NHS reforms – defending public health

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2012 Health Care Service Group Conference
15 December 2011
Carried as Amended

The turn of the millennium is often said to have witnessed a second golden age for Public Health across the UK. In the late 1990s and 2000s new programmes, services and initiatives were commissioned and launched intended to improve the health of our citizens and more directly to reduce the growing health divide between the wealthy and our most hard pressed communities and vulnerable groups. Hundreds of new services have been established to tackle obesity, help people quit smoking and promote safe sex; and scores of community-based projects such as Health Action Zones, Healthy Living Centres and Healthy Cities harnessed core budgets and lottery funding to spearhead democratic, bottom-up approaches to the implementation of this rich and exciting agenda.

Prior to this new golden age of Public Health successive Tory Governments starved the discipline of resources, particularly at a grass-roots level and refused to acknowledge the existence of health inequalities, preferring to claim that there are simply ‘variations’ in health that are not a product of the political and economic programmes advanced by the government-of-the-day. Those dark days for Public Health are back under the Tory-led Alliance, with NHS budgets about to fall to new commissioning bodies that have little experience or interest in addressing these issues. Public Health funding will move to Local Authorities many of which face huge pressures as result of spending cuts and many of those in political league with the ConDems eager to introduce outsourcing and privatisation. Scrutiny, accountability and addressing the democratic deficit in health and social care have also been diluted by the new administration, preferring to introduce weaker structures to oversee health and wellbeing spending locally.

Confirmation of the end of the golden age has come from various quarters such as the British Medical Association (BMA) who have consistently requested that the reforms outlined by Health Minister Andrew Lansley should place far higher priority on tackling health inequalities and steers clear of the private sector ‘cherry-picking’ the ripest Public Health services. The end of the age is marked by others through their silence; with the Faculty of Public Health siding with Lansley, prompting ‘The Lancet’ to ask in September “where is public health leadership”. The increasing gross inequities in health have already been highlighted during the recession on November 10th by Price Waterhouse Cooper, describing an ever widening prosperity gap, citing Scotland, Northern Ireland and the North East for particular reference. In Sunderland and across the Northern Region we have one of the steepest health gradients in Europe and employment in the statutory sector remains high in spite of government cuts and thanks to UNISON campaigning. It is estimated that around five-hundred Public Health jobs exist in the four PCT clusters in the region and thousands more are directly commissioned from within our Foundation Trusts.

During this period of great flux, uncertainty and retrograde reforms, UNISON must provide much needed leadership for Public Health and defend members, services, and funding to support the communities we serve. The first golden age of Public Health was heralded by social commentators such as Frederick Engels who graphically documented in ‘Conditions of the Working Class in England’, the health and circumstances of a society denied a welfare state and National Health Service. Conference recognises these modern challenges to a fairer, decent, and healthier nation and calls for the Service Group Executive to support all branches and regions to:-

1)implement an audit to discover the Public Health members that are employed by PCTs, consult with them and support them into the appropriate statutory body within the evolving NHS architecture

2)widen the audit and engagement to access Public Health staff working in other organisations deploying health improvement workers, predominantly within our Foundation Trusts

3)gather information on service level agreements held between NHS organisations to ascertain the size of Public Health spending locally and which services and members are directly employed by the funds

4)ensure public health staff are employed by commissioners (Clinical Commissioning Groups or Commissioning Support bodies) and stocked with all staff from the wider Public Health Workforce and not purely directors and specialists

5)lobby and influence Clinical Commissioning Groups and Commissioning Support bodies to maintain an agenda that addresses health inequalities and maintains/secures Public Health services in the public sector

6)campaigns that highlight a bottom-up, democratic approach to community health action programmes and locally driven health projects, coupled to campaigns to increase the membership across public health teams

7)organise training for activists that assists in understanding and influencing the new structures and organisations engaged in commissioning, procurement and scrutiny, including Health & Wellbeing Boards.