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30 March 2011: speech to the Chartered Institute of Environmental Health conference

  • Last modified date:
    1 April 2011

Check against delivery

We’re at an interesting point for health policy – a genuine turning point.

For the last decade, the story has been all about size and scale.

Do more, build more, launch more – that was the motto.

But frankly, thinking back, it always made me think of that fantastic episode of Yes Minister, where Hacker visits the hospital with no patients.

A hospital proudly described as one of the best run institutions in the country!

Of course, the satire bites because of the substantial truth behind it.

The old politics of the NHS has meant the physical building of hospitals often became more important than the services actually provided.

Now acute care will always have its place – clearly, it’s vital – but times change.

As people live longer and as care costs rise, buildings and institutions matter less. Services and outcomes matter more.

The goal today isn’t building more hospitals for people, it’s actually keeping more people out of hospital.

So perhaps Yes Minister wasn’t ironic at all, an empty hospital is perhaps the goal after all!

It does mean what goes on outside the NHS is now every bit as important as what goes on within it.

That’s why the work you do is so important – we need to do all we can to prevent illness and reduce our reliance on the NHS.

That, more than anything else, will help us sustain those core principles of public-funded, free at point of need, healthcare.

So how do we do it?

People realised early on that what surrounds us defines us.

The Institute itself was created because of the links the early Victorians made between illness and environment.

This was a connection picked up by the poor law commissioner Edwin Chadwick, whose campaign to improve sanitation helped to bring about the Public Health Act in 1848.

And with this came the first so-called “Inspectors of Nuisances” the early incarnation of today’s environmental health officers.

And the rest, as they say, is history.

So it’s a long and distinguished past you draw upon.

And today, more than 150 years on, physical environment is every bit as relevant to our health challenges.

It goes to the heart of what Michael Marmot describes as the ‘causes of the causes’.

We see the Marmot review as our compass and guide as far as the future goes.

It’s quite clear on the problem.

A marked social gradient in health.

Entrenched, stubborn and layered inequalities.

A miserable chain of factors linking where you’re born to how healthy you are.

And the environment is a key link.

Obstacles and barriers to health are all around us.

Concrete jungles breeding mental health problems.

Damp and draughty housing aggravating asthma, inflaming sickle cell and respiratory diseases.

The accidents, at home and at work, disproportionately affecting those from blue collar backgrounds.

And poor food hygiene causing unnecessary sickness and distress.

It’s our job to tear down these barriers – sometimes literally – to reduce inequality and improve health.

Your work often goes under the radar, but it makes such a big difference to people’s lives.

Few in my constituency in Guildford will realise the reason they can enjoy an evening out in our beautiful town, and a nice meal with friends without suffering afterwards, is because of the vigilant eye of the local environmental health team.

And even within professional circles, there’s not enough awareness of the difference you make – and your potential to do more.

I want that to change.

We need to position health at the centre of community planning and at the centre of public policy.

We need to do all we can to protect and defend against emerging threats to health – whether that’s food security or climate change.

And we need to ensure this wide-ranging professional field has a place at the top table of discussions locally and nationally.

Let’s be honest, that isn’t always easy.

Trade-offs and compromises happen, even when the sun is shining financially.

But, at the moment, with the outlook more gloomy, I can understand you must feel the scales are particularly tilted against you.

So can we genuinely make progress at a time when all eyes are on the money?

Can we continue to move forward when money is tight, and the priority is on economic recovery?

Well, I think we can and I think we should.

“The gold that buys health is never ill spent”, said the playwright John Webster.

Four hundred years on, it’s as true today as it’s ever been.

Better homes could save the NHS up to £600 million a year in treating respiratory infection.

Better cycling and pedestrian routes can help us reduce obesity and prevent costs of £50 billion a year by 2050.

Better parks and open space could reduce the incredible £2 billion a week that mental illness is believed to cost our communities and our economy.

Sometimes a small investment can make a big difference.

One of my favourite stories is the brilliant solution one trading standards team came up with to support healthy eating.

It was quite simple really – and fiendish too: they placed salt shakers with fewer holes in the top in local fish and chip shops.

The result? People consumed 50 per cent less salt in these shops.

I guess that those that didn’t reduce their intake at least got more exercise shaking the salt out!

It’s a classic nudge, and just one example of how creative partnerships – with business, with voluntary groups, with other government bodies – can make a real difference.

Another thing that caught my eye is the fantastic work licensing teams are doing with local venues to improve young people’s health.

Pubs and clubs, where young people naturally hang out, are perfect places for reaching out to them. For giving them support on their terms and on their patch.

Tackling binge drinking obviously – but also other problems like drugs and sexually transmitted infections.

I’m struck by the success councils have had in handing out condoms or even doing STI tests there-and-then at big city venues.

In many cases, diagnosing and treating people who wouldn’t otherwise have known they had an STI – and might be spending the rest of their evenings blissfully spreading their infection around town.

So again - a small commitment makes a big difference.

We need more.

We need the leadership and the strong collective vision to get all agencies working together.

We need coherent, long term plans for improving health.

And that’s what our public health White Paper is all about.

To give local government, local services and local people the confidence and power to work together towards long term gains.

Firstly, we’re putting in place a new way of measuring success.

Out go the top down targets.

In comes a new Outcomes Framework for public health.

We want to unite the system around broad outcomes, rather than divide it through narrow, process-led targets.

Second, a new ring-fenced budget. Promising stability and confidence.

Public health practitioners are always looking over their shoulder as far as budget cuts go.

Ring-fencing the budget sends out a signal.
No more hand-to-mouth strategies. No more volatility. No more feast or famine.

We want you to build a clear, long term strategy.

Third: new structures to provide local leadership and unity.

Bringing together the different players in public health can be frustrating.

I’ve heard it described as being like herding cattle.

Plenty of noise, but difficult to get moving.

So we’re taking a logical step.

We’re bringing in people with lassos.

The people are Directors of Public Health, which will be a clear figure-head for local community health.

The lasso is the new Health and Wellbeing Board, which will help them to rope in the action and investment necessary to meet local needs.

Not all Directors of Public Health come across as wannabe Clint Eastwoods, I realise!

But they will be genuine shepherds for the cause – there to safeguard and secure all interests – and like any good rancher, looking out for their entire flock.

And let me be clear: that absolutely includes district and borough councils.

It’s something I know the Institute is particularly worried about – this fear that lower tier authorities will be forgotten or ignored.

To be fair, it has happened in the past. County councils zooming off in one direction. Second tier authorities going the other way.

Those days are over. Our reforms simply won’t work unless lower tier authorities and their workforce are in the loop.

I’m not going to prescribe local structures, processes and membership. That, quite rightly, is best decided locally.

But the Health and Wellbeing Boards and the Joint Strategic Needs Assessment should give all parts of the system a chance to get involved.

No voice, no opinion, no professional group should be excluded if those outcomes are to be met.

More than just sharing ideas, we also want people sharing investment. Thinking big. Thinking collectively.

So there will be the scope and, indeed, the incentive – for people to pool budgets and work toward larger projects.

The Health Premium – with more money for councils that improve health outcomes and reduce inequalities – is about lighting that touch paper. Sparking action. Stimulating the big ambitions.

It also corrects a past mistake. The previous funding model could sometimes reward a lack of effort. The sicker a community became, the more the council got.

We want to turn that on its head. We’ll be rewarding success, not failure, inviting the bolder ideas we need.

At a national level, Public Health England will be the new home for all of those central functions within the environmental health field.

Despite the financial environment, we’re absolutely determined to retain a strong and effective health protection workforce.

So Public Health England will draw on the existing strength of the Health Protection Agency and others to improve our resilience to health threats.

Its other key role will be leadership. Keeping this high on the agenda across Government. Acting as a champion for health improvement nationally and locally.

So yes, we need to build up the evidence – the objective proof of why investing in the environment matter, and what sort of measures work best.

And yes, we need to make sure your voice is heard across Whitehall.

That’s why we’ve got the Cabinet sub-committee on public health, a Ministerial group bringing together Government departments to hold together national action on health improvement.

In addition, the new Chief Medical Officer will be setting up an advisory committee to guide and shape the work of Public Health England.

Both will help the environmental health professional to grow in influence and impact.

Conclusion

I’m not going to gloss over the obvious.

These are difficult times.

Difficult for many of you personally, working under the shadow of job insecurity or reductions to your budgets.

I’m sorry for that, and I’m extremely grateful for the professionalism you’re showing under this pressure.

Change is unsettling.

But change means we can do things better.

And, as someone once said, “sacred cows make the best burgers.”

So my message is still one of hope and optimism.

I think the reforms will make a positive difference.

They will open up possibilities and potential for environmental health practitioners.

I hope they will us to secure the improvements we all want to see.

Environmental health has a long and distinguished past.

We want it to have a bright and assured future too.

And with your help I’m sure it will.

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