The Bow Group emphasises the need for detail from the Government if it is to avoid failure on public health policy

Stuart Carroll and Gary Jones summarise the Bow Group’s response to the Government’s recent public health white paper, ‘Healthy Lives, Healthy People’, which is published today and available to download here as a pdf.  Stuart Carroll is a Senior Health Economist and the Chairman of the Bow Group Health & Education Policy Committee.  Gary Jones is a member of the Bow Group Health & Education Committee and a Public Affairs Consultant.

Just a couple of days before the Government closes its public consultation, we have published our analysis on the Government’s public health White Paper, ‘Healthy Lives, Healthy People: Our Strategy for Public Health in England’.  In a nutshell, we believe the Government’s intent is correct.  However, as with many of the other reforms currently sweeping across the NHS there is a clear and pressing need for more detail on how the ideas and concepts promoted in the White Paper will be implemented in practice.  This must be the key output from the Department of Health’s (DH) consultation.      

Our report analyses a number of different aspects of the White Paper.  A few key points include:

1)    We support the motives and rationale behind the creation of Public Health England, which if properly implemented will help support people in maintaining their health, mainly at a community level through local councils, whilst keeping a firm national grip on national public health issues such as flu pandemics at a national level.  However, in future it will be essential that Public Health England is funded adequately to undertake its important role.  This cannot be a one-shot measure or an easy target for spending cuts when the going gets tough.  We urge the Government to set out at the earliest opportunity how the funding structure for public health will precisely work and how this will be sustained over time.

2)    There is also a clear need for more detail on how exactly Public Health England will be configured, organised and structured. This is particularly important given that the new Public Health Service will be assuming critical roles and responsibilities. One such example is health protection where the functions of the soon to be abolished Health Protection Agency (HPA) will soon be transferred to Public Health England. The HPA’s current responsibilities are by no means trivial, covering highly skilled and intricate areas such as preparedness and protection against health hazards, infectious disease, and hazardous chemical, poisons and radiation. In the extreme sense, the HPA has responsibility for advising the Ministry of Defence on issues to do with chemical and biological warfare. How will Public Health England subsume such critical, and in extreme cases “life and death”, responsibilities without undermining current arrangements and ongoing research work?

3)    The Government’s plan to give Local Authorities more power and responsibility of their population’s health can be seen as a positive step and consistent with the wider vision to devolve healthcare decision-making to the local level. However, more detail is needed to explain how the plans will be implemented and how responsibilities will be allocated. At this point, the Government has only postulated a broad framework for implementation and important detail is missing.

4)    The creation of health and wellbeing boards (HWBs) is a welcome development and should enable GPs to combine their roles as patient advocate, commissioners of care and public health proponents in an integrated and coherent manner.  However, HWBs must not simply be “talking shops” that local stakeholders merely pay lip service to, but must be authoritative decision-making bodies that have clarity of purpose to join up public health.

5)    The current processes and procedures informing the evaluation, particularly economic evaluation, of vaccines through the Joint Committee for Vaccination and Immunisation (JCVI), soon to be abolished HPA (who is responsible for a lot of the infectious disease and economic modelling to inform JCVI/DH decisions) and the DH procurements pathways lack the clarity, clearness and certainty of the current NICE appraisal process as used for the evaluation of drugs and medicines. 

There is no doubt that the Government is right commit itself to tackling the causes of premature death and ill health, which continue to undermine health outcomes and compare poorly to many other European countries. The White Paper is also right to conclude that public health is a cross-cutting imperative that transcends the boundaries of the NHS and health policy, and actually incorporates a variety of areas including the environment, poverty, education and housing.

There is also much merit in the Government’s broader approach to “nudge” rather than “nanny”. The former is entirely consistent with Conservative principles and the latter has been empirically discredited despite the previous Labour Government’s pertinacious attempts.  There is little doubt that public health is a pressing imperative, but as with all things political and policy orientated it is essential an appropriate balance is struck between advancing the need for better health outcomes, and individual life chances regardless of background, income and social status, and the need to ensure people are not lectured, patronised and bombarded with misplaced and inaccessible information.

It is from this perspective that the success of the Government’s public health initiatives will be highly dependent on its ability not only to effectively implement its strategy, but also its ability to effectively communicate and disseminate its key policy messages to the public as a whole. As we are currently seeing with the Government’s wider plans for the “new NHS” as detailed in ‘Equity and Excellence’, this communication and implementation challenge can be considerable and unrelenting. Ultimately, reforms of this scale require confidence – the confidence of politicians, policymakers, the NHS and the wider general public. Without it, policy success (perceived or real) can quickly become elusive.

It is against this backdrop that, whilst it is important to reiterate the Bow Group’s admiration for the Government’s laudable attempts to place public health at the heart of the healthcare system, a strong emphasis on detailed implementation and accountability for outcomes must accompany the wider concept and prevailing rhetoric. As the DH consultation closes, there is an opportunity to refine and prepare the plan for a successful public health legacy. This is central to ensuring ‘Healthy Lives’ and ‘Healthy People’, and moreover the Government achieving greater lasting success than the panoply of White Papers, strategies and initiatives over the last 30 years. Otherwise, people will continue to ask one basic question: what is different this time? And an apathetic and disillusioned public will get the Government nowhere.