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Archive for April, 2010

By Dr Steve George, FPH Vice-President

Andrew Lansley’s commitment to public health, brought out in his interview with the Society Guardian (14/04), is welcome, but prompts a number of questions. The Conservative party’s health spokesman suggests that the Department of Health would be renamed the Department of Public Health, and that it would be given a new focus on prevention of illness. But if this was to translate into a genuine improvement in the health of the public, much more than the name of the body responsible for health would need to change.

Fundamentally, much of the Guardian interview is still focused on health care, or what might more aptly be called ‘illness care’. The public, and the politicians who represent them, must grasp the fact that ‘illness care’ has at best a tiny influence on the health of the public. Only after this realisation can there be any genuine change in the health of the public.

History has shown us that past improvements in health have appeared more as a by-product of a rising standard of living, rather than as a result of conscious policies to improve health. Certainly clinical medicine provides reassurance. It provides care and comfort. It provides treatment for acute emergencies. In certain instances it can provide cures, but these instances affect only a small proportion of people with morbidity. The USA and the UK have approximately equal life expectancies, despite the fact that the UK spends per head of population around a quarter of what is spent in the USA on health services.

So what about the proposed Department of Public Health? Lansley pledges that under a Conservative government patients would be given unprecedented detail on “good and not so good care.” Would this improve public health? Not a bit – even if patients learned the skills of adjusting results for case-mix – the mix of patients treated by a hospital/unit – and other confounding factors that are the bread and butter of people working in mainstream NHS public health.

What about the Tories’ proposal that hospitals would be paid variable sums based upon the quality and results of treatment? Would this produce improvements in public health, assuming that those results were interpreted correctly and correct measures of “quality” were in place? No, for the same reasons as above. It would almost certainly, however, make those responsible for hospital budgets reluctant to attempt to treat a patient likely to produce a poor result, and thereby drive down their tariff. And it’s by no means clear how a policy that would inevitably result in hospitals with poorer facilities and less well trained doctors receiving less funding would accord with the Tories’ promised moratorium on hospital closures.

What might improve public health is channelling money into improving social infrastructure in socially disadvantaged areas and reducing income inequalities. But neither seems likely, given that those inequalities have worsened over decades under successive governments of whatever political colour.

What we are likely to see instead is another health service reorganisation, and I’ll end with a quote often attributed to the Roman orator Gaius Petronius Arbiter:

“We trained hard, but it seemed that every time we were beginning to form up into teams, we would be reorganized. I was to learn later in life that we tend to meet any new situation by reorganizing; and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency, and demoralization.”

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As expected, all three major political parties have this week made strong references to public, or, as they most commonly term it, preventive health in their election manifestos.

Ahead of the General Election on 6 May, the Conservative party have, at least superficially, made the most explicit commitment, with their pledge to re-title the signs outside Richmond House “The Department for Public Health”. As we already learnt in their draft manifesto back in January, they intend to rechannel public health funding to the most deprived areas, offering a financial “premium” to target health inequalities. Confusion reigns as to how this might be implemented, and the manifesto in general is long on the whats, but short on the hows, but the proposals are certainly attractively packaged, at least for the floating voter.

The present incumbents have of course to defend their record, as well as identify areas where they could do better. Labour face the accusation, made in the Tory manifesto, that inequality has increased on their watch. An interesting spin on this was printed by the Institute of Fiscal Studies, but Labour’s manifesto is relatively weak on how they would further level the playing field. The author of the Labour manifesto, Ed Miliband had previously trailed the idea of universal free school meals, something that FPH had also touted in our manifesto. This pledge is somewhat toned down in the manifesto proper, instead promising to “trial free school meals for all primary school children in pilot areas across the country … [to] thoroughly test the case for universal free school meals, with the results available by autumn 2011”.

Most commentators agree that the NHS has improved under Labour, (at least enough for the Conservative party to want to claim themselves to be the rightful heirs of Bevan’s legacy) but their commitment to the preventive agenda is vague at best. Citing their current (and, in some quarters, heavily criticised) Change4Life social marketing campaign, and the smoking ban as evidence for the defence is fine, but where are the plans to make a healthy “future fair for all”?

The Liberal Democrats, with their eminently sensible and intelligent spokesperson Norman Lamb, possibly have the most tangible pledges for the nation’s health. The cynic might of course argue that they can afford to make such idealistic and resource-intensive promises, unlikely as they are to assume the reigns of power. Nonetheless, persuading a party to nail its colours to the mast of minimum alcohol pricing is no mean feat, particularly when their colleagues north of the border are more reticent to declare themselves. The Lib Dems also follow the Conservative’s lead in linking financial incentives to addressing inequalities, “linking payments to health boards (as they would rename Primary Care Trusts) and General Practitioners more directly to prevention measures”. Lamb has talked previously about what essentially amounts to a beefed-up Quality and Outcomes Framework (QOF), paying GPs for achievements rather than measurements.

A curate’s egg for public health then from all the parties; whichever the colour of the incoming government, they still have work to do to clarify how they will improve the nation’s health, particularly in financially straitened times.

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Very exciting news indeed.  Dame Tanni Grey-Thompson, 11-time Paralympic gold medallist, has been confirmed to give the keynote speech at our Annual Conference in London on 7 July.

Dame Tanni will provide  a truly inspirational start for what promises to be an action-packed day. Sue Tiballs, Chief Executive of the Women’s Sport and Fitness Foundation (WSFF) will be there to introduce her – Dame Tanni is  Chair of the Commission on the Future of Women’s Sport.

Other  speakers confirmed for the Conference include:

Professor Julian Le Grand, former No 10 Downing Street advisor, and Anna Dixon, Acting CEO at King’s Fund, taking part in “The Cuts Debate: Where Should The Axe Fall?” Chaired by Adam Brimelow, BBC Health Correspondent

Dame Carol Black speaking at the “Our Ageing Society: How Do We Meet the Challenges of the Next Decade?” – session

Denis Campbell, The Guardian, Mary Riddell, The Daily Telegraph and Dr Tony Jewell, Welsh Chief Medical Officer, discussing “Unhealthy Headlines: How Do We Prevent Another MMR Scare?”

Professor Martin McKee, London School of Hygiene and Tropical Medicine on the panel for “Cityscapes – How Do We Create Healthier Cities?”

• Samantha Callan, Centre for Social Justice Chairman in Residence, Chris Bentley, Head of Inequalities at Department of Health, and Peter Kellner, President of YouGov, at “Hard Times: Reducing Inequalities in a Tough Financial Climate”

The theme of this year’s Conference will be “The Next Decade: What Is The Future Of Public Health?” and we’ve got sessions on issues as diverse as the economy, the challenges of the new government and the effectiveness of health protection campaigns.

And for the first time ever, the Conference will take place in London, at Imperial College.

So see you there!

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