Public Health Observatories

Ian Lavery Excerpts

Tuesday 17th May 2011 Commons Chamber

[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—

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

Marmite?

[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.