Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 332 - 339)




  332. Can I welcome you to this morning's session of the Committee and begin by welcoming Siobhan McDonagh to the Committee. Can I also welcome our witnesses and thank you for submitting your very helpful written evidence. I would ask you each to briefly introduce yourselves to the Committee.

  (Mr Town) My name is Chris Town. I am Chief Executive of North Peterborough Primary Care Trust, but I am here today representing the NHS Confederation.
  (Mr Panter) David Panter, Chief Executive of the Hillingdon Primary Care Trust, again representing the NHS Confederation.
  (Mr Ransford) I am John Ransford, Head of Social Affairs, Health and Housing from the Management Board of the Local Government Association.
  (Cllr Stringfellow) I am Rita Stringfellow, Chair for the Social Affairs and Health Executive of the Local Government Association and I am also a North Tyneside Councillor.

  333. Can I begin by basically exploring the definition of public health and, particularly to the LGA, ask you about your evidence where you state in paragraph one of your evidence that the current framework for public health set out in saving lives is "unhelpfully dominated by medical thinking. This medical dominance leaves the framework inadequate as a way of understanding and responding to broader issues involved in improving and sustaining the public's health." Can you explain what you mean by that and what the implications are of that assertion for where we go from here?
  (Cllr Stringfellow) One definition we might look at is something like a society movement to improve the health of the population and, therefore, that action on all parts of society. I think we see that there are very many things that influence people's health and perhaps 70 per cent of the health impact in people's lives is not directly to do with a medical analysis. I think we see the value of joining up all of the things that impact on health, for example, education, leisure, housing, transport, environment, planning, safe community issues, and certainly there are many examples across local authority where the concerns that people have are about environmental factors that do have an impact on their lives.

  334. Certainly your Association has set out an argument in respect of rolled-up Government on public health, and one of the debates we have had is whether it was wise in 1974 to shift the public health function away from local government. Some of the witnesses that we have had in the inquiry so far have said that moving the public health function back into local government would not be particularly helpful, because local government has changed since 1974. How do you react to that?
  (Cllr Stringfellow) I think the whole world has changed. I think the Local Government Association's view would be that we do not seek to take over the management of public health, local solutions are going to be most effective, but certainly we see ourselves as having a very strong community leadership role in bringing together all of the strands that I mentioned in my previous answer.

  335. How do the Confederation feel about this area?
  (Mr Panter) I think, again, we would agree that the public health agenda has to be carried forward on a partnership basis and we have to separate out the public health awareness and responsibility from the very narrow public health function represented by public health doctors. In essence, where the management of public health function sits in some ways is neither here nor there. There are going to be different local solutions for that, but that function must be supporting the broad range of organisations—local government, health, the voluntary sector and the business sector—in helping to carry out their role in promoting public health.

  336. Do you see, within your own membership, different models from one area to another? We have Manchester later on who have developed their own particular model. Do you see it as being helpful that people can explore locally what is most appropriate in their areas? From what you see developing now do you see models that, perhaps, offer more merit than others?
  (Mr Town) I think experimentation is always helpful and this is a very complex area. I think the important bit is that we recognise that it is not just about the medical aspect of public health—public health consultants—but the wider public health input into the agenda, and that is around health visitors, community development workers and people like that. I think it depends on where you are. Certainly where I work in inner cities it is about engaging all those people and using the expertise that is available in the public health directorate to support that rather than necessarily be the only people involved.

  337. What about the specific role of the Director of Public Health, because, again, in some areas, like my own, the Director is based primarily in the Health Authority and some of them have been talking about joint appointments and some have joint appointments? What are your views on whether that role might be more influential back in the local authority? I can recall the very important role of pushing individual local authority departments in a direction they would not otherwise have taken. Should we be looking at that role in a new light?
  (Mr Ransford) Certainly the important thing is how they carry out that role most significantly and most essentially. I think that is much more important than where they are based, and that will vary from locality to locality. We see that as a strength of the system. You are quite right, I can remember the pre-1974 situation too, and the Medical Officer of Health was not only a senior officer of the local authority but one of the senior officers of the local authority with statutory powers, the annual report was an extremely influential document and could brigade resources, and that was clearly one of the major priorities. I think we have all moved on considerably in the last quarter of a century and it is quite possible to have that sort of influence in different places, because organisations are so much more fluid. As others have said, the concept of partnership is so important that the individual organisational base should not be as essential as it was. Including public health is such a long-term agenda, so you have to look at distant horizons as well as immediate ones in order to make things work.

  338. From the LGA's point of view how do you see the medical model folding back addressing the wider public health issues, because this, in a sense, links to the previous question?
  (Mr Ransford) Quite simply, in a way, the medical model comes with a series of culture, of understanding, of knowledge, of practice, which are absolutely essential to the process—no one would argue against that—but are only part of the process, because health, as Councillor Stringfellow mentioned earlier, can only be proved by a range of functions working together. So, again, it is about the way in which those essential skills are practised and that role is seen as part of a team work approach and not as something which is separate from the rest of the organisation. Again, it seems to me it is getting the purpose of that right and seeing the essential and appropriate place of the medical model within improving public health. It is almost as ludicrous, it seems to me, to say that a medical model is what should determine public health as that health is an NHS agenda. Of course, health is part of the NHS agenda, but it cannot deliver better health on its own.

  339. The Confederation would agree with that, presumably?
  (Mr Panter) I think that is absolutely right, and I think certainly from my own experience and my own new organisation, the group of staff that are finding a new lease of life is the health visiting workforce. They have training in public health, they are doing public health on the ground at a micro level on housing estates, and yet they have often been excluded because they have a different approach to that medical model. So, I think, even within the health sector itself the medical model is only part of what is required.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2001
Prepared 26 January 2001