Communities and Local Government CommitteeWritten submission from Professor Gabriel Scally

Summary

Improvement in the health of the population is one of the key tasks of civil society and it is appropriate that it is again going to be the task of local government in England. There are however serious concerns about the circumstances surrounding the transfer of some public health responsibilities from the NHS to local government. None of these are insuperable but unless they are recognized and dealt with it is unlikely that the transfer will be a success and, at worst, it may mark a deterioration in some aspects of public health.

Source of Submission

Professor Gabriel Scally is a senior public health physician who was, until March 2012, a Regional Director of Public Health in England. As the longest serving RDPH in the almost 40 year history of the post he is well placed to comment upon the current changes. Professor Scally’s current post is Director of the WHO Collaborating Centre for Healthy Urban Environments at the University of the West of England. He has published widely on public health and, along with Sir Liam Donaldson, is joint author of the standard textbook “Donaldsons’ Essential Public health”.

Comments on the Key Points Identified in the Call for Submissions

The introduction of a public health role for councils

The return of public health responsibility to local authorities is to be welcomed. There is a necessity for local authorities to examine their entire operation in respect of the duty to improve health. For example; the vast majority of local authority pension funds have significant holdings in tobacco companies. This will shortly be in conflict with the new duty. The new responsibilities will useful compliment current responsibilities such as environmental health, transport and planning.

The adequacy of preparations for the new arrangements

The preparations have been handled adequately given the uncertainties surrounding the structure and organisation of public health services.

The objectives of the new arrangements and how their impact can be measured

Given the split in responsibilities it is difficult to see how progress will be measured. There are substantial gaps in available data and the incorporation of the previously independent Regional Public Health Observatories and Cancer Registries into Public Health England (which is part of the Department of Health) does not provide reassurance that data and support around information will be forthcoming and free of central government interference.

The intended role of Health and Wellbeing Boards in coordinating the NHS, social care and public health at the local level

The remit of Health and Wellbeing Boards that has been consulted upon recently by the Department of health is very disappointing in that it concentrates on the commissioning of services. This will have the effect of concentration attention on the Social Care/NHS interface and lead to the relative neglect of health improvement and the importance of action on the wider determinants of health.

How all local authorities can promote better public health and ensure better health prevention with the link to sport and fitness, well-being, social care, housing and education

At the centre of the answer to this question should be the Director of Public Health and his or her team of public health specialists. They should have a broad remit in regard to the full range of determinants of health in local areas and form effective partnerships dealing with major public health issues such as alcohol, tobacco, obesity, air pollution etc. It will be important that they are not seen as a peripheral component of local authority functioning and placed in a subservient role to other Directors within the management structure.

Barriers to integration, including issues in multi-tier areas

District Councils have important public health roles, such as environmental health, and should be full partners in broad based public health programmes.

How the transfer to local authorities of the front-line health protection role and the creation of Public Health England will affect resilience arrangements at the local level

There remains considerable and unacceptable uncertainty about the health protection function and failure to clarify arrangements may place local populations at considerable risk in the event of a major health protection issue occurring.

The accountability of Directors of Public Health

There has been a failure to learn from history, and Directors of Public Health are not placed appropriately in many local authorities. In some places the public health function has been seen as a minor concern because of its limited budget and the highly trained staff as a threat to other professional groups. This bodes ill for the future expertise upon which local authorities will be able to call.

The financial arrangements underpinning local authorities’ responsibilities, including the ring-fencing of budgets and how the new regime can link with the operation of Community Budgets

The split of services and budgets between the NHS National Commissioning Board and local authorities may turn out to be disastrous for some important public health services and responsibilities. The areas of concern include screening, immunisation, health protection and sexual health. There are further genuine concerns about the allocation formula that is proposed for allocations to local authorities. If this is not handled properly the effects on services available to local people may be very severe.

October 2012

Prepared 26th March 2013