WORLD AT WESTMINSTER
A NEW APPROACH FOR PUBLIC HEALTH
The Government’s publication of the Public Health White Paper marks a new chapter for England’s healthcare, as it outlines a new approach to improving the nation’s health and attempting to eradicate inequalities.
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For more information Camilla Horwood Associate Director Portcullis Public Affairs Tel. +44 207 368 3100
info@portcullispublicaffairs.com
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he end of November saw the Department of Health publish its long anticipated proposals for a new approach to Public Health management in England ‘Healthy Lives, Healthy People.’ The White Paper is the Government’s response to the 2009 Marmot Review into health inequalities in England, which highlighted several challenges facing the population. The White Paper presents what Health Secretary Andrew Lansley has labeled a “radical new approach,” better equipped for the task of fighting the public health problems faced by the nation. It is hoped that this alternative approach “will empower local communities, enable professional freedoms and unleash new ideas based on evidence that works.” This represents a steadfast commitment to the Government’s mantra of localism and a focus on outcomes rather than processes. It also ties in with the Coalition’s Programme for Government, which suggested that freedom, fairness and responsibility were the keys to fixing what the Government called ‘broken Britain.’ By improving public health through self‑esteem, confidence and personal responsibility, the White Paper proposes that this new approach will “reach across and reach out,” addressing the root causes of poor health and well‑being. The White Paper also claims that the new approach will be responsive (by being led by local communities), resourced (through use of a ring‑fenced budgets), rigorous (by being professionally led and focused on evidence) and resilient (by strengthening and streamlining the current system). Whilst maintaining that the key to improved public health will be through local endeavour it is confirmed that central Government will retain a role in improving public health, specifically in intervention, when it is clear that a national programme would be more effective than various local alternatives. This will take the form of a ‘ladder of interventions’ adapted from the Nuffield Council’s Bioethics intervention ladder and influenced by the concept of “nudge” first devised by Chicago academics Richard Thaler and Cass Sunstein. Essentially, this means the government will guide people into healthier lifestyles by making healthier options the default option. The new body, Public Health England (based within the Department of Health), will streamline the current public health management system. It will have responsibility for nationally required health solutions and be responsible for funding, provision of evidence,
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data and professional leadership for local services. Public Health England will also be able to instruct general practitioner (GP) commissioning consortia to commission services on its behalf. There will be ring-fenced funding from the National Health Service (NHS) budget for spending on public health. This is estimated to be about £4 billion initially. Public Health England will allocate local budgets, weighted for inequalities, to local authorities for improving the health and well‑being of local populations. There will also be a new health premium, funded from within the overall public health budget, to reward local authorities for progress against the proposed public health outcomes framework, which are yet to be determined. Directors of public health will in future be employed by local government and jointly appointed by the relevant local authority and Public Health England. They will be the strategic leaders for public health and health inequalities in communities. It is hoped that charities and voluntary organizations will act as “advocates for excluded groups and catalysts for action” feeding into the notion of responsibility that is key to the government’s philosophy and is most evident in its calls for a ‘Big Society.’ The Government has also called for businesses to take increased responsibility for the impact their practices have on people’s health and wellbeing, which will form part of the Government’s new Responsibility Deal. The core elements of the proposed system will be set out in the upcoming Health and Social Care Bill, which will have to go through parliamentary approval. Subject to this, the government has pledged to have the proposed system in place by April 2013. Further details of the arrangements needed to make this happen are expected to be set out in a series of planning letters to be released throughout 2011. Initial reaction to the proposals from health opinion formers has been mixed, with many responding positively to the direction of travel and the principles contained, however, expressing concern regarding the lack of detail and the potential for disparity across geographical locations. Co‑operation between relevant services and activities will be the key to making sure the Government’s plans for public health work, but more clarity is needed before people will feel confident that these reforms can provide the improvements to public health outcomes, which are so needed.
January/February 2011