Published: 06/01/2005, Volume II5, No. 5937 Page 21

Paul Streets says delivering the public health white paper will require dogged determination from public health professionals

The Department of Health, and deputy chief medical officer Fiona Adshead in particular, are to be congratulated on the way they have championed the broader public health agenda and published a white paper within a respectable distance of the original target date.

OK, we didn't get the full smoking ban, but There is enough in there for us to get our teeth into while we sit in our smoke-free restaurants.

But We have heard promises before. So, what will make a difference this time?

Well the mood music is different.

There is public interest (for a while), and therefore political interest. There is NHS interest (I am always struck by how much commitment there is to the broader public health agenda among senior NHS professionals: It is just that they get chastised for unhealthy waiting lists, not unhealthy patients). And, in spite of the doom-sayers, as the Health Development Agency evidence base shows, we do know enough about what works.

Mood music is not enough. Delivery, delivery, delivery must be the mantra.

And delivery in this arena is tough - it will make four-hour waits look easy.

Success will only come with a co-ordinated effort across a range of initiatives and by a range of groups - many of which lie outside the control of the NHS and Whitehall.

It will require joined-up government, joined-up regulation and, most important of all, dogged determination from public health professionals who will need to lever, cajole and seduce to achieve change across the system.

This is a formidable challenge. With the exception of laudable but frequently unsustainable pockets of good practice, it has not been done before.

Current public health delivery mechanisms are weak: a DoH that instinctively thinks disease first and prevention second; an NHS with a mixed record in co-ordinating thoughts with actions; a public health profession that tends to focus on service planning or retreats into descriptions of the problem.

Added to this, however successful the transfer of the Health Development Agency to the National Institute for Clinical Excellence, there will be a year of hiatus whilst the new organisation consolidates, at a time when it should be central to supporting delivery.

The implementation proposals due this month will require more focus than the white paper currently implies.

Prioritisation is a real problem in public health because so much of what we do is interlinked - but prioritise we must.

That means a ruthless approach to less important issues. I would focus first on the prevention components of the cancer, coronary heart disease and diabetes national service frameworks, perhaps together with falls and older people.

In these areas the evidence is good and, although some would dislike the apparent 'disease' focus, the interventions required are wide-ranging enough to create interesting approaches towards partnership working, yet close enough to 'core business' for the NHS to see the importance.

Paradoxically, prioritisation may require a degree of central diktat, and it will also require an intelligent approach towards target-setting and regulation.

Most crucial of all, it will require partnership and networking skills to engage others outside the NHS.

One thing's for certain, failure is not an option if we are to avoid the nightmare scenario painted so vividly by Derek Wanless.

Paul Streets was chief executive of the Health Development Agency and this month becomes the first substantive chief executive of the Postgraduate Medical Education Training Board. The views expressed above are his own.