In the public health world there has been a bit of outrage over the governments decision to abolish the cabinet sub committee on public health (see page 8 of this report for its original membership and remit). I realise this will seem a bit parochial to those of you not in the ‘public health family’, but hear me out.
The Cabinet Public Health Sub Committee was announced in Healthy Lives, Healthy People: Our strategy for public health in England as the means by which the Secretary of State would ‘lead public health across central government’ (para 4.56) and ‘work across multiple departments to address the wider determinants of health’ (para 3.4).
The reason given for its abolition is that other government departments were not turning up to the meetings so there was little point it continuing to exist.
I am in a bit of a quandary here. Cabinet Sub Committee papers are not publicly available – so I have no idea what was discussed, who attended (or did not attend) and what difference this meeting made.
I struggle to see the difference it has made. Lets look at some wider policy areas that impact on the health and health inequalities. For a good up to date summary of the evidence see this recent report from the Institute of Health Equity.
- Welfare Reform Policy – does not seem to have taken into account the impact on the health and wellbeing on some of the most vulnerable – I have no idea if the Cabinet Sub-Committee on Public Health has discussed welfare reform. If it has what difference have the discussions made to the implementation of Employment Support Allowance, the Housing Benefit Cap etc?
- Abolition of Education Maintenance Allowance – Was this discussed at the cabinet sub-committee on public health and how did this discussion affect implementation of this policy.
- Funding support for early interventions – Government changes to business rates and early intervention grants are likely to lead to significant further reductions to SureStart services.
What should the public health profession do?
I am no supporter of this government or its policies but at the end of the day it was the responsibility of public health leaders to ensure that this sub-committee made a useful contribution and I think they failed. This despite a policy environment that actually presents a range of potentially useful levers – the work of the Institute for Health Equity makes a powerful case for a Health in All Policies Approach and the Department for Health does listen to them; the transition of public health to local government strengthens the potential for collaboration with the Department for Communities and Local Government; the growth in ideas around Citizenship and the Big Society still has interest at the top of Government; and of course there is the Public Health Responsibility Deal – that should connect with the Department for Business, Innovation and Skills.
Now, just because I mention the little list of policy levers above – don’t think that I am endorsing or supporting all of them. My point is that in the world of realpolitik there were plenty of pegs to hang a meaningful agenda for a cross cutting government committee – and yet public health failed to capitalise on this.
Do we care………really?
In my view the abolition of the Public Health Subcommittee is a blessing. Because in addition to the two reasons I mention above – lack of accountability and impact – its a diversion!
The real game is a local one. The public health profession in England needs to work within the national policy environment through local authorities to improve health and reduce health inequalities. Of course this means sometimes working in a context where government policy will be working against local health and wellbeing and worsening health inequalities. The public health task is to empower local politicians (Councillors and MPs) to make this clear to national government – they should be leading this debate and we should be supporting them.
A secret committee to improve wellbeing!
While having a cabinet sub-committee on public health is flattering and seductive it risks incorporation. The idea that a secret unaccountable committee is somehow an essential part of effective policy making at a national level is patently nonsense. It is even more outrageous when we consider that public health is about people taking control of their health and wellbeing. Do we really need a secret government committee to consider this?
Lets face it In the post Lansley world the role of the Department of Health is considerably reduced. The real action is going to be taking place in Public Health England, Local Government, the Voluntary and Community Sector and Clinical Commissioning Groups.
We need to focus on strengthening our local accountability and building our local base and make sure that future engagement with the government is in public and wherever possible through locally elected leaders – in the long term this might be more effective.
What do you think?