Back to top
Back to top

Government proposals may not be so good for the public’s health

Lack of clarity and detail in the Government’s public health white paper, Healthy Lives, Healthy People, could lead to failure in tackling the big public health challenges, says the UK Faculty of Public Health, and may not be so good for the public’s health.

The UK Faculty of Public Health (FPH) has published its response to the Government’s proposed reforms to public health, Healthy Lives, Healthy People, which sees the establishment of Public Health England (PHE) and the proposed move of directors of public health (DPHs) to local authorities.

Despite months of consultation and discussion, the white paper still fails to set out a clear vision for public health, in particular, the roles, responsibilities and accountabilities of those with the power to change the public’s health, and the structure of PHE. And it fails to recognise the vitally important contribution public health expertise makes to the planning, commissioning and evaluation of health services for local people – even more important with the move to GP commissioning consortia.

Of key concern is the very real danger that, if the proposals go through unchanged, directors of public health – who make life and death decisions about the health of their local communities – may not be required to have any public health training at all.

In its responses, FPH gives government a model of how public health could be developed to deliver its vision of reducing health inequalities and improving public health:

  • Give local authorities clear responsibility for protecting and improving the health of their populations, supported by Public Health England, including taking the lead, through their director of public health, on emergencies or outbreaks.
  • Establish Public Health England as a special health authority – to maintain independence and public trust, employing all public health specialists and seconding them out to local authorities and other bodies to ensure maximum efficiency and resource allocation.
  • Position the director of public health as influential and authoritative, with the professional freedom to challenge publicly gaps in local delivery, and to manage the allocated ring-fenced public health budget to ensure it is used for public health gains.
  • Embed public health expertise in all commissioning bodies, including GP commissioning consortia, to ensure the effective and efficient commissioning (and decommissioning) of health services for local communities, ensuring that the needs of hard-to-reach groups are included.
  • Develop a coherent and comprehensive framework for the appointment and regulation of all specialists in public health – to safeguard the public.
  • Ensure sufficient funds are allocated to the ring-fenced public health budget to enable it to deliver public health gains – and provide protection to prevent it being raided to fund other services.

FPH President Professor Lindsey Davies said: “Public Health England could be a tremendous force for good health, but equally it could become little more than a slimmed-down Health Protection Agency, part of the civil service and with no independent voice, rather than the comprehensive expert support service, employing the majority of England’s public health specialists, that many of us envisaged and remain ready to embrace. We can rescue the situation. But it needs government to listen to, and take on board, what we are saying, and implement our recommendations to deliver a truly world-class public health system.”

Written: 31/03/2011 , last modified: 09/11/2011