Good Riddance! Government Abolishes Public Health Cabinet Sub-Committee
Who cares?
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.
Evidence
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?
Mark, a great post as ever. But i fundamentally disagree with you on this one. Because the sub-committee didn’t have an impact, doesn’t mean it couldn’t have had. As far as i’m aware it was really set up to take the public health white paper through government. Now that has been done and Lansley has moved on, it has been shut down. But – as we argued and the Health Committee agreed – this is the only place in government where public health really could have come together with all critical departments and policies. It’s also a little misleading to argue the public health world missed its chance, this was a high level government committee, with no public health or other outside government representation. With its passing, there is now nothing, except bilateral conversations betweeen the DH and other government departments on specific issues, the public health voice in Whitehall is as a consequence diluted. I agree that the sub-committee’s actuality didn’t amount to much since its initial task was taking the white paper thorugh the machinery of government, but its undoubted potential will be sorely missed.
Perfectly fair comments. Of course its a ministerial/departmental committee. The challenge was to ensure that all members were properly briefed both inside and outside government so that they owned the committee and saw its value on their terms. We cannot expect them to manage this themselves. What strategy did we (the public health professional bodies and other NGOs) have to ensure that this happened?
I still think that my fundamental point holds – we need to build a local base and have politicians at a local level confidently advocating for this agenda – locally and nationally. Our job is to support them in doing this – If we don’t do this public health will continue to pop on and off the agenda at the whim of Secretaries of State.
Public Healths new position with local government places it in a tremendous position to develop this approach.
Whatever its potential, it plainly wasn’t working if no-one turned up. The mistake is to abolish it without putting in some sort of mechanism to ensure cross-government action on public health. What about putting improving well-being/reduce inequity into the objectives of every Permanent Secretary? And publishing those objectives? And providing a link to Public Health England for expertise? This won’t be a panacea, and I agree local advocacy will be vital.
The symbolism of these types of committee’s can (arguably) be quite important although I remember once participating in a peer review of a local authority who had refused to have an ‘older people’ partnership because they wanted to put their effort into making sure they and ‘the cause’ were at everyone else’s party, e.g. Housing, Health, Environment etc.
Having said that, there is a worrying void where public health once stood in the NHS since the divorce.
How is the NHS responding to the findings of Marmot now public health have found another home?