'Real change in public health will be made more difficult if service transfers are delayed'

The English approach to public health has been hampered for 50 years by failure to define the problem to be solved. We have allowed unjust and unequal environments and social systems to generate avoidable illnesses only to then buy back the health that has been lost through expensive health service treatments.

But if local government responds decisively and quickly, July’s publication of Healthy Lives, Healthy People: update and the way forward could mark the point where public health moves from being just one medical discipline to being a shared social aspiration of unifying importance to local communities.

This will require both a new “whole of government” and “whole of society” approach which can build on last year’s evidence given by the National Audit Office on why England failed to achieve the 2003 health inequalities targets.

The NAO claimed there had been a failure to grasp that only 15-20 per cent of inequalities in mortality rates can be directly influenced by health sector interventions that prevent or reduce the risk of ill health, with the real causes lying outside of NHS investment domains.

The main resource the transition to local government will add to public health improvements is the civic leadership available through the support of elected members, the renewed priority for health and wellbeing in all council plans and the ability of the director of public health to influence shared local priority setting.

The proposals outlined in the recent public health report provide a great opportunity to achieve a step change in public health, enabling us to address many of the problems that plagued our communities. But real concerns remain, about which we are lobbying government.

The most notable relates to the proposals to delay transfer of children’s NHS public health/prevention services to local government until 2015. The proposal is that these should be retained by the NHS Commissioning Board until then. This concerns us for a number of reasons, most notably that children’s and family services need reform to ensure more integrated models that can better drive a “Think Family” approach to some of the most intractable problems of inter-generational transmission of inequality and poor health.

This is a central intention of the government’s community budgets programme and is a major focus of the Sir Michael Marmot’s recommendations on early years intervention. Any barrier to further NHS/local authority integration of children’s and family services will sustain difficulties experienced by children and families, and frustrate progress for those charged with driving efficiency and reform.

The rationale for delay implies local government could not deliver the desired outcomes without the central control of the Commissioning Board. I am not aware of any evidence to support this. It seems to be in direct opposition to the government’s public health strategy of empowering local government to deliver improved health outcomes based on a new approach.  

I understand the grounds behind this delayed transfer is to allow the DH to increase health visitor numbers by 4,500. However, this could be achieved by putting a requirement on councils as a condition of the financial transfer. 

Excepting children’s services from the general transfer agreement seems to mark a loss of confidence in local government that appears incoherent when taken together with the policy as a whole. It would be a shame if this was the case, given the strong commitment from the government to change the way public health is approached. But unless it is addressed it could slow down the positive changes that have taken place so far.