Published: 17/03/2005, Volume II5, No. 5947 Page 13

Last week's public health delivery paper tells the service how to set about achieving the goals outlined in November's white paper. But with only weeks before PCTs must submit their local delivery plans to SHAs and worries about the lack of ringfenced cash, the pressure is on. Helen Mooney and Mark Gould open our three-page special by assessing the difficulties that lie ahead. Overleaf, we detail the key policy areas for action

'Health improvement and tackling health inequalities will become an integral part of the NHS's mainstream planning and performance systems and will be at the core of its day-to-day business.' So says the introduction to the public health delivery paper, published last week. Keenly awaited, its intention is to set out a plan of action for the NHS to deliver the goals set out in last November's public health white paper, Choosing Health.

It places great emphasis on primary care trusts' local delivery plans. But the problem facing most PCTs is that they have just weeks to amend their LDPs before they have to submit them to their strategic health authorities by the end of March.

'The timing could have been better and some of the timescales [in the delivery plan] are pretty adventurous, ' says Chelmsford PCT public health director Mark Shackell.

He says his PCT has already drawn up its LDP and will have to work out how to slot in the public health agenda: 'The LDP will have to go in with a footnote [promising more details later].

We have now got an additional set of work to do. We have not got compensation for putting it in later, but the LDP will have to take cogniscence of the requirements of Choosing Health.' City and Hackney PCT director of public health Dr David Sloan says:

'Our SHA [North Central London] has set a deadline of today for the submission of our LDP because they have to submit it [to the Department of Health] at the end of March.' Dr Sloan says that over half the LDP targets for City and Hackney PCT (one of the 88 spearhead PCTs identified by the government to pilot health initiatives) are based around health improvement and reducing inequalities. 'Although we did not have the detail until now, our LDP targets are not a million miles away [from the delivery paper].

One London PCT chief executive says that, although LDPs are supposed to be agreed for the next three years, 'there is some flexibility to change some of what has been agreed upon in years two and three, which we will have to do to implement the ideas in the paper'.

An added concern for the public health lobby is that none of the money allocated to meet the health improvement agenda has been ringfenced for PCTs.

Julie Higgins, public health director of Salford PCT (also a spearhead), says that because the funding is not ringfenced, the cash simply goes into the pool for everything else.

'It is a case of convincing boards and professional executive committees that the money should be spent on health improvement rather than on employing more cardiologists or increasing the number of beds in intermediate care'.

'The government has said this is really important, but It is not 'really important' enough to ring-fence money. I haven't yet realised the benefits of being a spearhead PCT relative to funding. I am not sure the government have worked out where the workforce capacity to respond to this agenda is going to come from'.

Dr Sloan raises further concerns over funding. He says that his PCT has received health action zone funding for the last three years. 'We have been allocated additional funding, but I am concerned it might be a re-badging of what we already have. I suspect health action zone money will be re-badged.' But there is general agreement that while the paper is quite patchy on delivery detail, it provides a framework for PCTs to draw up their own local health improvement blueprints.

'If PCTs claim they are going to find it difficult to implement, then That is their problem; how big do you have to write the message on the wall?' asks Faculty of Public Health president Professor Rod Griffiths.

Association of Directors of Public Health president Dr Tony Jewell says that the delivery paper's aim is that public health 'should have reached the same level of importance as other waiting times in a few years' time'.

'We will just have to hold our breath to see whether it happens, ' he says.


How progress will be measured:

through improvements in the health of the population locally, regionally and nationally;

increased delivery of high-quality (health improvement) services; data will be submitted to the Department of Health by strategic health authorities and local authorities;

by achieving project milestones (eg in the five health improvement priority areas);

delivery partners' (primary care trusts' and local authorities') progress reports.

During 2005 the DoH says that it will set 'trajectories' that allow progress against targets to be regularly reviewed.

It is also 'exploring with the Healthcare Commission how best to ensure that the new standards for NHS provision it will publish later this year achieve a balance between prevention and care'.