Public Health Observatories

Diane Abbott Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris]

Absolutely. That is a critical issue. In some respects, the Government have taken their eye off the ball. I will develop that point a little later and would like the Minister to respond to it.

As my hon. Friend pointed out, there is a clear and present danger of a reversal of health inequalities, which would be exacerbated by decisions taken elsewhere across Government. It is such an important issue, and one that I have long campaigned on. As someone who has worked in the health service and served on a local authority, I feel very passionately about it.

Remarkably, we are now considering proposals that risk losing our greatest weapon in tackling public health inequalities: evidence-based health intelligence. More recently, as my hon. Friends have noted, the Marmot review has restated the link between socio-economic factors and health, which are known as the wider determinants of health. One of the more serious threats to the future of public health intelligence is its future funding under the new arrangements proposed by the Government. In my view, the Secretary of State has shown little interest in the functioning of public health intelligence under these proposed structures.

Public health policies must take account of local circumstances as health inequalities remain stark, particularly in areas such as my constituency. For example, smoking-related deaths vary greatly across different parts of the country. Public health intelligence must drive public health practice. I appreciate that public health observatories self-generate revenue, alongside their Department of Health grant and moneys from primary care trusts and strategic health authorities. They also have opportunities to gain commissions from universities and charitable organisations, but it would be extremely risky to proceed down the Government’s proposed route without the certainty of their core Department of Health funding, which I understand is to be reduced by 30% this year.

Staff and people associated with the service have reported to me that valued employees are already being laid off at the north-west public health observatory, which is based at Liverpool John Moores university, and there is a similar situation at the north-east public health observatory. Local authorities commission the majority of public health services from a ring-fenced budget. What assurances can the Minister give me on safeguarding through this hiatus—this period of transition—and for the long term under the new arrangements?

I also thank David Kidney, the former Member for Stafford, who is now head of policy at the Chartered Institute of Environmental Health, for his assistance in preparing for this debate. The institute has stated its view that Public Health England must be established with a degree of independence, a point I made earlier, and with the ability to oversee arrangements for collecting, analysing and disseminating valuable data for public health services.

In short, it is now time for Ministers to provide concrete assurances that the role of public health intelligence, the collection of the evidence base and, in particular, public health observatories will be safeguarded for the future.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. There are just over 10 minutes left, so is it by agreement that I call the hon. Member?

--- Later in debate ---

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I congratulate my hon. Friend the Member for Easington (Grahame M. Morris) on raising this very important issue on the Adjournment. I, like everyone else in the Chamber, want to hear what the Minister has to say in response to the important points that he has made.

One reason why my hon. Friend’s debate is so important is that, amid all the public anger about the health service reforms, the effects on public health have not received the attention that they should have. Speaking as an east end MP, I must say that the information that the public health observatories produce is important in ensuring that whoever commissions services commissions for the population, not just for GPs’ lists. I live in an area where many communities are either not registered with a GP or in other ways socially excluded.

My hon. Friend has raised the important issue of health inequality, and it is easy to talk about that in the abstract, but we should reflect on the fact that this is 2011, because the life expectancy of someone in the richest part of Glasgow is 10 years more than that of someone in the poorest part, and if we take the Jubilee line tonight we will find that the people living at every stop from Westminster going east until Canning Town lose a few years in life expectancy. This is a very real issue and an indictment of our society. I congratulate my hon. Friend again on raising it, and I will listen with interest to what the Minister has to say.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I am grateful to the hon. Member for Easington (Grahame M. Morris) for raising the subject of public health observatories, and I should probably declare an interest, because my husband is a public health physician. Anybody who has an interest in public health knows how important the observatories are, but time is very short, and I will not get to all the points that the hon. Gentleman made.

The public health observatories have been around for more than a decade, and they produce a whole series of high-quality data. Annual health profiles, for instance, of local areas allow for those comparisons that are so important, and there is no doubt about the importance of reducing inequalities. The reports of Sir Douglas Black, Peter Townsend and more recently Sir Michael Marmot are all key documents.

It is important to remember that over the past decade or so health inequalities have become worse, but I point no fingers, because it is testament to the fact that it is extremely difficult to reduce inequalities. The hon. Gentleman mentioned several issues that contribute to that. There are a range of factors, not least changing people’s behaviour, which is not easy. The Government’s contribution of £12 million to the observatories is testament to how important it is that we get good intelligence. He will have read the public health White Paper, in which he will see our commitment to this. For the first time, we will ring-fence funds for public health.

The movement of public health into local authorities has been fairly widely welcomed. There are transitional arrangements that we need to get right, but it will be based on a direct line of sight from the Department of Health, as we need to bring some things together. We need clear responsibilities and a clear outcomes framework to ensure that local authorities give us what we need, with all that based on good and sound intelligence. Although the public health observatories have done a very good job, there are some areas—for instance, changing behaviour—where the intelligence is not good and we have not collected it together.

We want the data and evidence from the observatories to be used to improve the health of everybody, regardless of age, ethnicity, gender, income or sexuality. The public health White Paper sets out a clear life-course approach to that. It is impossible to make these changes without good intelligence and information. Despite the wealth of data, the evidence of what works is not necessarily being used as effectively as it could be, nor is it as widely available as it could be, and it remains only part of the information that we need. In any system where there are numerous stand-alone organisations, there are always dangers of overlap and duplication, and we want to eliminate that as much as possible. In short, we want to move from a system where we have a complex web of information functions performed by multiple organisations towards a system where that information is fully integrated into the public health system.

As the hon. Gentleman said, this is not about one Department—the Department of Health—doing it alone, but about public health being absolutely everybody’s business. The difference can be made from the top to the bottom in Government and right across the different Departments; it is an issue for us all. If we are truly to make inroads into these very persistent, difficult to move inequalities in health, we have to approach it in that way. There is no question of losing the main functions of the observatories; on the contrary, in fact. By transferring those functions to Public Health England, we will improve how they are used.

The hon. Gentleman will be aware that we have consulted for several months on the new public health system, and we are continuing to listen. It is very interesting to see what we are getting back, with a warm welcome for many of the changes. There are always anxieties about difficult periods of transition. We have convened a working group on information and intelligence for public health, which is chaired by the regional director of public health for South Central Strategic Health Authority, Professor John Newton. It has representatives from the Department, the Health Protection Agency, the public health observatories and the cancer registries, and it is meeting fortnightly to develop our approach to public health information and intelligence. This is an opportunity to get it absolutely right.

The future of the observatories is being very closely managed, and that includes their locations. Department of Health funding for the observatories has been agreed for 2011-12. Although there has been a reduction in the core contribution for each observatory, the Department of Health funding set aside as the core public health information and intelligence budget remains similar to previous years, and that will be supplemented by additional Department of Health grants, so overall funding will be about the same.

I should like to thank the north-east public health observatory for its contributions, including in relation to the national library for public health and the learning disability specialist observatory. Its strong strategic relationship with the academic sector through its host, the university of Durham, has been particularly beneficial. Officials in the Department are in regular contact with both institutions so that financial and other pressures are addressed as they arise. Like most of its counterparts, the north-east observatory receives income from the Department of Health, the NHS and others. I understand that it currently has a working capital of about £1 million, which is not insignificant.

The university’s human resources policies require it to alert staff at least six months before any changes in employment, which is important for staff at this uncertain time. We are making sure that the university is aware of the ongoing need for the observatory’s work, and hence its expert staff. It is important that we do not see any loss in that.

We are lucky in this country to have such a rich source of expertise. We must ensure that we maximise the benefit of that expertise, knowledge and intelligence. I hope that I have reassured the hon. Gentleman. I thank him for raising this issue and giving me an opportunity to say how much we value the work of observatories. Their functions remain indispensable, but they must adapt to the new system. We want to streamline the system and do what we set out to do, which is to reduce inequalities in health. We will base any action we take on sound evidence.

[Ms Abbott]

Will the Minister explain how, under the proposed system, we can make the free-standing GP commissioning consortia, some of which may be managed by private-sector organisations, pay attention in their commissioning decisions to the issues raised by public health observatories and others? It seems to me that without PCTs and other regional structures, it will be perfectly possible for the commissioning structures to ignore what public health observatories say.

[Anne Milton]

I thank the hon. Lady for raising that point. In fact, we inherited that system. Time and time again, budgets for public health have been raided to meet short-term commitments. One point of ring-fencing public health funding is to ensure that public health is central to the work that the local authority does and that it informs the commissioning arrangements in a local area. It is not good having just one area looking at public health. We are ring-fencing that money and will have a clear outcomes framework that sets out what the Government expect.

We will ensure that the consortia have regard to the public’s health. When we say “public health” it can sound a bit jargonistic. We are talking about the public’s health and about reducing the inequalities that have dogged society up to now and which successive Governments have failed to reduce. We have to do something different. We are moving from a system in which public health got sidelined and in which the work of public health observatories, although valuable, was not mainstream, to a system where that work is brought into the mainstream and into the direct line of sight. All those who make commissioning decisions and all local authorities should hear the clear message from Government that public health is everybody’s business.

Question put and agreed to.