Public Health for 2015 election


From the West Midlands Socialist Health Association, April 2013

WMSHA has discussed public health at three meetings over the last year or so, with presentations by John Middleton (Director of Public Health, Sandwell MBC), Diane Abbott MP (Shadow Minister for Public Health), and most recently Cllr Steve Bedser (Cabinet Member for Health & Wellbeing, Birmingham City Council).  Following the last of these it was agreed that issues and ideas arising from these discussions should be circulated as an input to strategies for a future Labour government.  That is the aim of this paper.


Public Health is important to people in its own right, but also crucial to managing the demands placed upon the NHS when money is in short supply.  Among the challenges:

  • The whole health system is now very fragile.  Clinical Commissioning Groups took control of most NHS funds on 1 April 2013, just as the money ran out.  The four huge regions of NHS England are too distant and disparate to help them[1], tending rather to impede communications with the front line.
  • Public health (and healthcare outcomes generally) are strongly related to income and social class (however defined).  There are extreme and longstanding social contrasts within cities[2], and market forces and social policies are combining to make these worse.
  • Powerful economic forces (including globalisation and neo-con economic policies) are increasing inequality, particularly between North and South but also between inner cities and suburbs. This fuels growing healthcare demand, just as money is diminishing, so as well as being important in itself, public health success is crucial to NHS solvency.
  • Local authorities have become responsible for public health at a critical time, and may be blamed for circumstances beyond their control[3].  Within LAs, there will be pressure to divert public health funds to other urgent purposes.

However, on the plus side:

  • Many LAs have a strong ‘municipal socialist’ public health tradition to draw on[4].
  • Significant budgets have come with the public health function[5], and there is an opportunity to make better use of money by linking planning and commissioning across the social/health-care interface.
  • Tackling poverty has a huge public health benefit, which has not been exploited.

Ideas for the Labour Health team

We are two years from a crucial Election, so how can the Labour Health team best prepare the ground for an incoming Labour government?  We might need to start tying things down a bit more – including saying some things which may not be instantly agreeable to everyone.  Some of the early policy statements are starting to do this, and should be supported.

  •  The political narrative on public health and the NHS should centre on the health and well-being benefits of tackling social inequalities.  This not some sort of naive successor to ‘Big Society’, but links to the practical vision of economic development being developed by Chuka Umunna with productive jobs, real innovation and locally-based investment across the whole country[6].
  •  Labour should support and strengthen the move of public health to local authorities.  The key test of public health devolution will be ability of local authorities and local NHS to manage change, working across institutional boundaries[7].- However, public health funds need to continue to be ring-fenced, at least until the habits of collaboration are well bedded in
  • Hospitals are a public health resource, and the acute sector needs to use its power to pursue the public health agenda (eg tackling diet and smoking with patients and families alongside acute treatment).

In general Labour should be very careful about further organisational change as a policy lever, but there are a few exceptions:

  •  CCGs with boundaries that do not correspond to the other agencies involved in public health are not sustainable.  Uniting health and social care around the local authority platform will give planning for health real muscle.
  • the other thing that will need to go is the ridiculous NHS England ‘regions’.

Other important legislative changes would be:

  • Repeal of the current competition provisions in health and social care;
  • Reinstate the Secretary of State’s duty to provide and secure comprehensive health services;
  • The third sector has an important contribution, which should be better recognised in future contracting and commissioning arrangements for social health/welfare[8];

Birmingham is a young city – but children will die before their parents unless we do something urgently about diet/obesity.  Powerful lobbies oppose even small steps (eg food labelling, alcohol pricing).  Labour should legislate.

Finally, much bigger public health challenges may be on their way: eg food and energy scarcity, and antibiotic resistant infections.  The public health agenda needs to include creating the resilience to deal with these challenges. A genuine commitment to tackling climate change would help public health resilience by addressing fuel poverty and our vulnerability to world energy markets.

[1] ‘Middle England’ goes from Great Yarmouth to the Welsh borders; South from Dover to the Scilly Isles; and North from Sheffield to Berwick

[2] eg in Birmingham, north from Ladywood to Sutton, and to the east from Sparkbrook to Solihull (cited by Eversley in 1970s as the steepest social gradient in the UK); either side of the A45, Solihull itself is currently the most socially polarised borough in England.

[3] eg H&WB Boards have become responsible for post-Francis inspections – but without resources to do the job

[4] In Birmingham this goes back to the municipal housing, water and sewerage enterprises started by Joseph Chamberlain.  In the 1970s Birmingham pioneered clean air, noise abatement and lead-free petrol nationally, and WM was (and remains) a leading area for water flouridation.

[5] Birmingham’s H&WB Board directs £78m for public health; £38m for specialist housing; and £9m other

[6] There is an important contrast to be drawn with the present Government’s policies favouring the City financiers responsible for the recession, pumping up another property and development bubble and relying on the private sector for vital infrastructure and services like the NHS.

[7] For example ‘Be active’ scheme has overall (LA + NHS) Benefit-Cost ratio of 21, but the £1 has to come from LAs while most of the benefit is to the NHS acute sector (and there are long time lags)

[8] Working with Brook, LAs and NHS did well on teenage pregnancies under Labour – this is a good example