Memorandum by Manchester, Salford and
Trafford HAZ (PH 49)
1. The following submission is from Manchester,
Salford and Trafford HAZ in response to your memoranda of 22 May
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. 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.
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.
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.
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.
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 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.
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.