Select Committee on Health Minutes of Evidence

Memorandum by The NHS Confederation (PAH 78)


  1.1  The NHS Confederation is the membership body for NHS organisations, representing over 95 per cent of NHS Trusts, Primary Care Trusts (PCTs), health authorities, health boards and health and social services boards, and including Primary Care Groups as affiliate members.

  1.2  This evidence is presented in terms of the English NHS only.


  2.1  The NHS Confederation has welcomed the focus on public health policy by health policy makers through the Saving Lives white paper and most recently in the NHS Plan.

  2.2  It is pleasing to see the NHS Plan (chapter 13) embed work on prevention and tackling health inequalities within core NHS functions, as well as developing Local Strategic Partnerships to draw together strands of cross-agency work.

  2.3  This evidence concerns:

    —  the need for clear leadership of wider health functions;

    —  recognition of the contributions that are made to the health of the public by multi-agency and multi-disciplinary planning and working, and applying effort to improving the equitable provision of high quality health services;

    —  the need to establish a performance management system that can accommodate the local inter-agency partnership approach to tackling public health issues and strike a balance between central direction of activity with local discretion on priorities.


3.1  Leadership and integration

  3.2  There is a pressing need to improve the integration of planning instruments at local health/government economy level, drawing in the "action zones"—health, education and other local varieties—community care plans, joint investment plans, children's plan, health improvement plans and others.

  3.3  This integrated approach should ensure that there is systematic consistency between plans, and that each of the projects can satisfy the question of what impact there will be on the health of the public.

  3.4  This integration of planning should over time aspire to synchronise planning and resource allocation cycles between agencies.

  3.5  Strong strategic leadership is required to deliver this—at both local and national level. National leadership should be concerned with setting a strategic direction but should not suffocate local initiative by being overly prescriptive, particularly in terms of specifying how policy should be implemented.

  3.6  The competency of local leadership to draw together all the relevant strands of work and mobilise the constituency to deliver improved public health is more important than national nomination of a lead agency.

  3.7  From the NHS perspective the Health Authority has a key strategic role in tackling public health problems, although the nominated lead agency for a local economy-wide strategic partnership should be open to discretion based on local circumstances and skill mix.

3.8  Multi-disciplinary and multi-agency effort in tackling wider public health issues

  3.9  The NHS Confederation is strongly supportive of moves to broaden the definition of public health professional and public health specialist, and recognise the value of a multi-disciplinary workforce.

  3.10  In this way we would also like to see that Director of Public Health posts open to public health specialists with requisite knowledge and skills and not limited to those with medical qualifications.

  3.11  The entire "NHS family" has a contribution to make to improving the health of the public.

  3.12  The PCG/PCT reforms have seen primary care services brought under the managed framework of the NHS for the first time.

  3.13  Before the establishment of PCGs and PCTs, primary care in the NHS had neither the structure to enable a more forward-looking approach to address wider community health needs, nor the mechanisms to meaningfully influence strategic planning. Even though it is reasonable to say that often the GP surgery has had a good handle on immediate needs of their registered population, and there are some good examples of primary care in action in tackling wider public health issues.

  3.14  PCGs and PCTs clearly have a part to play in planning and delivering public health including contribution to the HiMP development process.

  3.15  However it should be recognised as entirely reasonable for new primary care organisations to concentrate their main efforts on developing and improving primary (and secondary) care services and delivering clinical governance.

  3.6  The contribution of a well organised modern health service to overall public health and health outcomes is often underestimated. There are positive ways through delivery and commissioning of better organised and higher quality health services—at both primary and secondary care level—in which the NHS can make a significant contribution to the health of the public. At the NHS Plan rightly identifies, public health will be improved by efforts to implement the National Service Frameworks for cancer and coronary heart disease, to systematically engage secondary prevention therapies in public health and to adopt more integrated approaches to managing chronic diseases.

3.17  Performance management and local autonomy

  3.18  Working in a collaborative manner and developing Local Strategic Partnerships is important. The style of performance management adopted by the Departments of Health and other agencies has the potential to fatally undermine effective partnership working. Heavy-handed performance management has the potential to stifle local initiative.

  3.19  Existing performance management frameworks are applied on a single-agency basis—NHS & Regional Office, DETR, SSI and others. This single-agency accountability approach through distinct performance management frameworks could impede progress of local partnerships. It may unnecessarily require constituents of the partnership to put in effort to address the distinct requirements of their agency, thereby taking energy away from the core purposes of the partnerships projects.

  3.20  The NHS Confederation considers that the inter-agency approach to delivering the public health agenda locally should be supported by a single performance management framework that can accommodate the inter-agency partnership in tackling public health issues. It should also allow local partnerships to achieve a balance between central direction of activity against local discretion on priorities.

November 2000

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Prepared 26 January 2001