Tuesday, 19 May 2015

Public Health Post-election: What is its future?

Posted by David J Hunter, Professor of Health Policy and Management, Durham University and Fuse Deputy Director

The Conservatives’ election victory has brought both old and new faces into the ministerial team at the Department of Health. Jane Ellison returns as a junior minister and will retain the public health brief thereby bringing a degree of continuity to the post. She was growing into the post in the run-up to the election and public health insiders speak well of her.

Public Health Minister Jane Ellison
The fact there has been extensive coverage of the other ministerial appointments in health excluding hers might say a great deal not only about the place of public health in the government’s health priorities but about the level of importance the media attaches to the subject.

Clearly the funding difficulties plaguing the NHS will be uppermost in Jeremy Hunt’s (back as Secretary of State for Health) in-tray with the integrated health and social care agenda not far behind. But the new government is also committed to implementing the Five Year Forward View (5YFV) produced by the NHS Chief Executive, Simon Stevens, last October. Herein lies the hope for public health and surely the near certainty that it will occupy a high place on the government’s list of priorities.

Public health did not feature prominently in the Conservative Party’s manifesto and no major new initiatives were promised. None of the parties had much to say about public health during the campaign. And yet the new government is going to come under significant pressure to up its game over the next five years with the call for ‘a radical upgrade in prevention and public health’ featuring prominently in the 5YFV.

Not only that, but Simon Stevens rarely misses an opportunity in public to stress the importance of public health, admonishing successive governments for their failure to implement the Wanless ‘fully engaged scenario’.  Since the NHS failed to heed the warning, it ‘is on the hook for the consequences’. Wanless wanted a transformed NHS that put health and not illness first.

The 5YFV urges the NHS to redeem itself over the wasted years by becoming an advocate for ‘hard hitting action’ on avoidable lifestyle-related illnesses. Because these put added pressure on health care services, tackling them at source has to be a high priority if a universal service free to all at the point of use is to be sustained.

The latest projections from WHO published a week ago show that Europe faces an obesity crisis by 2030 and that urgent action is needed by governments. In the UK, 33% of women are forecast to be obese by 2030 compared with 26% in 2010. For men, the figures are 36% and 26% respectively. The figures are worse in some other WHO member states with only The Netherlands doing better and remaining stable.

As we know, although there is no silver bullet for tackling obesity restricting unhealthy food marketing is regarded as a key policy lever available to governments. Where this leaves the government’s responsibility deal approach to addressing key public health challenges is uncertain. Even if its critics are persuaded that it is working, the key question in the light of the WHO projections is whether it is working fast enough given the urgency of the crisis looming in under 15 years’ time.

Another key development concerns devolution within England and the Northern Powerhouse initiative. Local MP for Stockton South, James Wharton, has been made the first minister for the project. It builds on the DevoManc announcement earlier this year which put local government in charge of the NHS budget for the Greater Manchester region. Chancellor George Osborne, the architect of this experiment, in his first speech since the election will announce today similar devolved arrangements for the City regions, including Newcastle.

The move to devolve power and responsibility could have major implications for public health as local government will be able to pool budgets and adopt place-shaping policies to improve health and wellbeing and tackle the social determinants of health.

But the catch must be that these developments are occurring at a time when local government is on its knees. With no let up to austerity in sight and with further public spending cuts to come which will fall heavily on local government, the question has to be asked: is local government being set up to fail? Whatever the outcome, there will be significant implications for public health which cannot be predicted. Watch this space.

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