Experts in public health have expressed fears that the health secretary's vow to 'take public health out of the ghetto' is a 'cover' for short-term cuts in research and education.
In a speech to the London School of Economics last week, Alan Milburn said: 'The time has come to abandon. . . lazy thinking and occupational protectionalism' within public health which left it 'marginalised'.
Making the case for a future expansion of the NHS in providing occupational health services for its staff, Mr Milburn warned that preventive measures were 'not always' grounded in knowledge of what works and what does not.
'We cannot afford well-intentioned but ineffective programmes. That is why I have tasked the NHS research and development programme to provide a better evidence base for health promotion.'
Public health directors and charities in the field told HSJ that Mr Milburn's words could be seen as 'a cover' for plans to reduce public health funding from a number of sources next year.
Donald Reid of the UK Public Health Association described 'a mad dash to slice as much as possible from anything that isn't aimed directly at waiting lists' - a point taken up by NHS Confederation policy director Nigel Edwards, who said: 'It looks like there has been quite a bit of raiding of central budgets to get money out to the service.'
Mr Edwards said 'slightly higher than expected' health authority allocations made earlier this year had led to suspicions that some central budgets had been cut.
Despite headline figures showing a slight increase in overall R&D budgets - from£435m this year to£449m in 2000-01, HSJ sources reported cuts within that budget which would have an impact on public health, already 'under attack' with the 'downscaling' of the Health Education Authority.
Next month, the HEA will become the Health Development Agency - losing 'two-thirds of our staff and all our campaigning role' in the process, a spokesperson admitted. The HDA has yet to learn what its budget for 2000-01 will be, but says cuts are 'inevitable'.
Liverpool University senior lecturer in public health Dr Alex Scott-Samuel recalled a civil service comment that Yvette Cooper - taking on the role of public health minister in a junior capacity - would have 'fewer resources at her disposal' than her predecessor.
But NHS director of research and development Professor Sir John Pattison insisted that public health R&D was 'liable to be better' after implementation of a strategy - due to be published later this year - begins.
The public health R&D strategy would 'throw up more opportunities' for public health 'in time', he said.
He said current figures did not classify which parts of the national R&D budget affected public health. Options under consideration in the strategy - due out later this year - include the absorption of HA public health R&D budgets into broader R&D funds.
Mark Baker, public health director for North Yorkshire HA, said the current 'patchy' evidence base for public health could 'survive cutbacks in the immediate future' as long as the opportunity was used to take a 'radical look' at future research.
Professor John Ashton, North West director of public health and health policy, also backed reform, adding: 'We don't have the right people running public health R&D - that needs to be addressed.'
Occupational health role on 'long-term agenda' Sources close to health secretary Alan Milburn have said the increased role for the NHS in occupational health would be 'a long-term agenda' and that decisions as to whether to take a 'top-down' or developmental approach in introducing occupational health schemes had not yet been made.
Mr Milburn said 'beacons of good practice' included NHS occupational health departments that 'break even' or make a profit by selling services outside the public sector.