Published: 10/02/2005, Volume II5, No. 5942 Page 11
There are very few incentives for managers to make public health a priority and a real danger that initial enthusiasm generated by the white paper will fizzle out, the King's Fund has warned.
Its report, Managing for Health, warns that, without a radical rethink on targets and performance management, little will be achieved by the NHS in health improvement.
'The danger is that, without it, there will be a third Wanless [report] in a few years' time, lamenting how little progress has been made in shifting the balance from healthcare to health, ' it says.
The report is based on interviews with 32 senior managers in primary care trusts and strategic health authorities. It found universal agreement that current performance management frameworks gave the acute sector top priority.
Linda Marks, co-author and a senior research fellow at Durham University, said: 'It was very clear to people what made heads roll and what didn't. And it wasn't public health.' National health improvement targets - such as for smoking cessation - were considered too broad. It was not possible to measure whether they had been achieved, as insufficient data was available.
Ms Marks said there were two views on whether tough targets were needed for public health.
'Some people saw the NHS as an organisation needing targets to make anything happen. Others were critical of the role played by targets and incentives.' They were also split on performance management, with some arguing that it had delivered real improvements in acute care and should be made tougher in public health. Others criticised the current regime as poor management.
The report throws doubt on whether the NHS can or even should lead on public health: 'The official line... is that the NHS has had to concentrate on sorting out the acute sector, but the time is now right to look outward and upstream. Such reasoning is both disingenuous and ahistorical.' Institute of Healthcare Management acting chief executive Rosey Foster confirmed the emphasis on the acute sector: 'People are keen to sign up to public health but where does it fit?' Neither she nor the majority of her team had read the white paper, she confessed.
But Faculty of Public Health president Professor Rod Griffiths said the report missed the point.
'There is no right place for public health. The essential skill is working across boundaries. Right now the NHS is where the government has put the money.'
www. kingsfund. org. uk See Speak Out, page 23.