Responding to Tuesday’s update from the Government on the timetable and process for the restructuring of public health, leading health organisations and alliances have set out six tests they believe Government proposals must pass to deliver truly world-class outcomes in levelling-up health and securing a population resilient to future health risks. Their open letter to the Government sets out six texts for public health beyond health protection, the future of which remains unclear.
The six tests are:
- Test 1: Sufficient and secure funding to scale up health improvement interventions
- Test 2: Sufficient high-quality public health experts in health protection, health improvement and healthcare public health functions
- Test 3: The commitment and infrastructure to deliver health improvement at the national, regional and local level
- Test 4: A stronger health intelligence function which supports both health improvement and health protection and underpins accountability
- Test 5: Improved coordination between the NHS and local government
- Test 6: Strong relationships across health protection and health improvement across all four nations of the UK
These tests are endorsed by a wide range of leading health organisations, including The Health Foundation, the Faculty of Public Health, Association of Directors of Public Health, the Academy of Medical Royal Colleges, Smokefree Action Coalition, Cancer Research UK, and the Richmond Group of health and care charities.
The publication of these six tests follows a joint statement endorsed by over 120 organisations across the health sector which sets out the principles a new public health system must be based on, to ensure delivery of the Government’s interlocking pledges to ‘level up’ society; significantly increase disability-free life years, while reducing inequalities; to improve mental health; reduce obesity and alcohol harm; and to end smoking.
Dr Jennifer Dixon Chief Executive of The Health Foundation, signatories of the statement, said: ‘Our analysis shows that an extra £0.9 billion a year is required to reverse real term per capita cuts to the public health grant since 2015/16, and at least an extra £2bn a year would be needed for adequate investment in the most deprived areas. And that was before the pandemic struck.
‘The Government’s prevention strategy set out a target to deliver at least an extra five years of healthy life for the population by 2035 and to close the health gap between the richest and poorest. So any additional spending on health protection to fight COVID-19 must not be at the expense of cuts in funding to tackle the many preventable causes of poor health.’
Professor Maggie Rae, President of the Faculty of Public Health, also a signatory, said: ‘There has been significant redeployment to health protection as a result of COVID-19, which has left PHE’s health improvement and wider functions, such as education, training and workforce development, seriously under-resourced. Whatever level of staffing is determined for the new health protection agency from April 2021 onwards, it cannot be at the expense of reduced resources for health improvement and healthcare public health functions.
‘Our public health workforce must be properly trained to work effectively across all domains of the public health system, readily able to tackle widening health inequalities which have been exacerbated by COVID-19. A key test of the new system will be whether it has sufficient capacity to deliver nationally, regionally and locally. Leaving any part of this out risks compromising the whole.’
Dr Nick Hopkinson, a respiratory specialist at Imperial College London and chair of Action on Smoking and Health, speaking on behalf of the Smokefree Action Coalition said: ‘Smoking rates have fallen by 60% since the start of the century because of a robust national strategy, backed up by strong regional delivery and effective, evidence-based local action. This is the model the Government must implement for all aspects of health improvement if we are to successfully address the risk factors for poor mental and physical health and reduce inequalities.’
Paul Farmer, Chief Executive of Mind, also a signatory, said: ‘The coronavirus crisis is as much a mental health emergency as a physical one, so public health efforts should be equally focussed on both. Since the beginning of lockdown rates of depression have doubled and tens of thousands of people have told Mind that their mental health was deteriorating. There is plenty of evidence for how to prevent people from developing mental health problems but we now need strong national leadership, accompanied by investment that will reach the frontline, if we hope to prevent a national mental health crisis in the wake of COVID-19 and take the pressure off our NHS.’
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