‘Medical’ and ‘public’ health
By Sir Richard Thompson, President of the Royal College of Physicians
Prevention is better than cure. It is a cliché, but it is true. There are opportunities within public health policy to address the rising demand on the NHS and other public services. It is obvious to me that the future viability of the NHS depends on a coordinated approach to public health, nationally and locally.
Secondary care specialists and public health doctors are crucial, providing specialist knowledge and expertise on clinical issues and the health of the population.
Giving local authorities greater public health responsibility does give us an opportunity to tackle the broader social determinants of health, such as housing and air quality. However, there is a risk that there will be a dislocation of ‘medical’ and ‘public’ health.
To avoid this, we need to take an integrated approach. I believe public health specialists should also sit on the board of all Clinical Commissioning Groups (CCGs) and the NHS Commissioning Board. Reciprocally, hospital doctors should be represented on Health and Wellbeing Boards, which will be based in local authorities. This will help to develop and strengthen their links with the NHS.
I have been calling for the statutory registration of public health professionals. This will help to ensure that directors of public health, and public health staff that support them, have the skills and experience needed for this expert and specialised job. I would encourage the government to give the Health Professions Council the role of regulating public health professionals.
I am extremely sceptical about the Responsibility Deal’s ability to resolve major public health issues, such as obesity and alcohol. The RCP, along with five other health organisations, declined an invitation to sign up to the alcohol responsibility deal because of serious reservations about the proposed alcohol pledges.
There is an inherent conflict of interest when industry drives public health policy, and in particular the alcohol deal only set out a number of aspirational, unenforceable and weak pledges. The ‘carrot’ approach of voluntary agreements with industry is unfortunately not enough to prompt healthy behaviours; it needs to be complemented by the ‘stick’ approach of legislative solutions where necessary.
Recently, the Health Select Committee voiced concerns about the independence of Public Health England (PHE) and I must say that I echo its unease. PHE must be authoritative, independent and able to hold the government to account. To do this, PHE must be visibly and operationally independent of Ministers. Locally, directors of public health must have sufficient influence, and therefore should be appointed to chief officer level within local authorities. They should have the authority to determine the best way of distributing the local authority public health budget.
There are opportunities within public health policy to address the rising demand on the NHS and other public services; they must not be missed. The government must use all available levers to improve and protect the health of the population, otherwise the NHS will be swamped.