Memorandum by Manchester Health Authority
1. The following submission is from the
Public Health Department of Manchester Health Authority in response
to your memorandum of 22 May 2000.
2. We welcome the opportunity to comment
on this important issue and have structured our reply around your
stated terms of reference.
3. Modern day Public Health benefits from
the very real breadth and diversity of people that play a crucial
part in promoting health and preventing illness. The Public Health
function at present tends to be identified with the National Health
Service and as such is associated with health care rather than
broader public health issues. A consequence of such separated
working might mean that individuals and organisations outside
the NHS (that have Public Health goals) do not consider Public
Health staff to have legitimate partnership roles. Effectively
tackling poor health requires greater recognition of the wide
range of people working towards a common public health agenda.
4. The above suggests a need for a Public
Health work force that has a broad skills base and is capable
of undertaking the tasks needed to improve public health. Training
and Development should reflect this diversity and include a focus
on housing, employment creation, environment, transport as well
as health care.
5. We applaud the many initiatives that
the government has introduced to tackle poverty and health inequalities
but have some concern over the sustainability and coverage of
some of these programmes.
6. Joint working is one of the primary focuses
and positives of Public Health. Whilst the advantages of such
an approach are many, in practical terms there does seem to be
overlap in roles, particularly in relation to strategic plans.
For example, in Manchester at present, the Local Authority takes
a lead on the Manchester Community Plan and Agenda 21 Plan. The
Health Authority leads on the Health Improvement Programme. These
plans overlap to some degree in both their focus and time commitments
for individuals. It may be more effective for all agencies to
focus on one (Local Authority led?) plan. This would serve to
free up time and resources to implement rather than to write plans.
7. In order to facilitate joint and partnership
working at a local level, Central Government can best lead the
way by ensuring more central co-ordination of policy and inter-departmental
8. We recognise the pivotal role of the
newly formed Health Development Agency in setting standards and
raising the quality of the Public Health function. This focus
is a positive one but it is also important to ensure that previous
functions, particularly in relation to information campaigns and
training are not lost by default. The responsibilities now undertaken
by independent contractors would benefit from national co-ordination.
9. The potential for PCGs and PCTs to be
health-improving organisations can be developed. Delivering Public
Health at a local level has many advantages but it is crucial
that a population focus is maintained. The capacity of PCGs and
PCTs to deliver the Public Health agenda needs to be addressed
and the current national Public Health Workforce review and the
National Workforce planning review provide a timely opportunity
to do this. Consideration should be given to how PCGs and PCTs
will be monitored on their public health actions.
10. In relation to the points made in paragraph
one about the broad nature of Public Health, it might be appropriate
to ask the question whether the Minister for Public Health is
best placed in the Department of Health.
11. The focus of the Director of Public
Health has been the Health Service for quite some time. If this
emphasis is to change to reflect the need for leadership for the
broader public health agenda then the status of the Director of
Public Health would need to be legitimised at local authority
level. Such a move is likely to be most successful if driven and
supported by Central Government.
12. A clear focus is needed to reduce inequalities
in health. The Acheson report was a welcome acknowledgement of
the extent of inequalities in this country. It also provided an
opportunity to translate national issues into local targets, although
this has not been developed. Such stages could be monitored through
the many local initiatives such as Health Action Zones, Education
Action Zones, Healthy Living Centres and Health Improvement Plans.
Local initiatives such as Surestart are very positive steps towards
addressing inequalities. Their benefits might be optimised by
wider coverage and longer-term commitment.
13. In conclusion, local initiatives are
a welcome approach to reducing inequalities although the challenge
remains as how best to learn from, and roll out such programmes.
To effectively tackle poor health, there is a need to legitimise
the broader public health agenda. This should take place at all
levels, from Government, through to Local Authority and Health
Authority partnerships, to Primary Care Groups and Trusts.