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HSC calls for Health Premium to be dropped

2 November 2011

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The Chair of the Health Select Committee has called for the government’s ‘half-baked’ Health Premium policy to be scrapped, following a report into public health reforms.

Under the government’s new public health service ‘Public Health England (PHE)’, ring-fenced grants will be given to local authorities according to a needs-based formula.

The proposed ‘Health Premium’ will award additional funding for heath improvement services if local authorities prove they have made progress in “improving the health of the population”.

In its report, the Committee has raised serious concerns that such a move will target resources away from the areas with the “most significant continuing problems”.

Stephen Dorrell told MiP the policy demonstrates the “wrong analysis of how public bodies behave” and that he “doesn’t understand it”.

Dr Peter Carter, Chief Executive and General Secretary of the Royal College of Nursing (RCN) said the introduction of an “untried and untested” Health Premium risks increasing health inequalities.

The government’s suggestion that the current spend on public health services could be over £4bn also raised a few eyebrows in the report.

Dorrell said the only way public health costs can come “anywhere close” to £4bn is the inclusion of community dentistry.

“The £4bn figure seems to have emerged, like the mythical pot of gold at the end of a rainbow,” he said.

“It is clearly a Whitehall cock-up and the result of a paper being leaked somewhere along the line.”

Many of the members of the Committee also voiced their concerns that public health money, with the right “creative” legitimate reasons, could be spent on a whole host of issues facing local authorities.

Those mentioned included: salt and grit to prevent the elderly from falling, home insulation and the filling in of potholes.

“We also share the Committee’s concerns around ring-fencing of the public health budget, with a recent survey of our members finding that 76% fear it could be raided by local authorities for other areas, such as road maintenance and housing,” said the RCN’s Dr Carter.

Dorrell told MiP it is “unhelpful” and “suspicious” to have a number in circulation without specific details of what services it covers.

“The danger is that the services will be made to fit the number,” he said.

The review of the government’s public health reforms has also led the Committee to demand PHE is seen as a “fearlessly independent body free from the control of Ministers”.

Failure to do so may lead the government to avoid facing “uncomfortable questions” on health inequalities, it is argued.

The British Medical Association (BMA) has welcomed the Committee’s call for PHE indepence.

“We have stressed to the Committee, and to the government, that in order to protect public health, it is essential that Public Health England has genuine independence and the resources to make decisions free from the constraints of central government,” said Dr Richard Jarvis, Co-Chair of the BMA’s Public Health Committee.

“At a time when the NHS faces unprecedented financial challenges, it is also vital that funding for public health is protected so that doctors and specialists in this area can work towards improving the health of the nation and reducing health inequalities.” 

The review also criticises the government’s Responsibility Deal, with the Committee remaining “unconvinced” the scheme will, by itself, resolve major issues such as obesity and alcohol abuse.

Grahame Morris, Labour MP for Easington and a member of the Health Select Committee, said too many organisations have found themselves in a position where they can “develop and influence” government policy.

“The government should not put itself in a position where it can only do what certain companies will allow it to do,” said Dorrell.

“It has a wide range of weapons at its disposal and should act on them.”

When asked why the government has failed to deploy the ‘weapons’ available to encourage a responsible diet, Dorrell told MiP “he didn’t know” but rejected the argument that it is in the drinks companies’ “pockets”.

Dr Vivienne Nathanson, the BMA’s Director of Professional Activities agrees Responsibility Deals give too much power to the food and alcohol industry.

“Responsibility Deals that allow the food and alcohol industry to dictate public health policy are not the answer to either the obesity epidemic or the alcohol misuse crisis that the country is facing,” she said.

“These issues are complex but the government needs to have the courage to make tough decisions like introducing a minimum price on alcohol and mandatory food labelling.”