Public health

The Government believes that we need action to promote public health, and encourage behaviour change to help people live healthier lives. We need an ambitious strategy to prevent ill-health which harnesses innovative techniques to help people take responsibility for their own health.

  • We will give local communities greater control over public health budgets with payment by the outcomes they achieve in improving the health of local residents.
  • We will give GPs greater incentives to tackle public health problems.
  • We will investigate ways of improving access to preventative healthcare for those in disadvantaged areas to help tackle health inequalities.
  • We will ensure greater access to talking therapies to reduce long-term costs for the NHS.

Your comments (12)

  1. Wendy Cocks says:

    I am just concerned about local agendas – how will it ensure that those with rare conditions are treated? Is there any responsibility in place for everyone in the community to receive treatment? How will spending be prioritised?

  2. R Bates says:

    GPs already have extended power and they are, rightly so, run like businesses. It is not fair therefore to give providers such power over spending decisions. It is the Government’s responsibility to reduce health inequalities and prevent ill health and Government-appointed champions should be charged with ensuring that is achieved – not local businesses who stand to gain from spending decisions and will be “incentivised” to consider public health priorities. Whether it is PCTs, health authorities, local authorities or some other type of organisation that is NHS run and accountable to the Department of Health can be decided and GPs could take roles within the orgnaisation, as has happened in the past. Don’t remove the balances and checks that exist within PCTs and Strategic Health Authorities.

    Also, think hard about giving local communities greater control over public health budgets- maybe we don’t want to have to take control, make spending decisions and generally be involved in the NHS, maybe we want the Government to provide us with excellent health care while we enjoy our lives. It’s not necessarily an attractive proposition.

  3. Julie Martin-Hirsch says:

    I am pleased that the government has acknowledged health visitors by promising an increase in health visitor numbers (see section ‘families and children’), but disheartened by their lack of acknowledgement for school nurses. As specialist community public health nurses (just like health visitors) we too follow the ‘Standards of proficiency for the Specialist Community Public Health Nurse’ (NMC 2004) and relate to the changing health needs of the public and communities we serve, responding to current and future need. Undoubtedly, school nurses have the specialist skills and knowledge and play a vital part, working collaboratively across professional boundaries to assess and address health inequalities and the health needs of school aged children and young people.
    The previous government promised that by “2010 every PCT working with children’s trusts and local authorities will be resourced to have at least one full-time, year-round, qualified school nurse working with each cluster or group of primary schools and the related secondary school, taking account of health needs and school populations” (DH 2004 Choosing health: making healthy choices easier.) This was an ambitious strategy that unfortunately has not been achieved and consequently leaving huge gaps in the school nursing service expectations and service delivery. However, with an increased workforce and manageable caseload, school nurses can help the government achieve their goal by delivering a proactive service, promoting and encouraging positive health behaviour changes to allow the next generation to take responsibility for their health and their children’s health.

  4. I am pleased that the government has acknowledged health visitors by promising an increase in health visitor numbers (see section ‘families and children’), but disheartened by their lack of acknowledgement for school nurses. As specialist community public health nurses (just like health visitors) we too follow the ‘Standards of proficiency for the Specialist Community Public Health Nurse’ (SCPHN) (NMC 2004) and relate to the changing health needs of the public and communities we serve, responding to current and future need. Undoubtedly, school nurses have the specialist skills and knowledge and play a vital part, working collaboratively across professional boundaries to assess and address health inequalities and the health needs of school aged children and young people.
    The previous government promised that by “2010 every PCT working with children’s trusts and local authorities will be resourced to have at least one full-time, year-round, qualified school nurse working with each cluster or group of primary schools and the related secondary school, taking account of health needs and school populations” (DH 2004 Choosing health: making healthy choices easier.) This was an ambitious strategy that unfortunately has not been achieved and consequently leaving huge gaps in the school nursing service expectations and service delivery. However, with an increased workforce and manageable caseload, school nurses can help the government achieve their goal by delivering a proactive service, promoting and encouraging positive health behaviour changes to allow the next generation to take responsibility for their health and their children’s health.

  5. Jo Lewitt says:

    Asking the public to make decisions about spending in public health would requre them to be fully informed about the confusing abundance of research and evidence and best practice across the country (and the rest of the world). Public health outcomes are often long term and so communities may not see the outcomes within their lifetime. Short term outcomes do not fit within the public health agenda.
    However it may be that the general public are much wiser than anyone takes them for and what they may demand is what some would call ‘common sense’. For example: build us more cycling routes, give us public transport that we can afford to use, help us to create neighbourhoods which we are happy for our children to play outside until dusk in, with play rangers encouraging them to manage risks, provide healthy food in all our schools and early years provision, involve children in the growing and cooking of the food, teach children lifeskills in school, discuss parenthood, reproduction and breastfeeding as a normal part of life in primary and secondary schools. Encourage children to learn through play for as long as possible and dont push them into academic tests before they are ready. Embed public health messages across the entire NHS primary and secondary care services. Treat us holistically. Remember that we are all unique and part of nature (didn’t you see avatar?).
    Unfortunately those who live in the most deprived areas who are most likely to benefit from public health intervention, are unlkely to engage in any of the ‘consultation’ exercises that are undertaken, or to join boards. Poverty remains to be the main influence in public health and action to tackle poverty needs to come from government.

  6. Patricia Henry says:

    I totally agree with Julie Martin- Hirsch.
    It is disappointing when the School Nurse role is not acknowleged along side that of Health Visitors as playing a vital part in addressing the health needs and behaviours of young people and families. Not only do school nurse have a public health role in helping identify, planning and evaluating the health initiatives that will help address the health inequalities, safeguarding concerns and the many other health needs such as obesity, physical and emotional well-being of children and young people. We also are in a unique position of having some access to children who are `out of school`. This means we can work with our partner agencies in carrying out home visits on these group of young people to, among other things, assess and review their health needs.

    `Out of school `children are increasingly being recognised as a vulnerable group of individuals who are at risk by the very nature of them not being at school. School Nurses have the skills and knowledge needed to help identify and support these young people as well as the 5-19 age group of children and their families. Many School Nurse now work full time which means we are seeing clients all year round for example, at nurse-led enuresis / bowel and bladder clinics. This is a service that is often not recognised as being unique to the School Nursing Service.
    School Nurses can indeed help the Government achieve their goal in our daily public health role working closely with the next generation in a number of areas, but we need the workforce and resources to do so.

  7. andrew Harrison says:

    I think what Jo says above about the lack of public knowledge on research in public health areas rings true. However the operative term he uses is ‘confusing abundance’ . After many years of effort there is no evidence that current and costly approaches in public health actually work – sex education, contradictoy dietary advice, exhortations to exercise.- but as a Nation we get fatter and lazier, teenage pregnancy levels continue to rise, alcohol abuse is worse than ever, smoking levels are the same in poor areas as they were 10 years ago.

    Much public health mehtodology seems to be based on the principle that if people are not listeing the idea is to shout a little louder – e.g. lots of expensive TV advertising
    It might be said that communities themselves could hardly do worse than the ‘public health professionals’ and is more likely to take on board messages and methods that they themselves can take ownership of and have had a major part in creating creating on issues they want to deal with.

    This is innovative and a very very good idea worth trying and it could work – communites will probably ask for guidance and professional input but may not wan to be told to deal with stop smoking when they might want to deal with, say, drug addiction. Goodbye National Public Health targets,that were pointless anyway as the NHS (and Local Authorities) could do little to meet them anyway- except fudge the figures

  8. andrew Harrison says:

    I think what Jo says above about the lack of public knowledge on research in public health areas rings true. However the operative term he uses is ‘confusing abundance’ . After many years of effort there is no evidence that current and costly approaches in public health actually work – sex education, contradictoy dietary advice, exhortations to exercise.- but as a Nation we get fatter and lazier, teenage pregnancy levels continue to rise, alcohol abuse is worse than ever, smoking levels are the same in poor areas as they were 10 years ago.

    Much public health mehtodology seems to be based on the principle that if people are not listeing the idea is to shout a little louder – e.g. lots of expensive TV advertising
    It might be said that communities themselves could hardly do worse than the ‘public health professionals’ and is more likely to take on board messages and methods that they themselves can take ownership of and have had a major part in creating creating on issues they want to deal with.

    This is innovative and a very very good idea worth trying and it could work – communites will probably ask for guidance and professional input but may not wan to be told to deal with stop smoking when they might want to deal with, say, drug addiction. Goodbye National Public Health targets,that were pointless anyway as the NHS (and Local Authorities) could do little to meet them anyway- except fudge the figures

  9. Michael Parkes says:

    I am concerned that the commitments listed in the Programme relate mainly to influencing “choice” and access to health services. Our physical and mental health and wellbeing arises out of a complex range of determinants many of which are not of our choosing and are not to do with NHS health services.
    Issues such as housing, environment, work, food access, education etc. are all critical to our health and indeed these topics are listed elsewhere in the programme. There is a need therefore to cross reference between sections in order to explicitly identify how policy and action in these other areas will impact upon and hopefully support public health and how partnership work between agencies of all kinds is to be promoted.
    A feature of public health intervention that has not so far been raised is consideration and evaluation of the impact of regulation. Public health is not just to do with attempting to influence choice. When Government considers a risk to health to be unacceptable it may legislate to compel improvement and protect people from harm. Improvements derived from this approach are diverse and many and include cleaner air & water, safer food and workplaces, better private sector housing, safer vehicles and products, control of noise nuisance and most recently “smokefree” workplaces and public places.
    As an Environmental Health Practitioner I believe that it is important that the contributions made by a wide range of workers beyond the DH/NHS to protecting and promoting public health is properly recognised and that these resources be optimally directed.
    Finally, we need to state that improving public health is the key “invest to save” activity that will deliver a more productive population and an affordable NHS.

  10. The actual Critical Life insurance coverage supplies a ‘list’ of diseases, such as not curable ailments that the insurance policy can secure.

  11. School Nurse says:

    I agree with the comments above about the School Nurse role – which is underestimated. A properly resources service could go along way to tackle the inequalities you mention – we have knowledge of local areas, easily accessible to young people and have the skills to work with this client group.
    Our preventative public health role is being eroded towards more reactive work. You mention giving GPs incentives to do more PH work – they are driven by the medical model – we (and our Health visitor colleagues) are the Specialist Public Health Workers who can make a difference to the future health of children and young people.

  12. Les Jordan says:

    I am concerned that the price of alcohol will increase because of a body of people that are not in touch with reality.
    Go into any town centre over a weekend and you feel that you are in Beirut , drunken louts abound’ why?’ I believe the law is weak, stop drinking in public, stop bars from selling shots and other high strengh booze , raise the legal drinking age to 21.
    Walk round any park on a Sunday morning and count how many empty beer cans, cider bottles you can find, again why?, is it because shops are selling to underage teenagers, an easy way to deal with this is to take the shops license away for a couple of weeks, if they re-offend then close there business
    I go to CAMRA real ale festivals and I have never seen any trouble, sure folks get merry, but they have a good time and are never aggressive, why? because they drink sensibly and only drink beer not mind altering concoction found in the town bars.
    it does not matter how much the price of alcohol costs there will still be a drinking culture all the time towns are turned into some thing from the wild west.
    This is true with smokers, the cost of tobacco is always raising because of a false belief that it will make people stop, but smokers still keep finding the money
    The people who suffer are the majority that do not have a drink problem but do like to have the occasional BBQ and buy there cheap wine or lager from the super market.
    And it will only be the rich folk that can afford booze, but I supose it is alright for them.

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