Archive for the ‘Brexit’ Category

By Mark Weiss, Senior Policy Officer, Faculty of Public Health, markweiss@fph.org.uk

Last week, cross-Party Peers debated the ‘Do No Harm’ amendment to the EU (Withdrawal) Bill in the House of Lords, and FPH’s Senior Policy Officer was there to watch. A ministerial assurance that there will be no rollback of public health standards is welcome. We now call on the Government to put that assurance on the face of the Bill.

Responding at the despatch box on behalf of the Government, Lord Duncan made a ministerial commitment to the spirit of the amendment, assuring the House that “there will be no rollback of [public health] standards”. The Government’s “intention to secure the highest possible engagement on matters of wider public health” will, he set out, be a “cornerstone” of the Brexit negotiations, and the UK’s leadership role in public health will continue to be a “beacon” to the EU.

Yet this ministerial reassurance stops one step short of a simple, necessary, and, as Baroness Jolly asserted, “Brexit-neutral”, commitment to put on the face of the Bill the “high level of human health protection” that would guarantee its practical effect – to protect against a gradual erosion of our vital public health legislation, policy and practice. As former Coalition health minister Baroness Northover observed, if it is the Government’s intention to not roll back on public health standards, then it should “enshrine that in the Bill”.

In calling on Lord Warner to withdraw the ‘do no harm’ amendment, the Minister reasoned that such a commitment is unnecessary, since it is already Government policy, simply replicating the Secretary of State’s existing duty to protect the public’s health. In fact, the amendment is broader than this duty in a number of important ways supportive of the Government’s intention. And, at committee stage, a large number of cross-party peers united to outline how.

Lead Peer Lord Warner outlined that the duty to ‘do no harm’ is placed on the whole of government, including a wide range of public authorities – a very important distinction that is far broader than the Secretary of State’s existing duty. It further covers, as Baroness Jolly set out, the whole of the UK, “irrespective of whether legislation is made or adopted in Westminster, Belfast, Cardiff or Edinburgh”. It reminds a wide range of interests that they must continue to protect and ‘do no harm’ to public health.

The public need, peers stressed, an “effective legislative provision to challenge in court the Government, devolved administrations and public bodies when they fall down on the job of protecting public health”. Landmark cases, such as the failed challenge by the tobacco industry to the Standardised Packaging of Tobacco Products Regulations 2015 show that the amendment, which is based on the high level of protection under Article 168 the Treaty of Lisbon, is such an effective legislative provision.

In that example, Article 168 was used to interpret EU tobacco products law as well as the powers to implement it. Article 168, the High Court emphasised in its judgment, places the protection of public health “at the epicentre of policy making”. In this way UK courts would be under no misapprehension about what Parliament expects them to continue doing after Brexit.

While the Minister offered assurance that the Government will be addressing existing protections for public health as part of the negotiations, Conservative Peer and Chair of the Committee on Climate Change, Lord Deben, cautioned that whether or not the UK upholds the highest standards of public health “will not be part of the negotiation at all”. We cannot, he made clear, have a system whereby law is “affected by the whims—or sensible policies—of Ministers”.

The EU (Withdrawal) Bill, Baroness Jolly made clear, “is where our constitutional stability and certainty will be secured within the UK legal system”, and is where the amendment should sit. It would not be sufficient, as Lord Hunt asserted, for the duty to be placed within a “theoretical health and social care Bill which may be introduced” at some future point. Peers further agreed that health, alongside the security of the nation and our economy, are surely the most important duties of any Government.

The duty would also be supportive of the Department of Health and Social Care in ensuring that the public’s health is a key part of the Brexit negotiations. Baroness Jolly noted regret among Peers that the Secretary of State for Health and Social Care “is not a member of the Cabinet committee for EU exit and trade”.

An issue of particular concern, the negotiation of future free trade agreements, was raised by Peers. While the Minister offered reassurance that our “values and principles [will not be] traded away”, Lord Brooke focused attention on the 760 treaties with 168 countries that the Government will need to negotiate – many of which will affect the public’s health and our national health service. Baroness Northover warned that public health standards “could be out of the window” should the UK decide to lower them “in an effort to increase competitiveness”.

Baroness Finlay noted the unprecedented and co-ordinated effort by transatlantic think tanks to secure the “ideal” trade arrangements “which would involve the UK diluting, for example, its existing standards on food safety”. The precautionary principle, she said, may be under serious risk. In turn, Lord Warner asserted that the duty to ‘do no harm’ has already been used in the High Court to determine the standard according to which freedom to trade versus public health is balanced.

Ultimately, while a ministerial reassurance is welcome, the Minister cannot offer reassurances that we have nothing to worry about while at the same time making clear that future Governments might decide on a different path, one perhaps that didn’t put the health of the people of this nation at its heart.

This amendment does not seek to preserve EU law and regulation. It simply ensures we have some legal precedent and interpretative guidance on which to draw when protecting the public’s health in the future. British courts, on the basis of our doctrines of parliamentary sovereignty, will decide the future interpretation of the law. This, as Baroness Jolly put it, “should give remainers a rosy glow [while] Brexiteers will be grateful that the amendment puts a marker down: British law for British people.”

In closing her speech, Baroness Neuberger – former CEO of the King’s Fund and Fellow of FPH – said that she could not “remember the public health community coming so strongly together on anything since tobacco packaging”. As we approach the report stage of the Bill in mid-April (when peers get a chance to vote on amendments), we need your support more than ever and ask again for your help. There are a number of ways in which you can get involved:

1. Tweeting your support for the amendment using #DoNoHarm and following @FPH
2. Talking to your professional networks about the amendment and encouraging their support
3. Speaking about the amendment at any conferences or events you’re attending
4. Talking to Parliamentarians you are in contact with and, if possible, introducing them to FPH
5. Sharing intelligence on grant funding opportunities enabling us to do bigger and better things.

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By Dr Emily Dobell DFPH, Public Health Registrar

The start of 2018 has been an exciting time to work with the Faculty of Public Health. In a team of policy and communications specialists, registrars and a hugely experienced advisory board, we’ve spearheaded a campaign to ensure that Brexit, one of the biggest public health issues facing this country, will ‘do no harm’ to public health.

I applied to join the team in December, realising that this was going to be a real opportunity to learn about influencing national policy as part of my registrar training – and it’s proved to be exactly that. Brexit is a watershed moment and at FPH we’ve been campaigning to make sure that the assurances made about post-Brexit public health are set out in legislation as part of the EU (Withdrawal) Bill.

On the 31 January, it was thrilling to see Crossbench Peer Lord Crisp, former CEO of the NHS, make the case for a ‘do no harm’ amendment to the EU (Withdrawal) Bill during its Second Reading. (This was the moment Peers could debate any aspect of the Bill and signal their intention to make amendments.)

The next day, Lord Warner tabled it as an amendment to the Bill which will be discussed at Committee Stage on or around the 26 February. This is when every line of the bill is scrutinised and proposed amendments are voted upon. I’m proud to be part of the team that has supported Lord Warner and co-signatories Lord Patel, Lord Hunt of Kings Heath and Baroness Jolly who are now working tirelessly to back this amendment in order to secure our existing high level of public health.

So what exactly is the ‘do no harm’ amendment and why do we need it?

The ‘do no harm’ amendment will guarantee and protect the health of future generations as we leave the EU. While the current Secretary of State for Health has outlined the Government’s commitment to ‘maintain participation in European cooperation on disease prevention and public health’ – an assurance that is appreciated – conversations with the public health community have highlighted that concerns still exist about the potential impact of the Bill on the public’s health. Without the safety net of EU law, and in the context of significant cuts to public health and wider health budgets, we fear the gradual erosion of our existing high level of vitally important public health legislation, policy and practice.

If included in the Bill, this line of legislation would be a golden opportunity for the Government to provide much-needed reassurance to the health community that Brexit will ‘do no harm’ to the public’s health and will not put increasing pressure on the NHS.
We have made huge progress in public health during our time in the EU and the public needs assurance that their health is of paramount importance as we leave. The ‘do no harm’ amendment could be the most important piece of legislation we see passed in our lifetime.

Please join FPH in supporting this amendment and encourage the wider public health community to do the same. FPH will be tweeting throughout the Committee Stage debate, so please add your support by following @FPH on Twitter and using the hashtag #donoharm.

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By John Middleton, FPH President

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I wanted to let you all know about the progress we’ve been making with our two flagship influencing projects and to ask you, our FPH members, for help.

You may recall that in June last year I let you know that we had decided to focus the efforts of our small, but perfectly formed, Policy and Campaigns Team on two vital public health priorities – Brexit and Public Health Funding.

This followed a significant policy consultation and prioritisation process with our members through the first half of 2017.

Before I tell you where we’ve got to with these two campaigns it might be helpful to remind you that these two issues aren’t the only two policy areas FPH is working on. We also have five policy committees and 30 (and growing) Special Interest Groups all developing and shaping policy and making the case for a very broad range of public health issues.

In terms of the Brexit and Public Health Funding projects, since June last year we’ve done a number of things in order to be ready to start campaigning at the beginning of 2018.

We’ve talked with a range of different public health stakeholders – including the Public Health Minister, Steve Brine MP – to find out where they thought we should focus our efforts within these two large policy areas. Through this consultation process we drew up ‘long lists’ of possible policy asks.

We’ve also created two campaign project groups, made up of staff and – for the first time – specialty registrars on placement at FPH. As well as giving us more capacity to deliver both campaigns, we’re keen that these projects provide an opportunity for our public health trainees to learn about, and play a vital part in, campaigning for policy change at a national level.

We’ve also created two Advisory Boards of senior FPH members – one for each campaign – to ensure we’re able to draw from the vast expertise we have on both these issues. I won’t embarrass the Board members by highlighting particular people but trust me when I say that both Boards are packed with very senior, experienced FPH folk.

The Advisory Boards met in November and December and shortlisted three policy asks for each campaign. I’m very pleased to announce they are:

For Brexit:

1. We are calling on the UK Government to introduce a ‘do no harm’ clause into the EU Withdrawal Bill – with the effect that the Government commits to ensure that the Bill’s powers are not used to reverse or amend regulations critical to the health of the population.

2. We are calling on the UK Government to ensure the UK’s future relationship with the European Centre for Disease Prevention and Control – we think it is vital that we can continue to work in close partnership with our European partners to tackle serious cross-border threats to health security, e.g. blood borne viruses, pandemic influenza, viral haemorrhagic fevers, and chemical and radiation incidents. In so doing, we will provide a model for the UK as it considers how to continue to play a significant role in other EU public health agencies.

3. We will be calling on the UK Government to ensure that the impact on the public’s health is a vital determinant in our post-Brexit trade agreements – we will develop with the public health community a set of evidence-based public health principles for negotiating ‘healthy’ trade agreements. We will call on the UK Government to adopt these principles as it negotiates our future trading arrangements.

For the Public Health Funding campaign:

1. We are calling on the UK Government to invest in a public health ‘transformation and innovation fund’ to support the upgrading of prevention and population health services in local authorities – FPH members are telling us that they have gone to heroic lengths to deliver more with less and less but they cannot make the ‘radical upgrade’ in prevention services asked of them without additional dedicated funding. This is needed to enable their teams to make the step change in the types of services they provide and how they provide them. We think this fund will need to be in the region of an extra £1bn per year but the exact figure will be determined during the policy development phase.

2. We are calling on national governments to conduct a review into NHS spending on public health and prevention – our aim is to ensure that the approximately £2 billion spent in England annually on prevention and public health services ‘in the NHS’ is spent appropriately and as effectively as possible. We’ll also be looking at what an increased funding settlement for prevention in the NHS might look like in order to help deliver the radical upgrade. As part of this we will be encouraging STPs to focus more on the prevention agenda.

3. We are calling on Public Health England, and other relevant national bodies, to develop an improved ‘dashboard’ for public health services – we want to ensure updated dashboards include what our members think are the key public health performance metrics and indicators. We hope this dashboard will enable the public health community to agree what a ‘good’ public health service looks like, where it is occurring, and to further encourage the sharing of best practice between different areas and sector-led improvement.

Over December and January both campaign project groups have been pulling together their campaign plans for the first year of what will be three-year long campaigns.

These plans have now been signed-off by our Advisory Boards and, as a consequence, I’m delighted to say that at the end of January the Brexit campaign took its first steps and started to make the case to Peers in the House of Lords for our ‘do no harm’ amendment.

It’s been incredibly exciting to be so closely involved in the journey FPH has been on over the past year to get us to this stage and there’s an awful lot of campaigning activity to follow in 2018 and beyond.

And that’s where you come in!

We’re looking to create informal networks of FPH members who are particularly interested in Brexit or Public Health Funding (or both) who we can involve in each campaign on a regular basis.

The kinds of things we’d be looking for you to help with are:

  • Asking for your views as we’re developing our policy thinking – i.e. acting as an informal sounding board as we’re testing our draft ideas and thinking, so that we can be confident that what we end up saying in public and to governments is closely informed by what our members think.
  • Helping us decide which campaign messaging works best – eg. which messages do you think are most inspiring? which messages are likely to play best with local and national decision-makers? which hashtag do you like most? We want to know what you think.
  • Championing our campaigns on social media – eg. retweeting and commenting positively about tweets FPH sends out and saying supportive things about our campaigns on other social media.
  • Speaking up at conferences and events you’re attending – to highlight the importance of these issues and our specific asks.
  • Responding to questionnaires and surveys we will be doing throughout the campaign.
  • Introducing us to your networks – if you play Canasta with Philip Hammond, table tennis with Jeremy Hunt, or go paint-balling with Jeremy Corbyn then please do let us know.

If you’d like to find out more, then please email our Policy and Campaigns Team via policy@fph.org.uk and tell us which campaign you’d like to get involved in.

Thank you so much in advance for your help and watch this space for future updates on both campaigns. We’ll be updating you very soon on our Brexit activities so far in the Lords.


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By Prof John Middleton, FPH President

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August was a stock-take month for me. I held several meetings which all pointed to the need for public health and the woeful neglect of public health expertise by local, national and international policy makers.

Early in August we held a productive session of the Global Violence Prevention Special Interest Group which resolved to look at training tools for work in conflict and post-conflict areas – how to make rapid needs assessments, how we build alliances with public health resources in conflict areas and how we make sense of prevention and resolution of conflict through working with political scientists, theologians, international lawyers and aid non-governmental organisations. The work is being led by Daniel Flecknoe and Bayad Nozad. We plan to join up this work with that of Brian McCloskey and David Heymann for Chatham House (Royal Institute of International Affairs) looking at emergency responses in conflict zones. Mark Bellis’s work for the Commonwealth will also play a key part. The FPH statement says our unique role is in preventing violence and building and implementing the evidence base – locally, nationally and internationally. Economic inequality and unequal power-sharing are major causes of violence at local, regional and international level, and major challenges for the public health community, whether in relation to violence, childhood obesity or premature mortality. It is clear to me that FPH can play a greater role in violence prevention by harnessing the disparate skills of our members, from the frontline to high-level international policy – in emergency preparedness, health protection and health services organisation and in public mental health and community development.

In August I also met with David Ross from the armed forces public health services. They clearly have much expertise to contribute – in relation to international conflicts and closer to home. We have resolved to have a meeting with forces colleagues in the new year. The root causes of violent behaviour are also often the root causes of accidental violent injury. This was never more demonstrated than with the Grenfell Tower disaster. I am pleased that we could respond to the terms of reference consultation for the inquiry. Sadly our representations were not heeded and a limited range has been set for the inquiry with a junior minister leading consultation on the implications for social housing and some superficial examination of the causes of the causes. Nevertheless, I am extremely grateful to the FPH members who responded rapidly to our request for help on the Grenfell submission and particularly to Ruth Gelletlie who put together our response on the terms of reference. We received a wealth of material on every aspect from health protection and response, public mental health responses, health inequalities and the London housing market, building design, regulation and controls and social issues regarding migration and homelessness. Ruth and colleagues in the revitalised Housing and Health Special Interest Group will be drawing on this material for our formal submission to the inquiry (and for a listening minister…?)

A sustainability and transformation partnership has announced a £2.7million contract with the private sector for a year’s support for an accountable care organisation. It’s a mind-numbing figure and would buy an awful lot of public health health-care expertise and analysis. We will follow this programme carefully and see what it teaches… and in the meantime, continue our work to rebuild training and capacity in healthcare public health.

As we return from the summer holidays, FPH will once again get into full swing with major policy-planning days. Our workforce strategy is nearing completion and will be formally signed off in November. We are much exercised by the need to build our membership and would urge you to invite all your colleagues to join us – we have a category for virtually everyone working in public health or associated with our work. I will also be involved in the Academy of Medical Royal Colleges planning days. Our policy team priorities on Brexit and public health funding are taking shape. I will be at the Public Health England conference in Warwick at which we will launch the Public Health Prevention Concordat for good mental health. I will also be speaking at MEDACT’s conference in York with the International Physicians for the Prevention of Nuclear War on the theme of the progressive-health movement. I will also be speaking at the Oxford public health registrars symposium on the theme of partnership in public health. I believe there are still places available at all of these meetings.

As the US President flexes his nuclear options, and our government stumbles over complex imponderables of Brexit, it is clear to me we absolutely need a progressive health movement which addresses inequalities in income, in opportunity, in education and environment, which understands and builds new programmes for public mental health and conflict resolution, which stands strongly for non-violent resolution of problems, which looks at the health impacts of all policies and across future generations, and which believes in partnership, in shared benefits and better outcomes for all.

Can I draw your attention to an exciting event coming up which provides a unique opportunity to share learnings about advocacy. Mike Daube, Professor of Health Policy at Curtin University, Perth, Australia, will be delivering the DARE Lecture entitled ‘Not a Spectator Sport: public health advocacy and the commercial determinants of health’ on 27 September in London.

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By Professor Simon Capewell, FPH Vice President of Policy 

Next week, voters across the country will head to the polls to determine the make-up of the next Government. The outcome may be uncertain, but this much is clear: we cannot allow the public’s health to be side-lined over the course of the next Parliament. At FPH, we are committed to ensuring that policy-makers embed health in all policies. Following the announcement of the snap-election, we therefore rapidly produced our short-list of priorities for the next Government. They are:

1) Realising Brexit’s ‘health dividend’
2) Shoring up and increasing public health funding
3) Making sure the specialist public health workforce is adequately staffed and supported

We’re doing all we can nationally to advocate for these issues. But we cannot do it alone.  We need your help to deliver our message to your local parliamentary candidates and get them to commit to our asks. As an FPH member, you are well-placed to do this because Parliamentary candidates are much more likely to listen to the concerns of their constituents- especially when those concerns are presented against the backdrop of local data or case-studies- than they are to national organisations with no concrete links to their community.

Over the next week or so, candidates will be in a mad dash to meet as many of their constituents as they can. What they hear on your doorstep or at a hustings in your community may follow them into the House of Commons. To help you get started, we produced this brief one page guide outlining how you can campaign on behalf of FPH. It includes sample questions to ask, opportunities to take advantage of, and tips for building relationships with your candidates.

Make sure you also visit our General Election webpage to access allStart Well, Live Better front cover of our resources (including our Start Well, Live Better manifesto) to help you campaign and to see the election ‘asks’ from our allied organisations and partners.

Finally, we want to hear from you! Your feedback is invaluable to us. If you do speak to any of your candidates, we would love to hear how it went. Or, if you need help in reaching out to them, please feel free to email FPH’s policy team (policy@fph.org.uk) for some advice and guidance. We want to help as many members as possible build and maintain relationships with their candidates, both in the run up to election and, crucially, with the next government. Thank you for your continued support.

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By Professor Azeem Majeed, Head of the Department of Primary Care and Public Health, Imperial College London

The departure of the UK from the European Union (EU) will have wide-ranging consequences for public health. The UK first became a member of the EU in 1973 and as a member of the EU for over 40 years, the UK has played a full part in European-wide public health initiatives. These have covered many areas, including food regulations, road safety, air pollution, tobacco control and chemical hazards.

Cross-national approaches to public health are essential when dealing with issues that do not stop at a country’s borders (eg. air pollution) and when dealing with large, multi-national corporations over which any single country will have only limited influence. Although EU public health initiatives have had important positive effects on health in the UK, there will be strong resistance from pro-Brexit politicians in participating in future programmes, as they generally view them as unnecessary interference in the UK’s internal affairs. The UK will also find that it is no longer able to lead such programmes or have much influence over their content, which will inevitably damage the leading role that the UK has played in public health globally.

The NHS will also find itself facing major challenges because of Brexit. With over one million employees and an annual spend of over £100 billion, the NHS is England’s largest employer. For many decades, the NHS has faced shortages in its clinical workforce and has relied heavily on overseas trained doctors, nurses and other health professionals to fill these gaps. This reliance on overseas-trained staff will not end in the foreseeable future. For example, although the Secretary of State for Health, Jeremy Hunt, has announced that the government will support the creation of an additional 1,500 medical student places in England’s medical schools, it will be more than 10 years before the first of these extra medical students complete their medical courses and their subsequent post-graduate medical training.

The recruitment of overseas-trained health professionals has been facilitated by EU-legislation on the mutual recognition of the training of health professionals. This means that health professionals trained in one EU country can work in another EU country without undergoing a period of additional training. For example a cardiologist or general practitioner trained in Germany would be eligible to take up a post in the NHS. Moving forward, it’s unclear that this cross-EU recognition of clinical training will continue. As inward migration to the UK looks to be the most politically contentious area in our post-Brexit future, we will need to take urgent action to ensure that the NHS has sufficient professional staff to provide health and social care for our increasingly ageing population.

The UK’s government will also have to address the issue of access to healthcare, both for EU nationals living in the UK and UK nationals living overseas in countries such as Spain. Currently, all these individuals are entitled to either free or low-cost healthcare. It’s unclear what will happen in the future, and this is particularly important for the UK nationals living overseas, many of whom are elderly and who will have a high level of need for healthcare. As the NHS has never been very effective in reclaiming the fees owed to it by overseas visitors to the UK, the UK may find itself substantially worse off financially when new arrangements for funding cross-national use of health services are put in place.

In conclusion, Brexit will have important impacts on public health and health services, with scope for wide-ranging adverse consequences for health in the UK. It’s therefore essential that public health professionals engage with government to ameliorate these risks and also gain public support in areas such as the benefits of participation in EU-wide public health programmes and the continued recruitment of health professionals from the EU.

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