Select Committee on Health Appendices to the Minutes of Evidence


APPENDIX 53

Memorandum by Manchester, Salford and Trafford HAZ (PH 49)

INTRODUCTION

  1.  The following submission is from Manchester, Salford and Trafford HAZ in response to your memoranda 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.

PUBLIC HEALTH FUNCTION

  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. Insufficient recognition is given to a whole range of people working within public health outside the National Health Service (for example in regeneration, energy, efficiency, housing). The public health function at present is mainly identified with the National Health Service and as such is very much associated with health care rather than broader public health issues. A further consequence of such seperated 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.

THE INTER-OPERATION OF HEALTH ACTION ZONES, ACTION ZONES, HEALTHY LIVING CENTRES, EDUCATION ACTION ZONES, HEALTH IMPROVEMENT PROGRAMMES AND COMMUNITY PLANS

  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 approach are many there seems to be considerable overlap and duplication in roles, particularly in relation to strategic plans. For example the Local Authority takes a lead on the Community Plan and Agenda 21 Plan. The Health Authority leads on the Health Improvement Plan. 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 that to write plans.

  7.  In order to facilitate joint and partnership working at a local level, Central Government needs to ensure more central co-ordination of policy and departments working together.

THE ROLE OF THE HEALTH DEVELOPMENT AGENCY

  8.  The newly formed Health Development Agency has an important role in setting standards and raising the quality of the public health function. Whilst recognising the usefulness of this focus, it is important to ensure that previous functions, particularly in relation to information campaigns and training are accounted for. The responsibilities undertaken by independent contractors should be co-ordinated nationally.

THE ROLE OF PCGS AND PCTS

  9.  The potential for PCGs and PCTs to be health improving organisations can be developed. Whilst recognising the advantages of delivering public health at a local level, it is critical that a population approach 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. It is important that PCG/Ts participate in local area based initiatives.

THE ROLE AND STATUS OF THE MINISTER FOR PUBLIC HEALTH

  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.

THE ROLE OF THE DIRECTOR OF PUBLIC 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 and the role to be legitimised at a Local Authority level, such a move will need to be driven and supported by Central Government. Training and development issues may arise.

THE EXTENT TO WHICH CURRENT PUBLIC HEALTH POLICY IS REDUCING HEALTH INEQUALITIES

  12.  A clear focus is needed to reduce inequalities in health. The Acheson report provides an opportunity to translate national issues into local targets. Such targets 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 Sure Start are very positive steps towards addressing inequalities. Their benefits might be optimised by wider coverage, and longer-term commitment.

  13.  In conclusion, to best 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/Trusts. The importance of working in partnership with the communities we serve should not be overlooked.

January 2001


 
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