Dear Colleagues
For your information I enclose press release of the UK govt's response to
the Parliamentary Select Committee on Health's Public Health report, which
deals heavily with health inequalities and includes information on a
national consultation on ways of implementing health inequalities targets. I
dont think this has been published yet, but if anyone knows different please
let me know.
The full govt response can be downloaded from
http://www.doh.gov.uk/phreport2.htm
David
David McDaid
LSE Health and Social Care
London School of Economics and Political Science
Government Response to the House of Commons Select Committee
on Health's Second Report on Public Health
Presented to Parliament by the Secretary of State for Health By Command of
Her
Majesty July 2001
1. The Government welcomes the Committee's report on public health and its
overall endorsement of
existing policies for improving health and reducing health inequalities,
set out most recently in "The
NHS Plan." In particular it welcomes the Committee's acceptance that
within Government
responsibility for public health should remain within the Department of
Health (DH).
2. As the Prime Minister said recently, the General Election result has
given the Government a
strong mandate for reform and an instruction to deliver modernised public
services that will make an
appreciable difference to the quality of people's lives and life
opportunities.
3. At the heart of modernised public services there needs to be a common
sense of purpose. Within
public health there is a clear consensus about the focus on:
the protection of the public's health;
health promotion and disease prevention programmes;and
reductions in health inequalities.
4. On the last point, the Government has reaffirmed its determination to
tackle disadvantage in all its
forms. A key element of that commitment will be the delivery of the
specific national targets,
announced in February, for reducing inequalities in health. The
Inequalities and Public Health Task
Force established last autumn will be responsible for overseeing
implementation of the strategy for
reducing health inequalities.
5. As the Committee acknowledged in its report, as part of that programme
it is essential to address
the underlying determinants - what Acheson calls the "upstream" factors.
The Government has
already made substantial progress in this area. Furthermore, since the
Committee reported - and
following the recent General Election - the Government has announced that
health inequalities will
be the subject of a cross-Government spending review. That will
significantly strengthen
co-ordination of policies to address the range of "upstream" determinants
of poor health.
6. To inform the spending review, and to ensure effective delivery of the
health inequality targets at
local level, we are launching a nationwide consultation on the measures
needed to implement those
targets. The Department of Health is publishing a health inequalities
consultation paper on spreading
best practice and the main measures needed to narrow the health gap. The
Department will be
consulting key stakeholders, particularly local government, the voluntary
sector, other agencies and
community groups to draw up an implementation plan. Particularly important
will be establishing the
critical role of the new Primary Care Trusts (PCTs) in addressing health
inequalities in this area.
7. The roles for PCTs, Strategic Health Authorities (see para 10 below)
and regional public health
functions set out in this document flow from the Secretary of State for
Health's speech on "Shifting
The Balance of Power" on 25 April 2001. A discussion document will be
published on the emerging
views about the implications for the NHS of the Secretary of State's
speech. A consultation exercise
will be held in the Autumn on the boundaries for Strategic Health
Authorities.
8. The public health delivery system will be enhanced additionally as a
result of the significant shift
in the balance of power within the NHS announced by the Secretary of State
for Health in May. More
power will be put in the hands of front-line staff and organisations in
order to make the health service
more patient-centred. Primary Care Trusts are best placed to deliver
change at local level. They have
the best knowledge and information about local health needs, and they have
responsibility for
providing services - smoking cessation, healthy diets etc. - essential to
the achievement of the
targets. For the first time, there will be a public health team in each
PCT with a Board level
appointment to lead this work.
9. Primary Care Trusts - the organisations closest to the concerns and
aspirations of patients and
clinicians - will in future be the prime interface between the local
community and the NHS, and will
lead the latter's contribution to joint working with local Government. In
particular they will become the
focus for delivery of public health programmes and the wider objectives
for social and economic
regeneration. Primary Care Trusts will work as part of Local Strategic
Partnerships (LSPs) to ensure
co-ordination of planning and community engagement, integration of service
delivery and input to the
wider Government agenda.
10. Around 30 new Strategic Health Authorities will replace the existing
95 Health Authorities (HAs).
Each Strategic Health Authority will have its own Director of Public
Health (DPH) who will create and
develop a public health network and manage the local performance of PCTs
and NHS Trusts in
delivering public health goals and reducing inequalities.
11. At the same time, the Regional Offices of the Department of Health
will be abolished by 2003.
Four new Regional Directors of Health and Social Care will oversee the
development of local services
and provide the link between the NHS and DH. Regional Directors of Public
Health (RsDPH) will lead
a single, integrated public health function for the region, which will be
located in each of the nine
Regional Offices of Government (GOs). It will develop multi-sectoral
approaches across Government
and with other partners to tackling the wider determinants of health, for
example through regional
work on economic regeneration, education, employment and transport, and
through contributing to
the over-arching strategic regional sustainable development frameworks.
12. As well as a common sense of purpose, modernised public services also
need to have clear
delivery systems, and "Shifting the Balance of Power" provides an
opportunity to make public health
services clearer and more consistent. The Committee itself acknowledged
that this had not been
sufficiently the case in the past, although the establishment of the
Health Development Agency
(HDA) and a network of regional Public Health Observatories (PHOs) have
helped to strengthen the
evidence base and the quality of information that informs public health
interventions. The report of the
"Chief Medical Officer's Project to Strengthen the Public Health
Function," issued on 28 March 2001,
has advocated the development of a multi-disciplinary workforce for public
health, with improved
training and development capacity, and those changes should also improve
the quality and
consistency of services.
13. The Government is determined to bear down on the big killers and the
main determinants of
ill-health. The prevention of coronary heart disease and cancer is core to
the Government's work on
reducing health inequalities. By tackling the major risk factors for these
chronic diseases, such as
smoking, physical inactivity and poor diet, early deaths can be reduced.
Recognising the links
between diet and later disease, "The NHS Plan" highlights these as key
areas for action. The
five-a-day programme aims at increasing access to fruit and vegetables and
one of the key elements
of this approach is the National School Fruit Scheme. "The NHS Plan" also
reinforced the
Government's strategy for tackling smoking set out in "Smoking Kills" and
set out measures to
tackle smoking including setting up world-leading smoking cessation
services. "The NHS Cancer
Plan" which followed placed increasing emphasis on the need to address
inequalities and focus
activity on harder to reach smokers. It is recognised that the greatest
impact on reducing health
inequalities that stem from smoking will be the activities of smoking
cessation services, and
following an investment of £50m over three years they are now up and
running and achieving their
targets. Other measures such as our education and media campaigns are
designed to help shift
attitudes and change behaviour.
14. With these changes the Government believes it has laid the foundations
not only for a
modernised health service but for a modern public health service too - one
which will lay a greater
emphasis on the protection and improvement of the population's health, and
which will at last start to
reduce the widening gap between the best and worst off in society.
