Published: 19/09/2002, Volume II2, No. 5823 Page 25

The Department of Health's annual priorities and planning guidance for the NHS will put a renewed focus on health inequalities.

Sources claim this marks an important shift for the government and will give public health professionals a crucial weapon in the fight for extra resources and management time.

HSJ has seen drafts of the guidance document. Its health inequalities chapter indicates there are no new public health targets, but suggests primary care trusts will be given sufficient flexibility to put together policy meeting local circumstances.

A draft copy drawn up during the summer said the focus for PCTs will be on mainstream services, but where necessary 'specific action' will have to be taken to meet the needs of vulnerable or socially excluded groups, including the homeless and asylum seekers.

It also says that each PCT, working in partnership with its local authority and others, should conduct an equity audit in a bid to identify local priorities for action.

HSJ understands PCTs may also be required to put together a financial strategy to underpin delivery and to increase staff capacity to meet national and local targets.

The guidance has been softened through subsequent drafts. It has become less prescriptive, with the government taking an arm's length approach to the way targets should be met.

Comprehensive delivery plans will be drawn up by strategic health authorities covering the PCTs in their area, but the main focus on how targets will be met will take place at PCT level.

The publication of the priorities and planning guidance was expected to coincide with a speech by health secretary Alan Milburn at the Faculty of Public Health Medicine next Tuesday.

However, the recall of Parliament to discuss action against Iraq has meant that Mr Milburn's appearance has been postponed.

Summer drafts of the guidance flagged existing targets on reducing smoking during pregnancy, breastfeeding, under-18 pregnancy and the implementation of the Sexual Health Action Plan.

PCTs are also likely to be told to reduce inequalities in coronary heart disease and cancer among disadvantaged groups by improving smoking cessation services, reducing obesity levels and the treatment of hypertension.

Janice Miles, policy manager at the NHS Confederation, said: 'It has to be welcome. I do not think it is a question of the NHS shifting away from the usual concerns of waiting lists and patient access. But if speculation [around the content of this guidance] is correct, it gives legitimacy for the NHS to work with other organisations like local government in tackling the issue.'

Ms Miles said the renewed focus on public health has been evident since the Treasury's comprehensive spending review earlier this year. It was during that process that a cross-cutting review examining health inequalities took place, a review apparently influencing this year's priority and planning guidance.