For some people, being classified as ill or disabled is not such a bad thing

For the first time in her 11 years, my daughter feels I have got a job that she can understand and take pride in. She has told her friends what I now do (chief executive of Trafford Healthcare trust) and our street cred at the school gate has gone up significantly.

She understands what a hospital does as fully as anyone I know. That kind of easy understanding is why everyone wants to talk to me now about the NHS, both the good and the bad. Many of my previous jobs have been harder to understand, have had medium-term goals, and were carried out between a range of places.

Hospitals are much easier to describe. Everyone has been inside one, everyone wants one nearby, and the public equates healthy investment in public services to the size and strength of their own hospital.

As the new primary care trusts are formed and sort out their priorities, it is likely that they, like many of their predecessors, will find it difficult to convince the public that they should invest in services and support systems where the benefits are not immediately obvious.

Many community and home-based services are still not measured adequately and are bedevilled by long waits or complex access arrangements. They are often used by people who are criticised by others who have no experience of or sympathy for the distress they may be experiencing. The users themselves may also treat the services with casual disregard.

Finally, if the PCT does decide that it can't or won't fund the service, clients are often those who take knocks for granted and rarely complain.

As acute trusts prepare for foundation status, there is already evidence that the money that used to be spent on public health work is going into the frenzied payment by results system. However, we are still not paying for actual results, mainly for treatments undertaken.

Language is very important and if it is results we really want, then surely health gain and reduction in demand must be high up on the agenda.

PCTs could already be irrelevant as they may not be able to pull back the resources to protect important public health areas such as child health and elderly care systems.

These systems define the very nature of the health service, as well as its hospitals, and serve to distinguish the British health system from other market-driven systems.

It has been reported recently that the life expectancy gap is widening again. Public health professionals must position themselves quickly and say what new health improvement services PCTs should encourage.

The drivers of the new tariff system are already talking about financial uplifts for quality services. It will be good to see it include reductions in health gaps and improved access for certain marginalised groups. People are not hard to reach ? it's often the services that are impossible to find.

If the money is to follow the consumer, then for people to choose services that support them to stay healthy, guilt-tripping their customers about their lifestyle and body image has to be a thing of the past.

We know that negative messaging does not work.

The reasons why people cannot change their lifestyle are complex. For some people, being classified as ill or disabled is not such a bad thing.

When doing one of my 'hard to describe' jobs I did research to find out why people, after a heart attack, dropped out of an excellent cardiac rehabilitation programme.

Lack of incentive

One of the main reasons for men over 55 was that their fear of being employed was greater than the risk of another heart attack. They wanted to stay on invalidity benefit as they felt there was nothing else worth getting better for.

These are complex and challenging issues, but the NHS must play its part in helping people deal with their self-respect as well as their physical health. It all needs to be in the national business plan.

Watchdogs are about to call for a ban on the advertising of junk food, yet how many of our hospitals and community clinics still have vending machines full of chocolate and sugary drinks' And many hospitals and PCTs have avoided the confrontation over smoke-free workplaces by pitching ludicrous smoke boxes in their grounds.

Will it take celebrities like Jamie Oliver to tell us how to do our business' Do we not believe that hospitals and health centres should be exemplars of healthy environments'

The health service has already found that the payment by results system can move money and create new services quicker than we've ever experienced before. So the challenge for the health improvers is to combine compelling health messages and treatments in the same time zone as people do other things.

Supermarkets have already understood the value of the five-a-day message, and increasingly are providing other health services. Can we say the same of the NHS outpatient departments and places where people may wait for long periods?

No matter how well we drive efficiencies into the system, there is a need for all NHS 'franchises' to play their part in reducing demand for services.

New incentives to ensure that services that promote health and well-being remain available must quickly be played into the tariff and payment by results. Because despite my newfound school gate credibility, keeping the punters turning up is not the only reason I come to work.

Edna Robinson is the new chief executive of Trafford Healthcare trust and the national lead for NHS Networks.