Local efforts to combat poor public health likely to be trumped by government targets for NHS

Local efforts to improve the health of the nation and combat the rising tide of obesity, diabetes and sexually transmitted disease are likely to be trumped by a culture that encourages NHS managers to give higher priority to hospital care.

A new report commissioned by The King's Fund report reveals that NHS managers find welcome developments such as patient choice, payment by results and the new contract for family doctors could divert efforts to improve public health. This report comes at a critical time as the government will explain how it plans to implement last November's public health White Paper later this month.

Managing for Health: What incentives exist for NHS managers to focus on
wider health issues? is based on interviews with chief executives, finance directors, directors of commissioning, planning directors and public health directors in strategic health authorities and primary care trusts. Many view meeting targets as an inevitable priority in the NHS and would not like this approach to be applied to the complex, multi-agency world of public health - although others agreed that targets have delivered some success in the acute sector.

Report co-author Professor David Hunter said:

'No-one would argue that the government is not now committed to tackling public health issues. The recent public health White Paper offers us a significant opportunity to tackle obesity and similar concerns. However, our report shows that NHS managers are struggling to take this agenda forward. They feel they are piecing together a 'jigsaw' policy, with public health taking a back seat as many of the incentives they face encourage them to prioritise acute care.'

The interviewees also question whether the NHS is the right organisation to lead on public health in the future. They point out that the NHS inevitably focuses on individuals, not the wider population as a whole, and they fear that the NHS emphasis could be on 'mild' health promotion messages.

The report calls for public health to be given a higher priority. Interviewees felt that public health was too often a minor part of NHS business. They cited the strong pull of the acute sector as one reason for this, and weaknesses in public health evidence, capacity, skill mix, leadership and resourcing as another.

The report says that to make progress, the organisations responsible for the nation's health - for example primary care trusts and strategic health authorities - need to give public health a higher priority throughout their planning, funding and business processes. It says they need clear policy direction, strong leadership and coherent and stronger incentives.

The King's Fund chief executive Niall Dickson said:

'The landscape of the NHS is changing, with many new reforms coming on board. This report makes it clear that NHS managers don't want the new reforms to stand in the way of getting to grips with public health.'

Read the report: Managing for Health: What incentives exist for NHS managers to focus on wider health issues?

Notes to editors: 

1. For further information or interviews, please contact Beverley Cohen on 020 7307 2632, or on 07774 218439 or Michael Moruzzi on 020 7307 2585.

2. Managing for Health: What incentives exist for NHS managers to focus on wider health issues? is by David Hunter, professor of health policy and management at Durham University, and senior research fellow Linda Marks.

3. They were commissioned to produce the report as part of The King's Fund Putting Health First programme.

4. Hard copies of the report will available from the King's Fund from 14 February 2005 costing £15. Please call 020 7307 2591.

5. The government's public health White Paper, Choosing Health - Making healthy choices easier, was published in November 2004.

6. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.