Public Health Observatories

Grahame Morris Excerpts

Tuesday 17th May 2011 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

I am grateful to have this opportunity to raise the very important subject of the future of our public health observatories, which are an integral part of the national health service. They are responsible for public health intelligence work—collecting the evidence base and directing how different agencies work to improve public health. It might be useful if I give a definition of public health. The best definition I have been able to find is one from the World Health Organisation’s expert committee on public health administration that was published as long ago as 1952. It defined public health as

“the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.”

The Association of Public Health Observatories represents and co-ordinates a network of 12 public health observatories in Scotland, Wales, England, Northern Ireland and the Republic of Ireland. That body brings together joint public health intelligence work from all its organisations across the United Kingdom and Ireland and also works in collaboration with its counterparts across Europe. Without that range of high-quality and trustworthy knowledge, expertise and support from public health observatories, much of the work carried out by practitioners and, indeed, local authorities, policy makers and the wider community, would be carried out in the dark. That would, without doubt, result in a less focused and less effective service delivery. All that makes public health observatories central to both local and central Government health policy and decision making.

Public health observatories were set up to monitor the state of the public’s health and the causes of poor health and health inequalities, with the information being used by a range of organisations involved in providing health care, including the NHS. The White Paper, “Saving Lives: Our Healthier Nation”, which was published by the Department of Health in 1999, proposed the establishment of the public health observatories that were then set up in 2000 by the Labour Government. The Association of Public Health Observatories was also established in 2000. That umbrella group provides a link between regional public health observatories and national arrangements. It comprises representatives from all the regional public health observatories, the Department of Health and other partners, and one concern that I wish to raise is the fact that its funding has been removed this year.

I hope that the Minister will accept that improving the knowledge and evidence base behind health care was a key element of the previous Government’s policy and was instrumental in making progress in tackling health inequalities. The changes outlined by the Health Secretary in the Health and Social Care Bill move us away from a co-ordinated health service towards a competition-based health service. The public health White Paper, “Healthy Lives, Healthy People”, published on 30 November 2010, set out a new structure for public health in England. Its aim was to shift the balance of responsibility away from central Government to local authorities. There has also been much greater emphasis on the need for people to be supported in taking more responsibility for their own health—the so-called nudge philosophy.

There are many public health issues that I would like to discuss but unfortunately do not have time to develop tonight because of the shortage of time. I want to press on and put some points to the Minister, particularly about public health observatories, and I hope she will have the opportunity to respond to them.

[Jim Shannon (Strangford) (DUP)]

Prevention is key to having a healthier nation and perhaps this issue should be reconsidered in the NHS review, as it might help to improve the nation’s health.

[Grahame M. Morris]

I am grateful for that and I agree. It is fundamental to have a solid evidence base on which to plan health interventions.

As I mentioned, the Government propose in the Health and Social Care Bill to transfer health improvement functions from PCTs to local authorities, and to create a new body, Public Health England, to be rooted in the Department of Health. Public Health England is expected to take on full responsibility for overseeing the local delivery of public health services, as well as dealing with national issues such as flu pandemics and other population-wide health threats from next year. The majority of public health services will be commissioned by local authorities. However, the revolution under way in the NHS is just as important to the future of public health in England.

The Bill, which proposes the abolition of strategic health authorities and primary care trusts, raises more questions than it answers. The responsibilities currently held by PCTs could be moved to local authorities, to the Department of Health, to commissioning consortia or to the NHS commissioning board. How the important work of public health observatories will be safeguarded for the future is still unknown. The decision to divide public health responsibilities between the Department of Health and local authorities will fragment any cohesive approach to tackling health inequalities. Whether new commissioning consortia will carry out some functions is at this stage unknown.

There are further concerns about whether Public Health England should be outside the Department of Health to protect its independence. If it was placed within the NHS, perhaps as a special health authority, surely that would better meet the Government’s own aim, often stated, of liberating the NHS from political control.

The Minister will be aware of the response to the White Paper by the public health observatories in March 2011. That response calls for a sub-national level of organisation of Public Health England to be created, with sufficient critical mass to ensure that the outputs of Public Health England continue to be valuable locally as well as nationally. There are many examples where that is the case, not least in my own region, the north-east, where the public health observatory has done excellent work on addressing inequalities that affect people with mental health issues and inhibit their ability to access services. The lessons of that can be rolled out across the country.

The important work of the observatories over the past decade has been self-evident. On 24 June 2008 the health profiles for every local authority and region across England were published jointly by the Department of Health and the Association of Public Health Observatories, an organisation which, as I mentioned earlier, has lost all its funding. Using key health indicators, public health observatories were able to pinpoint national health statistics at a local level, providing valuable information to address health inequalities and improve health outcomes.

As the Minister at the time, my right hon. Friend the Member for Bristol South (Dawn Primarolo), now the Deputy Speaker, noted, the importance of those statistics was

“to target local health hotspots with effective measures to make a real difference.”

In my constituency, Healthworks, an excellent clinic established in Paradise lane in Easington and opened by Sir Derek Wanless, is a prime example of how that information collected by the observatories was used to great effect to target the areas in greatest need.

The Association of Public Health Observatories, with the Department of Health, also published a health inequalities intervention toolkit to enable every English local authority to model the effect of high-impact interventions on the life expectancy gap. As far back as 1977, the Department of Health’s chief scientific adviser, Sir Douglas Black, was asked to produce a report on the extent of health inequalities in the UK and how best to address them. The report proved conclusively that death rates for many diseases were higher among those in the lower social classes. It acknowledged that the NHS could do much more to address the situation. It called for increases in child benefit, improvements in maternity allowances, more pre-school education, an expansion of child care and better housing. A further report was subsequently produced by Professor Peter Townsend. Indeed, only last week I attended a seminar, in which the principal speaker was Sir Michael Marmot, on the impact of cold homes on health outcomes. The report indicated that the cost to the NHS of illness resulting from poorly insulated houses and cold homes is £2 million a year.

[Ian Lavery (Wansbeck) (Lab)]

Is my hon. Friend aware of the Marmot report—

[Ian Lavery]

The Marmot review, published in 2010, stated clearly, as one of its nine objectives:

“Economic growth is not the most important measure of our country’s success. The fair distribution of health, well-being and sustainability are important social goals. Tackling social inequalities in health and tackling climate change must go together.”

[Grahame M. Morris]

I am grateful to my hon. Friend for mentioning that important and contemporary report. I completely agree with Sir Michael Marmot’s findings— and Marmite is also very good for public health. Building on the work of Professor Townsend and Sir Douglas Black, Sir Michael Marmot states as one of his recommendations:

“Action taken to reduce health inequalities will benefit society in many ways. It will have economic benefits in reducing losses from illness associated with health inequalities. These currently account for productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs.”

I mentioned the economic benefits of insulating houses. It would be a real step forward if the Marmot report’s six principal recommendations were incorporated and linked to quality standards in the public health outcomes framework that the National Institute for Health and Clinical Excellence is working on.

[Ian Mearns (Gateshead) (Lab)]

My hon. Friend mentioned the Black report, the Townsend report and the Marmot report, and I wonder whether Government officials and Ministers might in due course come to regard the Marmot review a little like Marmite—either loving it or hating it—in respect of its findings, because it is clear that the need to monitor what is going on in public health across the regions of England, such as the north-east, is vital for future policy developments.

[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?

[Grahame M. Morris]

indicated assent.

[Madam Deputy Speaker]

I call Diane Abbott.