Public health sidelined in the NHS White Paper, say top public health specialists
UK’s public health specialists have expressed concern that public health has been overlooked in the NHS White Paper - Equality and Excellence.
Results released today by the UK Faculty of Public Health (FPH) in its survey of 3,300 public health specialist members, show that there is real concern and uncertainty over the future of the public health profession and the White Paper’s impact on the nation’s health – despite the Coalition Government’s apparent commitment to improving the public’s health.
Professor Lindsey Davies, President of FPH, said: “We welcome the Coalition Government’s commitment to public health. The proposed National Public Health Service, the White Paper’s emphasis on outcomes and the new arrangements for directors of public health could make a real step-change in public health delivery.
“But instead of energising the public health workforce and renewing the focus on population health, there is a real risk that the reorganisation will lead to a fragmentation of effort.
“Opportunities abound, but to take advantage of them fully, all the strands of public health – health protection, health improvement and healthcare – must be in place and working together in the new system. The White Paper doesn’t mention public health inputs to healthcare at all. This is a serious omission, which must be put right.
“Independent directors of public health, free to report on the population’s health and the success or otherwise of local efforts to improve it, will be vital in the new system. Ringfenced budgets must be big enough to meet local needs, and public health teams around the country need the right staff with the right skills.
“The Coalition Government must now move quickly to give people the clarity they so badly need about their jobs and their futures. The UK is struggling to tackle some of the biggest public health challenges of this century, such as obesity, smoking, alcohol abuse and heart disease. We cannot afford to lose any of our highly trained public health experts who work so hard to create healthier lives for us all.”
The survey had 1,160 respondents. It found that:
- The public health workforce is not yet convinced that the NHS White Paper will have a positive impact on the population’s health. 39.3% of those surveyed thought it would not lead to any improvement, while 53.3% said they couldn’t assess at this stage the impact.
- The majority also doubt that it will offer better value for money. 38.3% thought that the new structures proposed would offer worse or much worse value for money, while 51.2% either thought it was too early to tell, or neither agreed nor disagreed.
- There is resounding support for a strong, independent Director of Public Health. 95% agree or strongly agree that the DPH should cover a defined geographical population. 91.5% agree that the DPH should report independently on the population’s health, and 98.3% think the DPH should be free to report objectively on the health impact of local policies.
- There is particular concern about healthcare public health, which many FPH members feel has been excluded or forgotten. 56.9% disagreed or strongly disagreed that structures outlined in the White Paper sufficiently covered the three domains of public health.
- The ringfencing of the public health budget is welcomed, but there is greater ambivalence about the impact of introducing a health “premium”. 79.6% supported the ringfencing of public health budgets. However, there are concerns about what this might mean in practice, and what indeed constitutes the public health budget.
- The public health workforce is split between support and opposition to greater GP involvement in commissioning. 25.7% thought that it might be a positive step, while 27.9% disagreed. A further 27.7% neither agreed nor disagreed.
- However, FPH members are virtually unanimous in the opinion that GPs would need public health input in commissioning. 97% either agreed or strongly agreed that it was “vital”. 93.4% agreed that without this input, population-based health initiatives would carry a low priority.
- There are critical concerns for the future of the public health workforce. 46.8% thought that the changes and uncertainty would mean fewer trainees applying to work in public health, while a significant minority of the workforce had either decided to retire or move out of public health practice (3.2%), were considering doing so (13.9%) or were unsure what they would do at this stage (27.3%).
- The emphasis on outcomes, NICE quality standards and equity is warmly welcomed. 91.3% supported the emphasis on equity, 84% the focus on outcomes and 86.9% the use of NICE quality standards for delivery.
- Public health specialists generally welcome the emphasis that the Government is giving on public health, but hope that this won’t turn out to be just “lip service”. Much will depend on the practical details of implementation and the content of the proposed public health White Paper.
Full survey results on the NHS White Paper – Equality and Excellence:
1. Do you believe that the White Paper proposals will lead to an improvement in the health of the population of England?
Yes 7.4%
No 39.3%
Cannot assess at this stage 53.3%
2. The emphasis on outcomes is welcomed by FPH and the public health community.
Strongly agree 28.9%
Agree 55.1%
Neither agree nor disagree 11.7%
Disagree 3.2%
Strongly disagree 1.0%
3. The emphasis on NICE quality standards for delivery is welcomed by FPH and the public health community.
Strongly agree 27.1%
Agree 59.8%
Neither agree nor disagree 10.6%
Disagree 2.1%
Strongly disagree 0.4%
4. The emphasis on the equity of outcomes is welcomed by FPH and the public health community.
Strongly agree 41.2%
Agree 50.1%
Neither agree nor disagree 6.9%
Disagree 1.4%
Strongly disagree 0.4%
5. The ringfencing of the public health budget is crucial in ensuring the population gets the best possible health with the available resources.
Strongly agree 49.6%
Agree 30.4%
Neither agree nor disagree 13.7%
Disagree 5.4%
Strongly disagree 1.0%
6. Budgets need to reflect a refocusing of national health funding away from an illness service to a wellness service.
Strongly agree 40.9%
Agree 40.7%
Neither agree nor disagree 12.6%
Disagree 5.4%
Strongly disagree 0.5%
7. The introduction of a new health premium will promote action on reducing inequalities.
Strongly agree 4.5%
Agree 25.0%
Neither agree nor disagree 59.1%
Disagree 9.5%
Strongly disagree 1.9%
8. The greater involvement of GPs in commissioning is a positive step in maintaining and improving the health of the population and reducing inequalities.
Strongly agree 4.6%
Agree 25.7%
Neither agree nor disagree 27.7%
Disagree 27.9%
Strongly disagree 14.2%
9. It is vital that GPs have access to expert public health advice to support their commissioning.
Strongly agree 79.0%
Agree 18.2%
Neither agree nor disagree 2.2%
Disagree 0.4%
Strongly disagree 0.2%
10. A lack of public health input into commissioning and heath strategy development by GPs will lead to a low priority for population focused health initiatives.
Strongly agree 66.1%
Agree 27.3%
Neither agree nor disagree 4.4%
Disagree 1.3%
Strongly disagree 0.9%
11. The creation of statutory health and well being boards will help to embed effective public health actions in local authorities.
Strongly agree 15.6%
Agree 43.1%
Neither agree or disagree 34.4%
Disagree 6.2%
Strongly disagree 0.7%
12. The director of public health should be a director-level post, directly accountable to the chief executive.
Strongly agree 71.3%
Agree 21.4%
Neither agree or disagree 6.0%
Disagree 0.9%
Strongly disagree 0.4%
13. The director of public health should be free to make objective assessments of the impacts of local authority, NHS and other local policies on the health of their populations.
Strongly agree 80.5%
Agree 17.8%
Neither agree nor disagree 1.4%
Disagree 0.2%
Strongly disagree 0.1%
14. The director of public health should publish an independent annual report on the health of the local population.
Strongly agree 68.9%
Agree 22.6%
Neither agree nor disagree 6.7%
Disagree 1.1%
Strongly disagree 0.6%
15. The Director of Public Health should be responsible for a defined geographical area.
Strongly agree 70.5%
Agree 24.5%
Neither agree nor disagree 4.6%
Disagree 0.4%
Strongly disagree 0.0%
16. The integration of social care with healthcare is vital to the health of the nation.
Strongly agree 29.6%
Agree 48.3%
Neither agree nor disagree 17.0%
Disagree 4.6%
Strongly disagree 0.6%
17. The proposed new Public Health Service should provide expert commissioning advice to support both social care and healthcare.
Strongly agree 46.1%
Agree 40.9%
Neither agree nor disagree 9.3%
Disagree 2.8%
Strongly disagree 0.9%
18. The structures outlined in the White Paper sufficiently incorporate health protection, health promotion/improvement and healthcare public health.
Strongly agree 2.2%
Agree 8.5%
Neither agree nor disagree 32.4%
Disagree 37.3%
Strongly disagree 19.6%
19. Thinking about the impact of the proposed restructure as we know it so far, what do you think the impact will be on the NHS delivering better value for money based on outcome measurements?
Much better value for money 1.7%
Better value for money 13.0%
Neither better or worse value for money 21.4%
Worse value for money 25.6%
Much worse value for money 12.7%
Cannot assess at this stage 25.6%
20. Thinking about the impact of the restructure as far as we know it so far, what do you think the impact will be on numbers of trainees applying to work in public health?
More people will apply 8.2%
There will be no impact 6.3%
Fewer people will apply 46.8%
Cannot assess at this stage 38.7%
21. Thinking about the capacity of public health to provide training, what do you think the impact will be?
Increased capacity 6.4%
There will be no impact 8.2%
Decreased capacity 51.1%
Cannot assess at this stage 34.4%
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