Key role for NHS in welfare reform

NHS Confederation chief executive Stephen Thornton said health authorities and trusts would have a 'key role to play in implementing the broad antipoverty agenda' set out in the green paper New Ambitions for Our Country: a new contract for welfare last week.

But he said the government needed to ensure that its public health, welfare reform and social exclusion agendas worked together towards its goals.

Donald Reid, chief executive of the Association for Public Health, warned that if this did not happen, inequalities in society could widen: 'The APH welcomes the general direction of the government's policies regarding welfare. Anything that can be done to get people into jobs is unquestionably pro-health, ' he said.

'But we are worried that some of the most dependent people could find themselves worse off.

'There is such an emphasis on people finding work that we are concerned that those who cannot work could become poorer and more isolated than before.'

New Ambitions says the government aims to rebuild the welfare state around work and security - 'work for those who can and security for those who cannot'. It sets out eight principles for welfare reform, the first of which is that 'the welfare state should help and encourage people of working age to work where they are capable of doing so'.

It says that people should be encouraged to insure themselves against risk and save for retirement, disabled people should be 'supported to lead a fulfilling life' that includes work where possible, and the welfare system should support families and children and tackle social exclusion.

The green paper says the NHS has a part to play in tackling inequalities through initiatives such as health action zones and healthy living centres, and sets health targets as indicators of progress in a number of policy areas.

'A decrease in the rate of conceptions among girls under 16 in the areas most affected' is given as a measure for judging success in supporting families, offering new opportunities to women and helping children.

Mr Thornton welcomed indications from social security minister Frank Field that the government would like to spend more on some things, such as health and education, and cut the bill for others, such as unemployment benefit.

But he said such a shift would be counter-productive if it pushed some people further into poverty.

'It would be damaging to people's health if the gap between rich and poor were to widen, ' he said. 'In the end, this would put further pressure on the NHS.'

The green paper has generally been well received by special interest groups.

The Royal Association for Disability and Rehabilitation welcomed the government's commitment to increase the number of disabled people in work, but said this would require new anti-discrimination legislation.

The Local Government Association said it welcomed the 'reassuring commitment to make change on the basis of principle and not the need to cut costs'.

But Sally Greengross, director-general of Age Concern, said 'pensioners can't work their way off welfare'.

She urged Mr Field to set out the details of how the government plans to ensure all pensioners 'receive a decent income in retirement'.