What is Andrew Lansley’s favourite phrase?
There is a strong possibility it is “evidence based”. Years of hearing from a wide range of interest groups that the Labour government’s reforms were not supported by evidence has made him determined to avoid the same criticism.
He used the phrase again when outlining the government’s public health plans at last week’s British Medical Association conference. The media created a furore around the health secretary’s attack on Jamie Oliver, but more interesting was the extended metaphor which followed his supposed maligning of the attempted school dinners revolution.
Those kids who disliked Jamie’s dinners brought in packed lunches, but the schools then decided to police their contents. Parents responded by giving their kids money to spend in local shops, which - Mr Lansley suggested - would inspire calls to ban shops from the vicinity of schools.
What gets up the health secretary’s nose is not the attempt to improve school dinners - he praised Mr Oliver’s initiative - nor even the widely reported “lecturing” people on bad habits. The bigger crime was the state’s attempts to frustrate personal choice and to control what individuals spent their money on.
Any attempt to understand the Conservatives’ approach to public health should start from here: informed choice is paramount and what an individual spends their money on is their responsibility.
In response to the article by Sandwell Primary Care Trust public health director John Middleton, public health specialty registrar Rebecca Cooper writes this week: “It is time for the NHS to set up a dialogue with people around their daily choices…The public health message should be an easy one to sell. Look after yourself… look after your community and the rewards you reap will be massive”. Mr Lansley said almost exactly the same thing to the BMA.
Rebecca Cooper’s letter
John Middleton should be commended for suggesting that 5 per cent of the NHS budget be allocated to public health. However, public health is not currently set up to spend this funding to best effect.
Today’s public health issues arise partly because people make choices unconcerned or unaware of the implications to their health.
What people need and what they choose can be very different things. Freedom of choice is nothing more than a vacuum through which we can be persuaded and flattered into making a choice that improves someone else’s profit margins.
It is time for the NHS to set out its stall and begin a dialogue with people around their daily choices. People expect intelligent, attractive messages that resonate at an individual level.
The public health message should be an easy one to sell. Look after yourself, look after your mates, look after your community and the rewards you reap will be massive. Feel better, look better, be liked, belong to a group, and so on.
We just need to get better at selling this choice, so we give the other sellers in the marketplace a run for their money. Then the 5 per cent will spend itself and it will be less about focus groups and more about focused people.
Rebecca Cooper, public health specialty registrar, Oxford Deanery
So what does that mean for the annual £4bn-plus likely to be allocated to public health spending this autumn? Are we about to enter a golden age of health education? Perhaps - but not in the way it has been conceived of in the past.
The public health role of the new Department of Health, as well as refocused PCTs, will be set out in the white paper later this year, but it will effectively be a rewrite of the Tories’ January policy paper A Healthier Nation.
The new department will be responsible for national public health campaigns. This activity should be accompanied by a “far more rigorous” approach to “monitoring and evaluating the direct impact of policies”.
So far, so evidence based, but the delivery mechanisms and incentives envisaged are very different. “Organisations” running national campaigns will be paid “by the results they achieve”, while business will be given a responsibility to help improve people’s health.
At local level, those commissioned to deliver public health programmes will get a “success payment for tackling problems like infant mortality… and given financial rewards for reducing the future burden of disease and cost”.
The evidence base will drive both policy and payment in public health.
So what could go wrong? Two potential complicating factors loom large from different ends of the public health spectrum.
The first is that much of the evidence does not support the health secretary’s faith in the power of personal responsibility and the positive influence of market mechanisms to drive change. The second is the growing public view that those who do not take care of themselves should not expect the NHS to pick up the pieces. When it comes to the misuse of scarce resources, the public can be as censorious as the nation’s favourite chef faced with a plate of Turkey Twizzlers.
It’s public health, Jamie, but not as we know it…
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It’s public health, Jamie, but not as we know it…