The new public health body for England must be, and be seen to be, “fearlessly independent” of central government, says the House of Commons Health Select Committee.
The new body, Public Health England (PHE), “must be visibly and operationally independent of Ministers. It must demonstrate that it is able to, and regularly does, speak ‘truth unto power’,” said the Committee’s chairman, Stephen Dorrell, launching a report by the panel examining government reforms proposed for public health.
Just as PHE needs to be visibly independent of central government, the Director of Public Health in each locality needs to be “a chief officer of the local authority with a statutory duty to address the full public health agenda within the locality,” the Committee adds.
The MPs also call for more clarity on who will be in charge in a public health emergency such as flu pandemic. PHE must be given a “clear leadership and coordination role for development – and, where necessary, delivering – ‘surge capacity’ at the supra-local level where public health emergencies cross local boundaries,” they say.
Two parts of the ring-fenced PHE grant to local authorities – the recurring fixed “baseline allocation” for health improvement and funding for mandatory services – will be allocated according to a needs-based formula. But the government proposes that authorities will only receive the third part of the grant – the Health Premium – if they make progress in improving the health of their local population, and the Committee is concerned at this.
“We believe there is a significant risk that, by targeting resources away from the areas with the most significant continuing problems, it will undermine their ability to intervene effectively and thereby further widen health inequalities,” the MPs caution.
The Select Committee report makes a range of recommendations, including that the Health and Social Care Bill should give the Health Secretary an explicit statutory duty to reduce inequalities in public health as well as to protect the public from dangers to health, and for the new Cabinet Sub-Committee on Public Health to have a clear remit to scrutinise the public health impact of policies across government.
Also, while the government is proposing that the Chief Medical Officer (CMO) will become the “professional head of the public health profession,” leaving the NHS Medical Director to provide professional leadership in respect of providing healthcare, the MPs believe that the CMO should perform both these duties.
The Health Select Committee report’s emphasis on independence for PHE has been widely welcomed. “We have stressed to the Committee, and to the government, that in order to protect public health, it is essential that PHE has genuine independence and the resources to make decisions free from the constraints of central government,” said Dr Richard Jarvis, co-chair of the British Medical Association (BMA)’s public health committee.
Jo Webber, deputy director of policy at the NHS Confederation, also said that this emphasis on full independence for both PHE and Directors of Public Health was “absolutely right.” During a major public health emergency such as a flu pandemic, “it is vital to reassure the public that the advice they receive is authoritative and independent of politicians,” she said.
Ms Webber said the Confederation also shares the Committee’s unease about the Health Premium. “We can’t see how the Health Premium is going to work as presently envisaged. Better-off areas will find it much easier to show measurable improvements in health inequalities. Without major changes, those areas with the greatest need could lose out,” she warned.
