Politics & public health
Tuesday 3 June 2008
'What would it take for politicians to make decisions based on health outcomes rather than the outcome of the next general election?' This was one of the questions asked of the panel at Tuesday afternoon's ADPH debate. The running of the NHS had been ‘ludicrously centralised and Stalinist' said Liberal Democrat Shadow Secretary of State for Health Norman Lamb. The approach of everything being dictated from Whitehall is a problem, and too many decisions are purely political, he said. 'A much more decentralised system would deliver better outcomes.'
'We need to be clear about what we mean by health outcomes – future health outcomes are likely to be public health outcomes,' said Opposition Shadow Secretary of State for Health Andrew Lansley. The government needs to be focussed on public health and the reduction of health inequalities, which includes tackling behaviour more than before – giving people information about the consequences of their diet and encouraging them to take responsibility.
The key thing is making the outcome of the next election determinant on good health outcomes, said Plaid Cymru Spokesperson for Health and Social Services Helen Mary Jones. 'In Wales, we have achieved cross-party consensus on a range of issues,' she said, citing the smoking ban which the Government would have introduced four years before it did, if it had had the legislative power to do so. 'I don't think you can rely on personal choice to deliver good public health outcomes,' she said. It is important to educate and empower people, but practical measures like food co-ops and healthy cooking courses are essential when dealing with deprived communities.
Policy has to be determined by outcomes, but the steps on the way to that could be painful, said Faculty of Public Health President Alan Maryon Davis. A powerful public health movement would make it easier for politicians to take brave decisions, he said, like tough legislative action to regulate the alcohol and food industries.
On the subject of whether there should be an independent UK public health commission given the UK now has four separate governments, Andrew Lansley said the key thing is working together - developing the public health infrastructure with better information on the quality of interventions. 'The more we can do to make sure devolution doesn't mean separation the better,' he said. A commission has the potential to be a retrograde step, in that it could make public health independent from government, he said.
'The whole point of devolution is that the four countries have different cultures and priorities,' said Helen Mary Jones. 'Of course we can learn from each other but we don't want to go back to a time when a country's public health priorities were set by a government the people did not vote for.'
Alan Maryon Davis pointed out that we already have the Faculty of Public Health and other UK-wide bodies. 'The risk of a separate body is that there would be a tendency for the government to say "we'll leave that to them,"' he said, while Norman Lamb said it was important not to reinvent the wheel - central government has a clear role and the Liberal Democrats will create a Secretary of State for Public Health.
To the question of why investment in a public health workforce had not kept up with that in other parts of the health service, Andrew Lansley said that the size of the public health workforce has changed because of the constant reorganisation that had taken place. 'Some degree of stability would be helpful,' he said. The central issue however is whether we are investing appropriately for public health. 'We need an independent public health budget, otherwise it will constantly be stolen for other pressing needs.' There is also no correlation between inequality and spending on prevention by PCTs, he said. 'That is telling us some very clear things about what needs to be done – we talk very glibly about creating a health service rather than an illness service.'
The issue of capacity is something that Plaid Cymru had been working very hard to address, said Helen Mary Jones. 'Unless you've got the workforce on the ground, you're not going to get change.' There are also clear issues about needing to ring-fenced funding, she said. It is 'bizarre and perverse' that, despite the enormous increase in NHS funding, public health spend has stalled,' said Norman Lamb. Another problem is that much of government policy has been the ‘blunt instruments' of waiting list targets and payment by results, he said, which distorts the judgement about decisions being made.
Alan Maryon Davis said that there are definitely issues around the leeching away of top talent. 'Politicians and policy makers often don't recognise the crucial public health role of both health protection and commissioning,' he said. ‘But at the same time, we ourselves in public health have to create job opportunities so people can see there is a steady career structure available to them.'
Watch the APDH Public Health Debate