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New minister needed for embedding public health across all policies - MPs

A ministerial position is needed to fulfil the government’s aim of integrating and promoting public health across other government departments, the Health Select Committee has said.

In a new report on public health since the passing of the Health and Social Care Act 2012, the committee said that although there has been progress on embedding health considerations in all areas of policy at a local level, this had been less successful nationally.

Dr Sarah Wollaston MP, chair of the committee, said that the government’s widely-criticised childhood obesity strategy was an example of “the gap in joined-up evidence-based policy to improve health and wellbeing”.

The committee said that a Cabinet public health sub-committee was “unlikely in itself to be the answer to securing more effective joined-up policy to improve health and wellbeing”. Instead, it said a new minister should be appointed in the Cabinet Office, who would work closely with the minister for public health to ensure health is embedded in all departments.

Although the 2012 Act transferred responsibility for public health to councils, the report warned that councils are struggling to fulfil this mandate due to a lack of funds and clarity over their goals.

Public health funding for local authorities suffered a £200m in-year cut in 2015 and is due to be reduced by 3.8% in 2016-17, followed by 4.2% cuts in 2017-18 and 4.4% cuts in 2018-19. By 2021, the public health budget will have been reduced from £3.47bn to just under £3bn.

The committee said: “Cuts to public health are a false economy. The government must commit to protecting funding for public health. Not to do so will have negative consequences for current and future generations and risks widening health inequalities. Further cuts to public health will also threaten the future sustainability of NHS services if we fail to manage demand from preventable ill health.”

Dr Jo Bibby, director of strategy at the Health Foundation, said good health and wellbeing are the foundations of a prosperous society and need sustained investment.

“The failure to tackle preventable health problems is driving up costs to the NHS, increasing demand for public services and damaging productivity,” she added. “In line with the prime minister's stated aim to reduce health inequalities, action needs to be taken to ensure those in the most deprived communities, whose health is already the poorest, do not suffer most as a result of wider reforms to local government funding.

“The committee’s recognition that health is not solely the responsibility of the NHS is also absolutely right, and we strongly support its recommendation that cabinet take greater responsibility for ensuring health implications are considered across all policies. At present, health impact assessments in government policy making are often sadly little more than a tick-box exercise.”

Under the Health and Social Care Act, local authorities are required to create Health and Wellbeing Boards (HWBs), which bring together partners within the NHS, public health, adult social care and children’s services as well as elected members and representatives from Healthwatch.

The committee said that there is ongoing confusion about the role of HWBs and that they risk suffering from ‘mission creep’ as national policy places more and more responsibilities on them.

However, the report said that there is “cautious optimism” that HWBs are becoming more capable of holding the system together in the face of increasing “fragmentation”.

The High Court recently overturned a decision by NHS England to stop commissioning the HIV prevention medication PrEP on the grounds that it should be the responsibility of councils.

The report also recommended that the government produces a statement clarifying what the duties of the Department of Health, Public Health England and NHS England are regarding public health.

NHS England is now seeking to appeal against the decision and has launched a consultation on how to commission the drug.

The report said that the issue needs “immediate resolution” and that NHS England and the Department of Health should clarify their positions on PrEP “without delay”.

A Department of Health spokesperson said: “We are committed to protecting the public's health. Over the next five years we will invest more than £16bn in local government public health services, in addition to what the NHS continues to spend on vaccinations, screening and the world's first national diabetes prevention programme.

“We  know local authorities are carrying out some excellent work in challenging circumstances and are pleased the committee has acknowledged their progress.”

(Image c. Mark Lennihan from AP/ Press Association Images)

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