comment: Small risk-taking team to take agenda forward is what is needed now

Published: 01/07/2004, Volume II3, No. 5912 Page 15

After months of speculation, the results of the Department of Health's review of arm's length bodies are emerging. The presence of some organisations on the list of those to be abolished will not be a surprise - but, to many, the fate of the Health Development Agency will be. As our Big Story reports this week (pages 10-11), the public health agenda is high in the public's consciousness, in part because of the efforts of the HDA.

But it would be a mistake if the public health lobby reacted with dismay or criticism to the HDA's dissolution. Derek Wanless's public health report earlier this year made clear that more of the same was not going to be anywhere near good enough. And despite the progress made under new chief executive Paul Streets , the HDA is not the organisation to break the mould. It lacks the levers to drive change at the speed necessary.

It appears that the bulk of the HDA's work, chiefly its core role of building evidence, will transfer to the National Institute of Clinical Excellence, which will widen its brief. This makes good sense, although NICE will have to demonstrate that it can translate public health theory into practical advice.

But what of the remaining element of the HDA's role? What public health needs, and what the Choosing Health white paper should deliver later in the year, is a small, flexible, risk-taking team led by a czar-equivalent, able to latch on to the best people and practice and use them to target priority areas, creating the kind of momentum that public health policy requires. This is just the kind of leadership that public health desperately needs - as Mr Streets told HSJ earlier this year (the HSJ Interview, pages 24-25, 15 April) Mr Streets has got the knowledge and breadth of experience to make his views worth listening to. They also qualify him for a leading role in strengthening public health leadership. l