The Health and Social Care Bill threatens the future of vital Public Health work across England, according to a new report from the network “Public Health for the NHS” published today. The network includes former Presidents of the Faculty of Public Health, more than fifty Directors of Public Health and the country’s leading experts in health policy and health systems analysis.
The areas of work threatened by the Bill include: public health services for children and young people aged 5-19; public mental health services; dental public health services; tobacco control and smoking cessation services; alcohol and drug misuse services; cancer screening and immunisation services and sexual health services.
Public Health practitioners carry out a range of key functions in the NHS, including:
- ensuring health protection for the public (covering areas such as infectious diseases, environmental hazards and public health emergencies)
- promoting efficient and effective evidence-based medicine and clinical care
- promoting preventive population-based medicine (e.g. screening and immunisation programmes);
- improving public knowledge about health and promote healthy behaviour
- identifying and tackling the social and environmental determinants of illness and health inequalities (e.g. unemployment, poor housing and pollution)
- health and health services surveillance, monitoring, evaluation and research.
The report gives four principal reasons why this vital work will be damaged if the Bill becomes law.
First, the transfer of many Public Health functions and services from the NHS to local government is unsafe. Local authorities should certainly have a stronger duty and mandate to promote health. But the Bill provides no safeguards or guarantees that these public health services will be provided as a universal entitlement to all, as under the existing NHS [1]. Local authorities are facing large cuts in the Government’s revenue support grant, an average of around 25% by 2015 and as much as 40% for some authorities.
Second, core Public Heath functions, which are important for health services planning and which improve the overall cost effectiveness of clinical care, may be devastated by the Bill. The Government’s intention appears to be to commercialise and privatise these functions.
Public Health practitioners provide expertise in: what services would best meet the needs of whole populations; monitoring and evaluating accessibility, quality, cost, safety and outcomes of health care services and facilities; and providing evidence and information to clinical practitioners, commissioners and the public about what is cost effective and safe.
Until the Bill, this work was done within Primary Care Trusts and other key organisations such as the National Institute of Clinical Excellence. The Bill gives (much) commissioning responsibility to Clinical Commissioning Groups mostly comprised of GPs who are not formally trained in population based commissioning or health services evaluation, and who wll be required to rely on commercial actors for support such as management consultants and healthcare companies.
Third, by imposing a market based structure on the health system, the Bill will weaken the ability of Public Health to perform crucial functions including: improving the uptake of cancer screening and immunisation programmes; coordinating multi-agency responses to prevent and respond to public health issues; and population based health surveillance and the monitoring of health outcomes.
Fourth, the Bill will weaken the duty and function of Public Health specialists to speak out in the public interest, especially on behalf of ordinary citizens and marginalised groups, and often against powerful or vested interests.
Some changes have been made to the Bill to improve the status and role of Directors of Public Health in local authorities, but it still means a reduction in their independence and public interest function. Public health leaders and specialists at the national level will also lose independence because future employees of Public Health England (PHE) will be subject to the employment rules of the civil service, reducing their independence and ability to speak out on matters of public interest.
The report therefore calls for the Bill to be dropped, and a stabilisation plan for the NHS to be put in place, including a moratorium on the transfer of Public Health functions and services to local government; the incorporation of CCG members into PCT clusters to enable clinically-led commissioning and planning of local health services within a single authority; and a requirement for GPs and Public Health specialists to work together to address the financial and clinical challenges facing the health system.
Commenting, Dr David McCoy said:
“Health professionals and the general public already know that the Health Bill threatens to do terrible damage to the National Health Service. But until now, the extent of the potential damage to vital public health work has not received the attention it deserves.
Public Health work is vital to tackling some of the biggest health problems we face, including diabetes and heart disease caused by obesity, lung cancer and many other illnesses caused by smoking, and AIDS and other diseases and conditions related to sexual health. But the Government’s “reforms” will lead to increasing health inequality, and make it more difficult for us to address these health challenges.”
Contacts
Dr David Mccoy 07952 597244 d.mccoy@ucl.ac.uk
Professor Martin McKee 07973 832576
Ian Willmore (media) 07887 641344 willmorei@live.co.uk
Notes to Editors
[1] In December 2011 the Department of Health listed in its fact sheet “Public Health in Local Government” a range of services for which local authorities will have commissioning responsibility, including public health services for children and young people aged 5-19; public mental health services; dental public health services; tobacco control and smoking cessation services; alcohol and drug misuse services; and sexual health services. The fact sheet said that: “Only some of the above services are to be mandated. The commissioning of other services will be discretionary, guided by the Public Health Outcomes Framework, the local joint strategic needs assessment and the joint health and wellbeing strategy”. See legal analysis of the Bill at http://bit.ly/yYUCGD
“Public Health for the NHS” is a group of more than 500 medical professionals, legal and academic experts, formed to defend the principle of a National Health Service free at the point of need and providing comprehensive and equitable healthcare to all.
A Better NHS 
“future employees of Public Health England will be subject to the employment rules of the civil service, reducing their independence and ability to speak out on matters of public interest.” – I find this particularly worrying