Memorandum by the National Health Service
Consultants' Association (PH 38)
The incentives to become involved in "joined
up thinking" remain slight. The customary reward is an invitation
to sit on another committee for which there is no payment, and
no clear health benefit. PCGs have been funded to attend to core
tasks, and this is not usually considered one. Involvement with
other agencies tends to be dependent on the enthusiasm and altruism
of one or more board members. A few of the more far-sighted Chief
Officers make time, but this seems to be the exception rather
than the norm.
PCTs may be able to support a full complement
of staff, but the focus is likely to remain on health services.
There is so much to be done to improve health services, and the
majority of board members will be more qualified to work in this
area, rather than the wider public health.
A Minister of Public Health is of central importance
in securing "joined up thinking" across government departments,
with regard to public health. The Minister must secure a full
complement of advisers to include public health specialists who
are not civil servants. A Minister may enjoy the company or ideas
of the academics, or those with "fresh" or radical ideas.
The best advice may come from people with balanced training and
Directors of Public Health currently tend to
work simply as executive members of their Health Authorities.
Health Authorities remain preoccupied by health services, and
the DsPH often finds it difficult to act as a physician for their
community. While a DPH may have the lead on inter-agency work,
there needs to be full commitment from the entire executive team,
with involvement of the chief executive and chair of the Health
The effectiveness of the DPH role is blighted
by the fact that there is no clarity about the role or definition
of competencies. This makes it hard for people to prepare for
the role or to develop while in the role. While the need is for
a team leader who is committed to the health of the local community,
who has extensive experience, the most experienced may well not
apply for such an ill-defined job. There is a school of thought
that the DPH should be the Clinical Director of the public health
directorate, and as with other Clinical Directors this post should
normally be held for about five years.
Inequalities in health are most effectively
addressed through progressive taxation. Governments need to do
more on this, within the constraints of popular opinion.
The next most effective way of addressing inequalities
is probably to improve education and opportunities for those in
deprived communities. The current attention to literacy and numeracy
skills in schools is most welcome.
Smoking is a major cause of health inequalities,
with people less committed to the future succumbing to addiction
to cigarettes as immediate gratification. The current investment
in smoking cessation is welcome but insufficient. The tax on tobacco
is well intentioned, but with the reality of addiction this is
effectively a regressive tax on the least well-off. Further tax
increases on tobacco should be imposed only after affective cessation
services have been put in place. A ban on all advertising and
promotions is absolutely essential. Measures need to be taken
to ensure that smoking is not portrayed in films or television
unless essential to a story. Current guidance is that the same
proportion of people should smoke on screen as offthis
does not assist with cessation and account needs to be taken of
the powerful influence of television characters and personalities.
All public spaces should be smoke free.
Alcohol is a further cause of health inequalities.
Those with least to look forward to in the future are more likely
to drink in excess. A cessation strategy needs to be developed.
The National Service Frameworks have placed
health inequalities at the heart of health service policy. This
is very welcome, with greater equity of access likely to be achieved
over the next decade. The impact of health services on health
remains slight however, and while the NSFs are backed by evidence
of effectiveness and reflect one aspect of public health thinking,
they fail to fully address public health opportunities.