A group of public health experts today outline their alternative way forward for reforming public health in England, in a way which would offer better control of budgets, a more united workforce, and a truly independent system free from party political influence. The Viewpoint is by Professor Martin McKee, London School of Hygiene and Tropical Medicine, UK and colleagues from University College London and the London School of Economics, and is backed by a Comment from four international doctors.
The Viewpoint authors say: "Independent public health advice is crucial to build public trust...Moving local public health functions outside the NHS risks them being overlooked to a much greater extent than when they were within the NHS."
The authors note that while the current UK Coalition Government is quick to point out perceived failures in public health under the previous government, they are saying much less about public health successes such as smoke-free legislation, new immunisation strategies and improving children's school meals.
The authors provide a direct comparison between the government's own proposals under the recently released white paper and their alternative model. Under current proposals the new body "Public Health England"(PHE) would see public health functions split between the Department of Health and local authorities, thus exposing them to political interference. The Viewpoint authors suggest creation of independent authority within the NHS for PHE so that the public can trust that health matters can be free from day-to-day political interference. In this way it will avoid making the same mistakes as were made during the BSE affair which so eroded trust in public health messages, and which were apparent in the distrust associated with the MMR vaccine.
Staff unity and morale would be maintained through this new model suggested by the authors at a time when population health faces enormous challenges from spending cuts, instead of the fragmented solution of the government. And one of the biggest dangers, say the authors, is ring-fencing of budgets. While public health funds devolved to local authorities would be ring-fenced, there is a significant risk local authorities could re-designate some of their existing activities as 'public health' so as to use some of these funds for other purposes. The Viewpoint authors' alternative is a truly ring-fenced budget held central by this new PHE authority, and deployed directly to Directors of Public Health in local authorities for specific public health purposes only.
The authors conclude: "The [UK Government's] current proposals will create further disruption that, we believe, can be mitigated—and thus avoid destabilisation at a time of historic change within the NHS...Our model is consistent with the core aspects of the government's draft legislation and its stated principles of enabling public health to fully engage with the work of local authorities and Commissioning Consortia."
They note that members from all government parties have expressed concerns over the proposed legislation and promised to scrutinise it carefully in parliament. The authors add: "We hope that our alternative proposals will assist in this process."
In the linked Comment, Dr Jan De Maeseneer, Department of Family Medicine and Primary Health Care, Ghent University, Belgium, and three colleagues say: "McKee and colleagues are right to stress professional independence, while working within the context of government. They present an alternative model that makes a lot of sense. They propose a more coherent approach combining, rather than segregating, national and local management...We look forward to the outcome of the debate in England, and hope that common ground can be found to advance the health of all."
Professor Martin McKee (Viewpoint), London School of Hygiene and Tropical Medicine, UK. T) +44 7973 832 576 E) martin.mckee@lshtm.ac.uk (please note, MM will be uncontactable between approximately 10 am and 5pm UK time Monday 28th February)
Professor Rosalind Raine (Viewpoint), University College London, UK. T) +44 759 611 4073 E) r.raine@ucl.ac.uk
Dr Chris van Weel, Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Netherlands. T) +31 24 3616332 E) C.vanWeel@elg.umcn.nl
Dr Jan De Maeseneer, Department of Family Medicine and Primary Health Care, Ghent University, Belgium. T) +32 478544188 E) Jan.DeMaeseneer@UGent.be
For full Viewpoint and Comment, see: http://press.thelancet.com/publichealth.pdf
NOTE: THE ABOVE LINK IS FOR JOURNALISTS ONLY; IF YOU WISH TO PROVIDE A LINK TO THIS VIEWPOINT AND COMMENT, PLEASE USE THE FOLLOWING, WHICH WILL GO LIVE AT THE TIME THE EMBARGO LIFTS http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60241-9/abstract
Note to editors: Additional quote: Prof. Lindsey Davies CBE, President of the Faculty of Public Health (not connected to the paper) says: "The authors of this timely paper raise some important points that deserve serious consideration and debate. Much of what is suggested could provide a clear way forward for public health in England, complementing the governments White Paper - Healthy Lives, Healthy People. There is still an astonishing lack of clarity on roles and responsibilities in the new system. Many of us are struggling to see how, if Public Health England is absorbed by the Department of Health, it will be able to carry out the many crucial public health functions that the public need and have a right to expect. The authors' proposals offer some interesting solutions which could provide a degree of security and operational clarity -and would go some way to ensuring that the health of the population is both protected and improved. We shall certainly be debating these ideas within the Faculty." (Contact +44 (0) 207 935 0243 E) enquires@fph.org.uk )
Journal
The Lancet