David Hunter On public health

Published: 13/05/2004, Volume II4, No. 5905 Page 17

As part of reorienting the NHS from caring for the sick to promoting good health, objectives to improve health outcomes and tackle key risk factors need to be given equal significance with waiting times and access.

There already exists a range of targets for improved health. Indeed, of the 33 priorities and planning framework targets for 2003-06, 11 have a specific public health remit.Often their failure to count lies in an absence of political will. If chief executives know their careers hinge on delivering the 'must do's' in acute healthcare, policies and targets directed towards public health inevitably take second place.

Political incentives would mean greater clout being given to health objectives in performance management arrangements.

There are also management development implications - managers should be judged on outcomes and in particular on their ability to manage the health of their communities.

There already exists a range of instruments, policy objectives and targets, backed up by a new inspection regime, which are designed to prevent ill-health and tackle health inequalities:

nthe priorities and planning framework 2003-06, which has reducing health inequalities as one priority;

npayment by results;

nstandards for better health, comprising 24 core and 10 developmental standards covering seven domains, of which public health is one;

nthe Healthcare Commission, which, unlike its predecessor, will inspect the implementation of the standards.

The PPF may mention health inequalities as a priority but it has little to say about health improvement more generally.

Furthermore, the thrust of the PPF is to maintain the government's emphasis on improving healthcare acute services.

The standards for better health, issued for consultation in February, include public health as one of the seven domains of NHS healthcare.

Within public health, the focus of the three core standards is on:

npromoting, protecting and improving population health and narrowing health inequalities through partnerships;

nmeeting the requirements of the national service frameworks and national plans;

nprotecting the public from infectious disease outbreaks and other health emergencies.

The issue in managing for health is not, therefore, an absence of policy objectives or vehicles and systems for achieving them.At stake is how far they are truly seen to matter, especially for chief executives who do not yet regard a failure to achieve them as a 'P45 offence'.

Incentivising behaviour, therefore, has to begin at the top. NHS chief executive Sir Nigel Crisp and chief medical officer Professor Sir Liam Donaldson could make an important gesture by jointly presenting a framework for public health policy in which local goals and targets, taking into account health status, can be agreed and form the basis of Healthcare Commission inspections.

David Hunter is professor of health policy and management at Durham University and a member of the steering group for the King's Fund Putting Health First programme.For more information on the programme, visit www. kingsfund. org. uk/pdf/healthfirstfactsheet. pdf