MPs call for cross-departmental public health minister

1 Sep 16

Improvements in national health will only be achieved if the government embeds health considerations into every aspect of policy making, instead of overly focusing on frontline providers, the Commons health committee has concluded.

In a major report, the committee examines developments in public health since 2013, encompassing the impact of the Health and Social Care Act 2012, which shifted local public health budgets from the NHS to local authorities.

The committee noted that the £200m in-year cut to the public health budget undermined local councils’ ability to deliver on their new responsibilities and provide consistent, quality care.

These cuts were a “false economy” since they added to the cost of future healthcare and risked widening health inequality, which, the report notes, Theresa May pledged specifically to reduce in her inaugural speech as prime minister.

The report flagged a key mismatch between current public health spending – which tends to favour hospitals and front-line providers – and the focus on prevention set out in the NHS 5 Year Forward View. To remedy this situation, the committee recommends the appointment of a Cabinet Office minister given specific responsibility for embedding health across all areas of policy at a national level.

Committee chair Dr Sarah Wollaston said: “The disappointing watering down of the childhood obesity strategy, published in August, demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing.

“Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims.”

Local authorities have had to cope rapidly with major system change, the MPs noted, and were tasked with delivering more with less. While some councils were demonstrating innovative practice, they were reaching the limit of savings they could achieve before services were materially impacted.

The report recognised that although local leadership could “bring enormous benefits” for public health, there was the danger that evidence-based decision making could be sacrificed in the name of short-term political considerations. To guard against this risk, the committee recommended the introduction of clearer standards and transparent monitoring, essentially to ensure groups that did not vote for elected officials receive the same level of service as those who did.

David Buck, senior fellow in public health and health inequalities at the King’s Fund, noted that the move to funding local government services through business rates instead of grants required a better system to ensure “that local decisions do not lead to widening inequalities in funding, services and outcomes”.

He also said the weakness of the government’s childhood obesity programme, highlighted by the committee, was persuasive evidence in favour of appointing a new cross-departmental health minister, to “co-ordinate public health policy across departments [and]… to hold departments strongly to account for their actions”.

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