Better Health For All

‘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.

Download the RCP’s public health submission to the NHS Future Forum.

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By Jan Maw, Public Health Adviser at the Royal College of Nursing

At this moment in time thousands of public health nurses are left in limbo, seeing changes on the ground but with no real news or updates from the people making them. The RCN is concerned that significant changes are being made to public health staff, in the absence of the guidance promised by the Government.

In the Update and Way Forward policy statement in the middle of July, the Department of Health committed to producing updates on the five key areas of reform during the autumn. Just to be clear, this set of work is an overhaul to the way we tackle public health issues, it isn’t a list of mere tweaks and small changes.  In case you aren’t aware, the five areas are:

• Public health outcomes framework
• Public Health England operating model
• Public health in local government and the director of public health
• Public health funding including shadow local authority allocations for 2012-13
• Public health workforce strategy consultation

Here at the RCN, we understand that the shadow budget allocations and consultation on the workforce strategy may not be released until 2012. What’s more, there is no sign of updates on the remaining three areas as 2011 draws to a close; meanwhile, RCN members are being affected right now.

Back in early November, the RCN welcomed the Health Select Committee’s report on Public Health; it recommended that uncertainty around the future structure and focus of public health in England must be resolved as quickly as possible. You can understand why we’re now concerned.

At the time, the RCN Chief Executive & General Secretary, Dr Peter Carter, commented that “Many public health nurses are currently in a state of limbo as they wait to see how proposed transfers to local authorities will affect their jobs and the services they offer to the public.”

While we understand that the issues requiring consideration are significant, nursing staff need clarity and deserve answers. On behalf of public health staff everywhere, I very much hope that 2012 provides us with more information, not only for the benefit of staff, but the patients who are so dependent on the care that they provide.

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