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by Professor Frank Kelly and Dr Julia Kelly
King’s College London

When the UK passed the Clean Air Act in 1956 to reduce smoke and sulphur dioxide, it led the world in cleaning up air. In recent years air quality improvements have miserably stalled. We have been breaching European Union (EU) limit values every year since 2005 for the modern day pollutants nitrogen dioxide (NO2) and particulate matter (PM). Currently there is no prospect of achieving compliance for NO2 in some areas until 2025.

More worryingly, evidence to support the detrimental short and long-term effects on health has increased substantially over the same period of time. Data for 2008 estimate that air pollution contributes to at least 29,000 premature deaths in the UK each year.

In 2012, the International Agency for Research on Cancer classified particulates in diesel fumes as a known carcinogen. In 2013, a WHO report concluded that the health effects of PM and NO2 can occur at concentrations lower than the their health-based Guideline values which of note, are lower than the EU limits we fail to adhere to.

In addition, other than the well-documented risks to cardiopulmonary heath, increasing evidence exists that air pollution exerts a wider threat, negatively influencing reproductive outcomes and neurological health.

The lack of progress in improving air quality isn’t due to lack of attention by professionals in the field or lack awareness by Government. I and other expert witnesses have given evidence to the Commons Environmental Audit Committee in 2010 and again in 2011 – the ensuing reports were blatant in their conclusions, calling in 2010 for ‘political will’ and ‘committed resources to meet air quality targets.

The 2011 report concluded that ‘the Government has failed to get to grips with the issue’ and ‘must not continue to put the health of the nation at risk’. In February 2014 the European Commission launched legal proceedings against the UK for excessive emissions of NO2. This is the first case by the EU against a member state for breaching limits. One can only hope that this may have the clout to shake political indifference to air quality in this country.

Unlike the powers that be, up until the beginning of last week, it is probably fair to say that the majority of the public was relatively unaware of day-to-day air pollution, the sources and the dangers associated with current concentrations. This is partly because PM can’t be seen by the naked eye and NO2 is invisible and probably owing to a poor understanding of what is undisputedly a complex science.

However on Sunday 30 March 2014 light southeasterly winds began to blow Saharan dust plus polluted air from Europe over the UK. This mingled with our domestic emissions from cars and industry resulting in high levels of rather unusual mix of pollution. Owing to the persistence of easterly winds and dry weather, poor air quality remained with us until the end of the week.

Light easterly winds taking pollutants from continental Europe to the UK where are own fresh emissions are added is not unusual – even dust flows from the Sahara are not uncommon. Instead, what really grabbed the attention of the nation – other than the visible hazy smog – was the prolific reporting of the events in every conceivable form of media.

This was because on the 1 April 2014 the Met Office, our national weather service provider, took over responsibility for forecasting air pollution on behalf of Defra. With that came greater publicity. In comparison, previous episodes have attracted insignificant coverage. Other than registered users of proactive air pollution alert services, you would have been hard pressed to hear about the even worse poor air quality affecting parts of England three weeks ago. This particular event culminated in London recording the greatest concentration of PM10 in 2 years.

The highly charged media coverage did not stop even when air quality improved. This was the result of a change in wind direction to southwesterly, coming in from the cleaner Atlantic, combined with wet weather washing the pollutants out of the air. Sunday’s press covered emerging evidence that traffic-related air pollution may target neurodevelopment and cognitive function as well as holding diesel fumes to account.

British drivers respond to the marketing of diesel cars as the “green” option – on the basis of reduced CO2 emissions and lower fuel costs – such that approximately one half of all new private car registrations in 2012 were diesel. Added to this, in most cities diesel engines power the majority of our buses and taxis. The image however is now tarnished.

Diesel engines emit especially harmful particulate pollution and owing to lenient European testing regimens, NO2 emissions have risen steadily of the past 10-15 years. It was reassuring that this information reached the front pages of the Sunday broadsheets.

This pollution episode has certainly raised the profile of what, to many, has previously been an invisible problem. However the chronic effects of air pollution, owing to year-round exposure, are much more worrisome than the short-term, often transient outcomes. We cannot afford to just focus on distinct episodes. As succinctly put in one online blog earlier this week: ‘We need to reduce air pollution when it isn’t making the headlines as well as when it is.’ Traffic must be reduced and we must ensure a cleaner and greener element to what remains on the road.

This can be achieved through a number of strategies: an expansion of low emission zones, investment in clean and affordable public transport, a move back from diesel to petrol or at least a ban on all diesel vehicles not fitted with a particulate filter and a lowering of speed limits. Focused education and continued evolution of sophisticated information systems can also achieve a durable change in public attitude and in turn behaviour.

But engagement must be blatant and put in the context of other public health risks such as passive smoking and utilise compelling messages such as premature death. There will be costs – but these should be balanced against the economic cost from the impacts of air pollution in the UK that are estimated at £9-£19 billion every year.

Cracking our air pollution problem is a huge challenge. It is highly unlikely that our major cities will ever be able to boast ‘pure air’ especially if strategies focus on small areas of an overall road network – as I have been quoted before: ‘air pollution does not respect any boundaries’. With bold, realistic and moral leadership however, enormous potential exists to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

by Tara Zolnikov

PhD Candidate, Developmental Science, North Dakota State University; Environmental Health, Harvard School of Public Health

Western Kenya is significantly affected by HIV/AIDs, with rates up to 15%. Many variables, including the environment and transient populations, contribute to the high percentage of HIV in the region.  The sister cities, Busia, Kenya and Busia, Uganda, are the busiest border crossings between Kenya and Uganda. Heavy commercial traffic travels from Kenyan ports to landlocked countries in Sub-Saharan Africa.

The mid-way location offers drivers a night’s stay and a profitable market for transactional sex.  Other contributing factors of the spread of HIV in Western Kenya are attributed to culture.   Cultural factors may include the unspoken acceptance of polygamy, disco matangas, and wife or sister inheritance.

While working with the Kenya Red Cross, I experienced a ‘disco matanga’, also known as a disco funeral.  Because of the low socioeconomic conditions of the province, this event takes place to help raise money for a deceased individual’s funeral.  This event also includes wife or sister inheritance, or the transfer of a widow to the former husband’s brother or family member.  The disco matanga has a select group of people who are invited, generally of the same tribal affiliation (e.g. Luo, Luhya).

The party, with music and dancing, starts around 10 to 11 pm and can last for days, but typically goes throughout the night until the morning hours.  Men are generally drink a “home brew” and smoke marijuana or chew miraa. An MC makes attendees pay if they want to remain sitting or go out and dance to avoid paying.

Men also pay for girls who they want for their dance partners.  This dance is also used to decide on later transactional sex; if unwilling, girls are frequently raped as a consequence.  To date, a solution regarding this cultural practice does not exist.  There are many reasons why risky sexual behaviour has not been addressed at disco matangas:

•    The high mortality rates resulting from AIDS contributes to a larger percentage of orphans in the province.  Orphanhood is also associated with risky sexual behaviour.  At disco matangas, orphans are also largely unsupervised.  This situation contributes to an increased risk of sex and resulting adverse health effects (HIV transmission, sexually transmitted infections, and pregnancies).

•    The environmental context of disco matangas contributes to risky sexual behaviours.  The location is frequently undisclosed until the last minute and located deep in the woods which would make any intervention within the event difficult to target.

•    There is not a lot of available entertainment in this region.  Adolescents look forward to attending disco matangas for entertainment.  How would any teenager feel if their parents told them they could not attend a school dance or prom? To eliminate this need for entertainment, an additional setting needs to be provided for adolescents.  A youth center is one viable option; however, it also needs to be free of charge and available at all hours.

•    Because communities are rural, it is difficult to disseminate information to every person that may be affected. How does one disseminate knowledge, education, or an intervention to a population inclusive of many ages, occupations, and located sparsely throughout the region?

•    The consumption of alcohol, miraa, marijuana, and “home brew” contribute to risky behaviours. Unfortunately, the female population is at an increased risk because men are more likely to consume these substances and display sexually aggressive behaviour without the consent of the female.

•    Because this province has the highest rates of HIV in Kenya, there is a surplus of public health messages being disseminated.  Personally, I think there has been a message shift from “don’t have sex” to “let’s put everyone on ARVs.”   I believe the shift of information is difficult for people to understand and digest.  ‘If we are all taking ARVs, doesn’t that mean we can’t contract HIV?’  We need to collaborate, combine, and coordinate our HIV education efforts in the region.

Public health interventions should consider cultural influences.  There are many times that we, as scientist, humanitarians, and public health advocates, forget that other individuals do not have the same knowledge base that we do.  Therefore, my initial instinct would be to design a phenomenological qualitative study to understand current knowledge and perceptions.

I would approach the population and ask if they are aware of the consequences of risky sexual behaviour and that disco matangas presents a scenario that may put them at risk for HIV transmission or pregnancies? If they are aware of this information, why do they continue to go?  The majority of the population has mobile phones, so is there a number that they would want to call if they were in danger?  I would further probe and ask for their solutions to the problem.

Researchers from the Western world come from such a different, individualistic perspective, but Western Kenya is a collectivist society and we should integrate these societal perspectives into our interventions.  Is there someone that could disseminate the message better than us – as researchers or as an outside influence?

My initial instincts are to design an intervention for disco matangas to introduce education on risky sexual behaviour to adolescents and their parents. Unfortunately, this may not be effective.  The better approach for involvement would be to include grandparents, because grandparents often live with and spend more time with the children who are attending these events.

The stories that I have listened to about the rapes that occur at disco matangas are gut-wrenching and as an advocate for gender rights, it is very worrisome.

Proposed solutions have been to include community health workers be on watch and attend the events, but because of the location and small exclusive invitees, this is difficult.  We have also thought about emergency phone numbers for adolescent girls to call, but again, who will be able to help them when they are one hour away from the nearest town?

Do we send a community health worker out in the middle of the woods at night to help a girl and risk the chance of getting raped herself?  Should we focus on eliminating the alcohol, the setting, or the night time setting?  Could we promote positive youth development and provide a social setting in a community centre?  Would adolescents located in remote villages have access to this?

There are many angles that we could consider from a public health programme implementation perspective, but what would be the most effective?  My instinct is to focus on girls and eliminate them from the disco matanga scenario.  If girls are attending disco matangas solely to interact with boys, peers, and friends, one possible solution would be to provide other sources of entertainment and ways for adolescents to socially interact in a safe setting.  Additional perspectives need to be garnered for further insight, resource feasibility, and sustainabilityto further explore this option.

  • Andy Graham – specialty registrar in Public Health, County Durham

A couple of years ago I found myself in need of a dissertation topic for an MSc in Public Health – ‘make sure it’s something you are interested in’ was the advice. Simple I thought, I just need to weave football and beer into a research project! All joking aside though, I have become interested in the relationship between the two over the years.

As a public health professional and former A&E nurse, I am well aware of the potential harms of excessive alcohol consumption. Also, as a fan who both attends matches and watches on TV, I have become increasingly aware at how visible this relationship has become. Of course, football and beer have long been associated, ever since Victorian landlords would set up teams, use the land out back for a pitch and, in the amateur days, employ the team as barmen in lieu of pay.

But at the risk of sounding like my dad, when I ‘was a lad’, you either went to the match, where as a young working class man it was normal to have a pint with the lads, or you waited for Saturday night’s Match of the Day for your football fix. The pubs were open sporadically, had no TVs, and the football was rarely broadcast anyway.

Fast forward a few years and we have football on satellite TV almost every night of the week and all day at weekends, most top flight football clubs sponsored at some level by an alcohol brand, marketing of alcohol, beer in particular, is rife and the norm appears to be drink beer and watch football with the lads in the pub. Opportunities to do both are far more common than when ‘I was a lad’, and not just within pubs, but within living rooms, where the cheaper alcohol deals of the supermarkets are very popular. As a dad myself I was disturbed by these developments, but hadn’t been able to quantify them.

I decided my dissertation would try to measure the amount of alcohol marketing that football TV viewers were exposed to. With the help of Jean Adams at Newcastle University, I planned the research. I chose six live broadcasts representing over 18 hours of footage, developed coding frameworks and watched 40 hours plus of coding footage to consider all the verbal and visual references.

The results shocked me:

• Over 2,000 visual images, 111 per hour on average, or around 2 per minute.

• 32 verbal references.

• 17 traditional advertisements, accounting for 1% broadcast time.

• Over 1,100 visual images in one alcohol sponsored Cup competition alone

The issue of traditional advertising commercials is interesting because the ‘voluntary’ codes of practice in place to regulate how alcohol is portrayed (should not appeal to youth, should not suggest social success, etc.) are most relevant to this type of advertising. Given that we know that quantity of alcohol marketing is more important than content, then the apparently unchecked stream of visual references in this research may be even more important, and we could argue that the current controls are completely inadequate because they are focused on content, rather than quantity.

I can’t help but feel that we have taken our eye off the ball – the globalisation of sports such as premier league football as a product, the satellite age, the endless thirst for profit and market share within corporations, the ‘self’ regulation that fails to control the exposure reported above, the relaxed licensing laws in this country, and the increase in type, availability, and affordability of alcohol. All of these things create a perfect storm in which alcohol and sporting idols become normalised as one and the same, and the brand becomes a member of the team. It feels as though the relationship between sport and alcohol has evolved towards its perfect and logical form.

I am disturbed to be one of a generation of football fans that has been manipulated in this way and that my children are also targets. And meanwhile, the alcohol industry has a seat at the policy making table through the Public Health Responsibility Deal. So we must ask the question: are we sleepwalking into a situation where drinking alcohol is so closely associated with the sporting heroes that children see on TV, that they are being actively normalised to become drinkers? No one seems to question this, but it is time someone did, and through public health advocacy it may just be up to us.

by Owen Sharp – Chief Executive, Prostate Cancer UK

For many working in public health, March is all about prostate cancer.

Since we launched the first ever prostate cancer awareness month back in 2009, we’ve certainly made an impact, but one thing we’ve realised is that one month a year just isn’t enough to highlight the huge impact of prostate cancer in the UK.

Prostate cancer is the most common cancer in men in the UK and predicted to be the most common cancer overall by 2030 . The disease kills over 10,000 men each year , putting it firmly in the top 10 causes of male death in the UK .

But it’s also a disease with no one-size-fits-all health message. There’s no test good enough for a national screening programme, no hard and fast symptoms – and often no symptoms at all. And it’s a cancer which targets a group who can be notoriously neglectful of their own health – men.

On top of that, research into prostate cancer is badly underfunded leaving tests and treatments trailing behind other common cancers. And the quality and availability of treatment and care can vary depending on where men live.

So this year, we’ve taken a different approach to getting prostate cancer on everyone’s agenda. Instead of 31 days of activity, we’re going to be campaigning 365 days of the year.

Men United v Prostate Cancer, which launched in January with Bill Bailey fronting our advertising, is our ongoing campaign to build a movement for men to unite against prostate cancer, raise awareness and funds, support each other, campaign for change – and make a real difference to men’s health in the UK.

If you work in public health, you’re probably already aware of some of the complexities around diagnosing and treating prostate cancer.

Prostate cancer can grow slowly or very quickly. Most prostate cancer is slow-growing to start with and may never cause any problems or symptoms in a man’s lifetime. However, some men will have cancer that is more aggressive or ‘high risk’, which needs treatment to help prevent or delay it spreading outside the prostate gland.

It’s these men that we need to reach. But, at the moment, there’s no reliable way of differentiating between slow-growing or more aggressive disease. Prostate cancer is diagnosed by a combination of PSA testing, physical examination of the prostate and prostate biopsy. Yet none of these techniques can conclusively tell whether a tumour is aggressive in its early stages, when it’s still confined to the prostate.

This means that newly diagnosed men can be faced with a tough decision – to have radical treatment and risk long-term, potentially debilitating side effects, like incontinence and erectile dysfunction, when the tumour might never affect life-expectancy or cause symptoms. Or, to have their cancer monitored and run the risk that the tumour might spread without warning.

Two of the main aims of our research strategy aim to tackle this.

On the one hand, we’re funding research into detecting men who are at high risk of developing aggressive prostate cancer, potentially enabling men to be closely monitored, giving a better chance of diagnosing aggressive cancer at an early stage when treatment is more likely to be successful.

And at the same time, our researchers are looking at how to differentiate between slow-growing and aggressive disease, so that men can choose the treatment paths that are right for them. By funding this kind of prostate cancer research we’re playing the long-game, working to create a better future for men with prostate cancer. But what about the men who are at risk now? Men United v Prostate Cancer aims to get men talking and engaging with their own health.

Although current testing for prostate cancer isn’t perfect, we want men over 50 to go to their GP if they have any health concerns at all – whether about their risk of prostate cancer or if they are worried about any symptoms.

But we know that men are much less likely to go to their GP than women and that issues around masculinity and embarrassment can be a barrier to men addressing any health concerns or worrying symptoms until it’s too late.

Joining Men United is a conversation-starter. Anyone joining takes a short prostate cancer awareness test which they can then share with their friends and family via email or social media. Over 150,000 people have taken the test so far, smashing our original target of 15,000.

We can’t force health information down men’s throats but we can get them to start thinking and talking about it.

  • by Baroness Kinnock of Holyhead

This article was originally published in the December 2013 issue of Public Health Today, FPH’s members’ magazine. It is reproduced here to mark World Water Day tomorrow, 22 March 2014.

When, in 2007, readers of the British Medical Journal were polled to discover what they believed to be the greatest medical advance since 1840, many people were surprised that they chose ‘sanitation’.

They shouldn’t have been. History emphatically demonstrates that clean water, functioning sewers and public hygiene are basic to health and wellbeing. That truth is plain – but may be so simple that it invites complacency.

In 1854, when Dr John Snow recognised the connection between a communal hand pump on Broad Street in Soho and a raging cholera epidemic, he isolated the pump, saved countless lives, helped to found the new science of epidemiology and swept aside the previous conventions that attributed cholera and several other diseases to ‘foul air’. The implications of this breakthrough seized the whole of society. The rich and powerful were almost as grievously affected by filth-generated disease as slum dwellers.

In addition, the economic benefits of protecting the workforce against a mass killer like cholera were evident even to those usually reluctant to support improvements in living conditions. Public investment in sewers, water filtration and chlorination became prodigious and rapid. Victorian civic modernisers, engineers and entrepreneurs laid a sewerage system through most of urbanised Britain, much of which is still in use today.

Progress on a proportionately huge scale and at rapid pace is needed now in large parts of the world. For at least 2.6 billion people in the ‘developing’ world lack of sanitation is the prime cause of ill-health and premature death, especially among under-fives.Great improvements have been secured since the 1980s when cholera killed an estimated three million people a year globally – but the annual mortality level is still around 100,000.

Incompetence or malice can have devastating effects. In Zimbabwe, Mugabe’s government took funds away from water treatment plants and refused replacement international aid until the cholera crisis became acute. In South Africa, privatisation of water programmes resulted in disease for the poor who couldn’t afford clean water, but not for the relatively prosperous who could.

The economic and social penalties of bad or non-existent sanitation are monstrous and the advantages of good sanitation huge. The World Bank has calculated that for every £1 spent on sanitation, £3 is returned in increased productivity. The association between cleanliness and Godliness is not proven. The link between hygiene and efficiency is.

However, the compelling evidence for the multiple benefits of good sanitation is still not enough to attract the high priority it deserves. Lack of money, pressure to pursue other objectives, packed and expanding cities, industrialisation and desperate water shortages all impede improvement. But these challenges must not be allowed to stall progress.

Let those who decide policies and funding make just one visit to a place where a two-year old girl is dying in agony and exhaustion from diarrhoea that could have been prevented if her district had access to clean water and a safe means of disposing of sewage. I have seen too much of such avoidable tragedy. It’s why I plead for more reporting, recognition and determination to cure this scourge by stopping its cause.

  • by Dr Anne Eyre
  • Trauma Training

I recently met a Director of Public Health. We were both in the lunch queue at a conference which was focusing on civil contingencies, the needs of people in disasters and organisational structures for addressing local resilience.

As we queued I asked her about provision of psychological (trauma) support services in her area for addressing the needs of people in the event of a major emergency. She replied, somewhat curtly, that she did not know: it was not her responsibility she said; it was not her budget. I was told I obviously hadn’t read the Health and Social Care Act, 2012.

Somewhat bemused, I sought reassurance. Perhaps I had misunderstood; she was not suggesting that psychological support services are not to do with public health? Sadly, I did not get that reassurance.

Just to be clear I went away and re-read the Act, and also the Department of Health’s guidance on the roles and responsibilities of Directors of Public Health in Local Government. This says that, among other things, Directors of Public Health (DPH) should offer leadership, expertise and advice on a range of issues, from emergency preparedness through to improving local people’s health and concerns around access to health services.

With regard to health emergency, preparedness resilience and response (EPRR) the role of Local Authorities, via their DPH, is to:

  • Provide leadership for the public health system within their local authority area;
  • Take steps to ensure that plans are in place to protect the health of their populations, and
  • Fulfill the responsibilities of a Category 1 responder under the Civil Contingencies Act.

This is encapsulated in the Emergency Preparedness Framework 2013 (NHS Commissioning Board, 2013).

At a time of tight budgetary constraint, and pressures on all those working within our public services, keeping trauma support and other mental health services on the agenda remains a formidable challenge in ordinary time, let alone in the context of major emergencies and disasters.

Perhaps this helps to explain why psychological support services, and indeed broader aspects of humanitarian assistance, remain the poor relation when it comes to emergency planning, response and longer term recovery in so many areas of the country. But these are integral aspects of public health, and not just in the event of disasters.

It is a worrying thought that our sense of health responsibility could become limited only to those activities over which we have direct budgetary control. Directors of Public Health in particular have a key role to play in delivering real improvements in local health in today’s health system. They are corporately and professionally accountable; with such seniority comes responsibility.

The challenge and expectation on all those who lead on health-related initiatives before, during and after emergencies, is that they will think holistically about people, across phases of disaster, beyond rigid organisational structures and within a multiagency framework in responding to the needs of their communities. For a long time this idea has been encapsulated in the concept of integrated emergency management and it is integral to so many of our organisational philosophies today.

I think it is important that we never forget that public health is about people and that responding to disasters – before, during and after they strike – is about helping and supporting people, including through the provision of robust public mental health services. This is not to say it is easy, and not to acknowledge that addressing mental health and other needs in today’s world of limited budgets and organisational structures can be difficult. However the challenge to those in leadership positions, and indeed all of us, is to work with and through these, not be constrained by them.

The public and those we serve will help ground us in this. Try telling those affected by the recent floods, or any other disaster for that matter, that public health in emergencies is not to do with psychological support.

References

  • Alison Macfarlane
  • Professor of Perinatal Health
  • City University London

with

  • Professor Allyson Pollock
  • Professor of Public Health Research and Policy
  • Queen Mary University of London

The NHS England leaflet ‘Better information means better care’, sent to every household in England has triggered a campaign to encourage people to opt out of the new care.data system by telling their GP that they do not want their health records uploaded to it.

Opting out will undermine both the new system and use of data from our existing national statistics  for research and national clinical audits. It will play into the hands of the private sector as it means  that data will be inadequate to assess the impact of government policies to privatise the NHS.

The aim of care.data is to link together coded records from general practice with data from other national data systems, starting with Hospital Episode Statistics. The plans are to provide ‘linked data, that will eventually cover all care settings, both in and outside of hospital.’ This is explained by the Health and Social Care Information Centre. England is well behind Scotland and Wales both in data linkage and in engaging with the public about it.

Care.data should not be confused with Summary Care Records, the purpose of which is to share clinical information between individual patients and the professionals who provide care to them. There are no plans to upload these records into care.data.

Although England has had NHS hospital data analysed at a national level for a long time, this has not been the case with data from general practice, where most care takes place. Because of this, the GP Extraction Service (links to pdf)  was set up in 2011 with a budget of £40 million to extract data from general practice systems and analyse them at a national level for England.

If this and the further data linkage works, it would provide valuable population-based statistical information for commissioners, public health and researchers. It would allow us to, for example, monitor inequalities in access and unmet need and changes in rates of heart disease and cancer.

The care.data system will cost over £50 million and its website gives no indications of any routine analyses to be done in-house. Meanwhile cuts of £9 million to the Office for National Statistics include cuts of £1 million in its statistical outputs which will lead to the loss of a range of highly regarded health statistics.  The future of the decennial Census, which dates back to 1801 in England and Wales and is essential for public health as it provides data on the whole population, is also uncertain.

There are justifiable concerns that the government is preparing the way for the commercial exploitation and use of our NHS data and that the private sector will have priority in accessing the data for analysis.  The person in charge of care.data, in his role as National Director for Patients and Information at NHS England, is former Sunday Times journalist, Tim Kelsey, founder of Dr Foster, a company which has been the subject of a critical parliamentary Public Accounts Committee enquiry.

Dr Foster analyses NHS patient data then sells back the analyses to the NHS organisations which collect the data.  Roger Taylor, co-founder of Dr Foster, has been appointed to a senior role in the Care Quality Commission and Kingsley Manning has been appointed Chair of the Health and Social Care Information Centre.

He is the former head of health at Tribal, now part of Capita, and the founder and former managing director of health and information consultancy firm Newchurch, which provided advice on PFI and sell off of NHS assets. These corporate appointments are akin to putting bankers in charge of NHS hospitals.

To make matters worse, Clinical Commissioning Groups do not analyse data in-house to inform their decisions. Since the Health and Social Care Act came into force, vital information functions have been outsourced to Commissioning Support Units, organisations which have no basis in law and are temporarily hosted by NHS England.

Plans to float these organisations on the stock market have been suspended in favour of turning them into social enterprises, staff mutuals, customer controlled social enterprises or joint ventures. Clinical Commissioning Groups should demand that these information functions and the associated NHS funds and staff be returned to them before any privatisation takes place.

Campaigners are concerned that pharmaceutical industry and health insurance companies will be simply ‘given’ the data, although Section 251 of the NHS Act 2006, requires them to state what uses will be made of data and how they will be stored securely.  They will also have to answer similar questions from the Health and Social Care Information Centre’s Data Access Advisory Group.

While applicants do not get ownership of the data they are able to use them and this raises serious questions about the purposes to which the data will be used and the extent to which analyses may be sold on.  There is still no clarity or transparency about the ownership and control of the data, how they will be accessed and used by the private sector or how statistics about NHS funded private care will be made available to all.

We need reassurance from government that the data will be used to produce and publish national statistics in line with the National Statistics Code of Practice. The Code, overseen by the UK Statistics Authority, is designed to be observed by all the public bodies that produce official statistics, is considered to be central to maintaining a unified statistical service that meets the needs of government and society and is both trustworthy and trusted.

As the government is privatising health care, it is crucial to have complete and high quality data to monitor the impact of these policies. The private sector has a poor track record for data collection. The atrocious quality of private sector data returns made it impossible to monitor contract compliance for independent sector treatment centres, the government’s £4 billion programme for elective surgery, where NHS funds were diverted to for-profit providers.

General practices owned by private companies such as Virgin, The Practice plc and SERCO will be protected from scrutiny if their patients opt out, as there will be no data about them as is already the case in nursing and residential care homes.

Instead a public campaign is needed to promote public data and oppose privatisation of both our healthcare services and data functions.  Patients and the public need to make it clear to NHS England that their consent for coded medical records to be uploaded to care.data is conditional on them not being used for commercial purposes or handed over to third parties, such as drug companies and health insurance and health care corporations.

Such a campaign must make links between opposing the privatisation of the data collection and analysis systems and opposing the privatisation of our health services and ensure that NHS England and Care Commissioning Groups oppose both.

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