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Posts Tagged ‘Andrew Lansley’

By Alan Maryon-Davis

Health Secretary Andrew Lansley wants to encourage people to eat healthily, drink sensibly, stop smoking and get more active without lecturing or hectoring them. People don’t like being told what to do or not do – least of all by the Government – so Lansley says we should provide them with information and incentives and let them choose for themselves – nudging rather than nannying. Hence the Great Change4Life Swapathon with its supermarket discount vouchers for healthy options. Lots of carrots, no sticks.

There’s also much nudging behind Lansley’s Responsibility Deal with the food, drink and fitness industries. Double nudging – Lansley nudging them to nudge the public. Industry will “pledge” to provide information and incentives encouraging healthier choices.

So where’s the fudge? In return for industry cooperation (and cash) Lansley has said he’ll go easy on mandatory regulations around such things as marketing, labelling, availability and pricing. To be fair, he doesn’t rule these threats out completely. He talks about the Nuffield Ladder of Interventions, with the least intrusive (information, education and incentives) at the bottom and the most intrusive (regulation and legislation) at the top. But he’s made it clear he doesn’t want to climb that ladder unless he absolutely has to. It wouldn’t fit his political philosophy.

So there’s a big fudge around how he’ll monitor adherence to voluntary approaches, assess progress and judge when to bring in mandatory controls. The food and drink industries are notoriously slippery, evasive and foot-dragging – just look at labelling and marketing. Meanwhile the health lobby is going along with the Responsibility Deal in the hope that things might be different this time – well aware they risk being be-smudged as part of the fudge.

I’d like to see a solid pledge by the Government to regulate or legislate if voluntary approaches fail and to be crystal clear about how and when such judgements will be made. Without an explicit commitment to use force if necessary, the deal will be seen as no more than a charade letting Big Business off the hook.

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By Alan Maryon-Davis

The public health white paper promises to ‘improve the health of the poorest fastest.’ Health Secretary Andrew Lansley has said that closing the health inequalities gap is a top priority, echoing the Marmot Review – ‘more must be done to tackle the causes of the causes of ill-health.’ To this end he has set up a cross-government committee on public health and has proposed a shift of responsibility for health improvement onto local government, along with a ‘ring-fenced’ public health budget. Joined-up at the top and bottom.

So far, so good. Many would agree that local government is the natural home for the public health and wellbeing agenda. It’s where the big local decisions about social determinants take place and where a properly coordinated approach could really pay off. Localism in action.

The flipside of course is that the Coalition’s Health Secretary, with one deft move, will be off-loading this most stubborn of health challenges. Despite massive investment by the previous government, the inequalities gap has continued to widen. In taking on this agenda, local authorities might find themselves accepting a poisoned chalice.

If that was apparent before the Chancellor’s spending review, how much more so it is now we know the breadth and extent of Osborne’s austerity drive. Massive cuts in benefits and public services, soaring unemployment, a deep-frozen NHS and the rise in VAT, all add up to millions more people in difficulty – a situation which, according to the Institute for Fiscal Studies, is bound the hit the poorest hardest.

We know that maternity problems, infant ill-health, low uptake of childhood immunisation, poor oral health, child and adolescent mental ill-health, accidents and violence, depression and suicide, cancer diagnosis and heart disease, and the debilitating dependency of old age are all strongly linked to social deprivation. We can surely expect a huge upsurge in demand on the NHS – at a time when services are already overstretched.

As ever, it will be the disadvantaged who will miss out. The health inequalities gap is bound to widen and no amount of shifting the public health deckchairs, as envisaged in the public health white paper, can stop it. Indeed the distraction and planning blight that comes with the wider NHS reorganisation laid out in the Health & Social Care Bill can only add to the barriers faced by disadvantaged people.

The Health Secretary no doubt sees all this, but is determined to push his changes through, despite a barrage of opposition from many quarters. His view is that, whilst things will be tough in the early years, there are green Elysian Fields beyond. In the meantime, we can help him to get it right by responding to the White Paper consultations and cajoling our MPs to amend the Bill as it goes through Parliament.

A key issue is the ring-fenced budget for public health, particularly for the health improvement element that will be passed to local authorities. We don’t yet know the size of the ring-fenced allocation at national level, although a figure of about £4billion has been bandied about. That sounds a big number – but by the time the many millions have been taken out to support the work that the Health Protection Agency is currently doing, and the National Treatment Agency for Substance Misuse, and national campaigns, and various other central initiatives, the amount distributed to local level will be much truncated.

And then that local pot gets divvied up between the Public Health England unit, public health support to GP consortia, prevention activity by GPs, immunisation, screening, drugs and alcohol, child health checks, health visiting, etc etc – the list goes on. So, what will be left to hand over to local authorities to tackle the health and wellbeing agenda? Not a lot, I suspect. Local authorities (and their Directors of Public Health) will be taking on a huge added responsibility with very little resource to throw at it. More for less indeed.

And those LAs struggling to improve their health outcomes because of challenging demographics could find themselves further disadvantaged by the Health Minister’s proposed ‘health premium’ scheme. The intention is to reward only those LAs who ‘make significant progress’ towards better outcomes, including reduced health inequalities. But those of us who have worked with multi-deprived populations know how difficult this can be, despite heroic efforts, without major demographic change. Although we’re told the health premium assessment would take deprivation into account, there’s every chance that yet again it would be the more disadvantaged populations who miss out on any extra funding. So much for improving the health of the poorest fastest. No, as bright ideas go, I can’t help thinking this isn’t one of them.

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Secretary of State Andrew Lansley’s speech plus short Q&A, Wednesday 7 July at the Faculty of Public Health annual conference

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Andrew Lansley this morning revealed his personal ambition for a new Public Health Service, where public health is something that is taken seriously at all levels – nationally, locally, and as individuals. The Secretary of State for Health announced that the Prime Minister has agreed to the formation of a Cabinet Sub-Committee on Public Health, which Mr Lansley will chair.

A new Health Premium which will target public health resources towards the areas with the poorest health was also announced, alongside confirmation that we can expect a public health white paper in the autumn. Mr Lansley also outlined his commitment to Change4Life, but said that he wanted to change it from being a government campaign to a social movement, with reduced central funding and great financial contributions from business, local government and charities.

Mr Lansley also made reference to last week’s controversy at the BMA conference, declaring that “contrary to the media reporting, I applauded Jamie Oliver’s initiative” and argued that the TV chef understood that encouragement and empowerment are what is needed to improve the public’s health, not regulations and rules.

Full text of the Secretary of State’s speech is now available here.

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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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