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Selbie: NHS has not 'done much good'

The new chief executive of Public Health England has said the NHS’s effort to improve health and reduce illness over the past four decades “hasn’t worked and has not been sufficient”.

Duncan Selbie made the comments in an interview with HSJ. He said individual NHS colleagues “had done good work and made a positive difference over the past 40 years”, but “what you couldn’t say is that as a whole we’ve done much good”.

Mr Selbie said: “We still have the same gaps in life expectancy and expectation of good health. That hasn’t altered and arguably it’s getting worse. It’s possible to respect the endeavours about improving health and reducing illness and also recognise that it hasn’t worked and it’s not been sufficient.”

The decision to move much of the NHS’s public health functions to local government, under the government’s reforms, was a “stroke of genius”.

He said the new system, which also includes public health roles for his own organisation and the NHS Commissioning Board, was “in a stronger place to do better” than the old.

Nicola Close, chief executive of the Association of Directors of Public Health, which has questioned parts of the reforms, said it was true the NHS “hasn’t done very well on the whole” in reducing health inequalities in recent decades, although there were “good individual examples”.

She said there were “huge opportunities” but also significant risks in passing the responsibilities to councils. Ms Close said some councils were not taking the responsibility seriously, and may not give it sufficient resources or attention. She said: “Getting funding right locally is going to be critical. There are risks in this whole process. There are councils which don’t yet understand their remit.”

Ms Close also warned that, in contrast to NHS organisations, councils could not be easily directed, so where they did not prioritise public health, “those areas are going to really suffer and it will be hard to pull them back”.

Readers' comments (6)

  • Bob Neilans

    In the seventies Public Health was part of Local Government so hardly stroke of genius!

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  • If the the NHS has not done well but can be directed, what does this tell Ms Close about the nature of NHS commitment to public health? And how much less commitment can the supposedly more autonomous councils really be expected to show compared with the NHS contribution since 1974.........? Self serving professional behaviours of the kind shown by too many public health leaders since the publication of Liberating the NHS are the real enemies of the public's health

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  • Martin Rathfelder

    Health inequalities are largely a consequence of economic inequality. It's not reasonable to expect the NHS to reduce them. Neither medical treatment nor advice about lifestyle will fix the fundamental problem.

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  • Wait until they've raped your Public Health budget and slashed your teams to the point they can't function and then come back and tell us what a "stroke of genius" the transfer was. My local council's director of commissioning is positively salivating at the prospect of getting its hands on the budget - ring fenced or not! Public Health in Councils will ALWAYS lose out to Child Protection, Education and Adult Social Care.

    If you all the Public Health people over the years have made little difference, what have you been doing withy ALL that money?

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  • The major social determinants of heath and health inequalities need tackling at a social policy level.

    The NHS has worked to address population health through its public health workforce. However the whole NHS workforce can exert an influence and lead by example.

    Employers of the 1.4 million NHS staff can design and sustain healthy workplaces, and the staff themselves are uniquely placed to influence patients, the wider health care community, and their own social contacts.

    NHS staff can't solve health inequalities, but they can contribute to reducing lifestyle risk factors for major diseases.
    Dr Sian Williams, Health and Work Development Unit

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  • The biggest 'lifestyle factor' for major disease & reduced life expectancy is poverty, closely followed by ignorance.

    I can't quite remember the last time I saw a public health person speaking about health inequalities and their effects on their populations. They only seem to emerge from seclusion when there's an interesting outbreak of something virulent. The rest of the time they seem to spend office bound, counting stiffs and sickies from on high.

    To command respect, public health services have to take effective action locally - and no, I'm not talking about more 'Stop Smoking' leaflets. They were never as effective as a simple ban.

    I think the old MoH model had much to offer, but they had teams of health visitors, tuberculosis visitors, specialist family planning and a full school health & dental service to work with. Where are they now...?

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