work, which is why I am open to advice.
Valerie Vaz: I am very
happy to advise you then.
Q346 Rosie Cooper: We
have heard concerns about the risk in the proposed health premium,
that it could act in a regressive way by rewarding wealthier areas,
which have the least tractable health problems, and penalising
poorer areas. I am an MP for West Lancashire where if you live
in one area, you will die 10 years before people living in another
area, around three miles away. What policy options is the Department
looking at to obviate or mitigate that risk? If you are doing
that, what are they? I am not only talking about the grand scale
but actually down to, for example, my constituency where I have
huge differences in health outcomes.
It is complex and I agree that we have to do our best to get it
I can give you the answer that I think you are not looking for,
which is where we currently are. It is reiterating what I said
earlier about the bigger funding issues. When we consulted on
the health premium we had a number of responses, not least those
in the area that you have indicated. Our intention is, as I think
you are very well aware, to incentivise local authorities to tackle
those areas where we can have a reduction in health inequalities.
Of course, this is a huge issue and one we have not managed to
tackle successfully so far, in spite of the best intentions of
a vast array of very capable people. The health inequalities gap
is still increasing, and that is not a surprise, given that the
health of the more disadvantaged is improving but the rate at
which the health status of the better-off groups is improving
even more quickly. Thus, the gap is increasing.
This is something that is at the heart of the current
Government's strategy for tackling health inequalities. Michael
Marmot himself said, at a recent meeting I attended with him,
that he was extremely pleased to see how the Government has responded
through the public health White Paper, in a strategic sense, to
address some of the key issues that he has been talking about
for a very long time. How the health premium can be made to work
is exactly what we are working on over the next one, two, three
or four months. We will publish the shadow allocations, including
the health premium, as intended and as reported in the various
documents that you have had before you for shadow running of those
health budgets from April next year.
Q347 Rosie Cooper: Forgive
me, but what I have heard since I have been here this morning
is a lot of change, intent, hope and whatever, but very little
evidencebased change. All these changes are taking place.
You don't have the evidence to back it up. You are trying to make
this work based on a strategic objective that nobody could disagree
with; we have never had any disagreement even before this reorganisation.
Wouldn't the amount of money and effort that has gone into all
this reorganisation have been better directed at issues such as
No. I think on public health we have a clear position, and
my apologies if it has not come across like that. In the funding
and outcomes area, we have consulted. The consultations closed
at the end of March. We have been assimilating all the responses,
through the listening exercise as well, and we are developing
policy. One of the very strong messages is, "Don't come to
us with the answers." In the responses that we have had the
people want to be able to play into the coproductionhow
these systems will work. That is what we are doing. We have said
very clearly that we will be doing that over the next two to three
Q348 Rosie Cooper:
If I come back to you in three months' time, you are going to
tell me how this policy will affect the differing parts of my
Specifically with the health premium. There is a timetable for
various pieces of information that we are working on over the
next two to three months. With the funding, we will be in a position,
we expect, to be able to issue shadow allocations for the start
of the next financial year. That is the timetable that we have
talked about and that people are working to.
Rosie Cooper: Thank you.
Q349 Mr Sharma: There
seems to be some confusion about the extent to which funding for
Public Health Observatories has been cut in 201112. In an
Adjournment debate on 17 May 2011, the Public Health Minister
referred to "The Government's contribution of £12 million
to the observatories". Can you explain to us what changes
have been made to the observatories budget this year and exactly
how that £12 million figure was arrived at?
I will come in there, Chairman, if I may. I should say, by the
way, that I spoke to the secretariat and it might be helpful if
I give you a written comment as well, since there are figures
involved, but I can briefly explain now as well.
If I take the overall approach to the funding first, in recent years the Public Health Observatories have received two types of funding from the Department of Health. The first is a core grant to support reasonable health intelligence infrastructure and the second is funding to support specific programmes of workspecific projects, such as the health profiles or the specialist observatories, and many of the other things that you will be familiar with. In 201011 these were, respectively, £5.1 million for the infrastructure and £7 million for the specific projects, the specialist observatories. That totals £12 million. That was for last year. I can give you the list of what made up the £7 million.
In this year, 201112, the budget committed by the Department to health intelligence infrastructure is the same£6.5 millionas it was last year. As last year, that budget will be used to support the Public Health Observatories but also to deliver some other public health intelligence functions, such as congenital anomaly registers and health impact assessment gateway projects. It is not only for the Public Health Observatories, but it is there for the Public Health Observatories and it is the same as last year. This year, however, we have asked the Public Health Observatories to work more in an integrated national approach. In fact, in different roles, I have been having that conversation with them for the last two to three years and there was widespread acceptance that the Public Health Observatories should be moving to a national structure. This recognises the change or move away from regions themselves, but particularly regional public health programmes that are not now funded. The requirement, and in fact the experience, is that the observatories have worked extremely well when they have taken national leader roles, things like the specialist observatories.
What we have asked them to do is develop a single integrated work plan and Professor Brian Ferguson, when he was here, indicated that he was working on that. He has been working on it for a year. We asked him for it, in fact, in March this year because we wanted to base this year's funding on it. He has told me that it will be ready by the end of July. While we are waiting for that programme, we have allocated £4 million to the observatories for this year for the infrastructure function. It is an unspecified amount upfront to the observatories which they haveguaranteedfor the whole year. If, when we have received it, the plan requires more than that for the observatories to deliver it, the budget is available to fund the plan.
We think the move to a national integrated approach will be efficient. For example, each observatory currently supports their own website. In addition, there is APHO's website. That is 10 websites pointing people to largely similar resources, so we think there are efficiencies from this single integrated work plan. However, I stress that the budget remains the same and it is available to support the observatories if they need it. We are obviously reluctant to support a model that is going to be left slightly out of date by all the other changes happening across the public health system.
In terms of the rest of the money, in other words, the specific projects, the specialist observatories and so on, that is business as usual as far as the Department is concerned. The figure, so far, is that £5.2 million has been confirmed for this year. I should say, by the way, that the £4 million confirmed for this year already would represent a reduction of 23% in the core budget if they receive no more money for the rest of the year. Obviously, if they do receive more money as the year goes down, that reduction would be less than 23%.
In terms of the special projects, the reduction is, as it happens, also equivalent to 23% compared to last year. Some of that is because programmes have come to an end; they were threeyear programmes that have reached their end. Some projects have moved; for example, the National Library for Public Health has moved to NICE. The same work is being done but not through the Public Health Observatories, so there is a reduction in the money going to the observatories.
Going back to the original figures, the money that I have mentioned is the money the observatories get from the Department of Health. In addition, in 201011, the observatories received £3.7 million from other Government Departments and from other sources such as the NHS Information Centre, making up their total budget.
Q350 Mr Sharma: Can
you tell us what the role is of the Working Group on Information
and Intelligence for Public Health, which you chair, and can you
summarise what it has achieved so far?
Following the White Paper and the recognition of the significant
change to the public health delivery system, there has been widespread
recognitionthe policy papers published have clearly said
thisthat information, intelligence and evidence have to
be at the heart of public health. We have been asked to set up
a group representing all the different interested parties, including,
for example, Cancer Registries, Public Health Observatories, the
NHS Information Centre, the Health Protection Agency and the National
Treatment Agency, to consider three things: what should the information
and intelligence function of Public Health England dowhat
should be the products; how we work from what we have now to what
we need in the future; and ensuring that essential products are
protected in the transition. Thus, there are three distinct functions:
designing the future, designing the transition and ensuring that
nothing gets dropped on the way.
In terms of what we have achieved, we thought the
right way to do this was to start with the productsto decide
what the new system needs rather than starting with the structures.
We have come up with a draft list of products that we have put
out for consultationI think we have had three weeks of
consultation so farand we have had, broadly, a very positive
response. We set ourselves a target of, by September, having agreement
from all the parties involved that this is the plan, these are
the products and then we will start working on implementation
from September. We already have nine draft projects.
Chair: Thank you very
much. We have two short questions that I would like to cover and
then we need to move on. Rosie wants to ask a question about NICE.
Q351 Rosie Cooper: Absolutely.
In your evidence to my colleague you indicated that some of the
work of the observatories was being done by NICE. I understand
that NICE is supposed to have a continuing role in evaluating
public health interventions, but we have recently heard from a
member of NICE's Public Health Interventions Advisory Committee
that its workload has reduced dramatically and that, in fact,
it has not met since December last year and usually they meet
monthly. Everybody is a bit mystified. Can you tell me what is
going on? If you are saying some of the work is going to NICE
and NICE has not met since last December, here we are, six months
later, and there is a bit of a gap.
I can tell you about the areas in which I am involved, but I will
pass over to my colleagues for the more general picture. The work
I am talking about is the National Library for Public Health.
NICE currently provides the National Library for Health, which
covers all the other areas, so it makes sense. In fact, the National
Library for Public Health started with NICE, has moved through
various places and is now back with NICE. It makes sense.
Q352 Rosie Cooper: Why
has this advisory board not met since last December?
I am a member of the NICE public health reference group, which
meets monthly, and is a very active group, but I will hand over
to David who may know more, or indeed
I do not know anything about their internal workings. I don't
know whether you do.
No. I can say that we are meeting regularly with the head of public
health in NICE. Some of the work they have done recently we discussed
with them and decided that it is better to take a different approach
for some of the guidelines. It could be that that is one of the
reasons why the advisory board has not met, but I am not sure
of the advisory board itself. What we have said consistently throughout
is that NICE will play this key role but we need to redefine what
that role is for public health because we want to have the whole
system, information and intelligence, properly integrated. I do
not know why the advisory board has not met.
Rosie Cooper: It sounds
like a Polo mint intervention: there's a great big hole through
the middle. Thank you.
Chair: David Tredinnick
wants to ask a question about emergency preparedness and resilience.
Q353 David Tredinnick:
The whole structure for dealing with emergencies seems to be going
through a period or process of considerable change. The Department's
memorandum of evidence says that "Arrangements for emergency
preparedness and response are to be strengthened and made less
fragmented" in the new system. How is that going to work
and how will the roles of the Secretary of State and the Chief
Medical Officer change?
We have spent a considerable amount of time already working with
the key parts of the system. One of the big challenges has been
having the current roles and responsibilities properly defined.
In the past, we have had difficulties because of a lack of clarity.
One of the huge advantages of the new system will be the clarity
that has not been there to date. The Secretary of State, ultimately,
will be responsible for emergency preparedness, resilience and
response and the new system, we expect, subject to some final
agreementnot least by Ministerswill have that clarity
of parallel lines from the NHS Commissioning Board side and from
Public Health England. Each of those two parts of the system will
be responsible, in public health terms, for their own preparedness
and for assuring that they have plans in place and are able to
respond. Wherever NHS resources are used, the NHS Commissioning
Board will be responsible and wherever public health is in the
lead, then Public Health England will be responsible. That key
element of the role at the front line of the director of public
health will also be properly defined with the clarity that we
have not had.
Part of what is going to happen in terms of the infrastructureas
people move around the system, and the changes that have been
referred to several times this morningis that it has already
been agreed that those people responsible for emergency response
and planning will be identified, where they have not already been,
at the earliest opportunity during this transition period. Special
attention will be paid to protect those posts so that as new organisations
are coming along, the people that are moving through the system
will be a part of the new system through transition, recognising
those risks, so that we get to April 2013 and the new system will
be ready to go with the right people in the right places.
Q354 David Tredinnick: Soldiers
often talk about "the fog of war". It is almost as if
you are talking about the fog of emergencies. It is the second
time today we have heard that at the Department you are having
to investigate what different areas in the Department's purview
comprise and how they work. I wonder if you are not dealing with
a very difficult situation where it has been very unclear who
is doing what out there and a lot of this has been hanging together
in a rather haphazard way. Do you think that is fair?
No, I do not think it is fair, if I may say so, and I am sure
Sally Davies will want to comment as well. The system has been
tried and tested and has been shown to work extremely effectively
in an emergency. By "emergency" we have to be slightly
careful. There is a huge spectrum of different emergencies. People
consider it everything from a local foodborne disease outbreak
as an incident that requires the sort of processes around it that
we are very familiar with all the way through to the national
emergency where the Department of State, the Secretary of State
himself, will hold the ring and bring together the different parts
of the system.
What has happened to date has been effective. What
will happen in the future, I think, will be even more effective
and the risk will be reduced. This is about having the right powers
and links between the different organisations and very clear concepts
of operationsvery clearly knowing what the relationships
are at all levels between the different parts of the systemright
through to that critical frontline piece, which is, as somebody
already mentioned today, the alignment not just at the subnational
level but at the very local level for emergency preparedness.
The Secretary of State has already said very clearly that he would
like that alignment between the Commissioning Board, Public Health
England and, very importantly, between the local resilience fora
on the DCLG side of the business.
Q355 David Tredinnick:
Thank you very much for that detailed explanation. What plans,
if any, are there for the designation of bodies as Category 1
responders under the Civil Contingencies Act 2004?
The bodies that are currently designated as Category 1 responders,
such as the Health Protection Agency, would suggest very strongly,
and we work on that basis, therefore, that Public Health England
will be a Category 1 responder. The bluelight services,
local authorities in their own right, are Category 1 responders
in some instances. We are working through Category 2 responders
as we speak. The constituent parts will not change. Ambulance
services will be Category 1 responders in the new system in just
the way that they are currently.
Chair: At that point,
we have overrun, significantly, where we were aiming. Thank you
very much for coming this morning. We have enjoyed meeting you
and we have enjoyed the debates. We will reflect on what you had
to say. Thank you very much indeed.
1 Witness correction: The appointments process for
a Chief Executive starts this autumn, and a Chief Executive will
be appointed by early 2012. Back