As WHO and others have said, in many countries ministries of health are generally weak when it comes to cross-government working and unable to provide the required leadership. Unless finance ministries are on board, then public health generally gets ignored or down-played.
There are different models to achieve this coordination, for example, the Health Committee Inquiry in 2016 (House of Commons Health Committee, Public Health Post-2013. Second Report of Session 2016-17, HC 140) did look at the issue of having a Cabinet sub-committee for public health (see paras 85-87, pages 39-40). The Committee's conclusion was that it was not persuaded that having a sub-committee had been a key driver for change or that it should be re-established. They did recommend that a minister in the Cabinet Office be given specific responsibility for embedding health in all policies across government, working closely with the Minister for Public Health in the Department of Health (para 94, p.41).
In its response to the Committee's report, the Department of Health (2016, Government Response to the House of Commons Health Committee Report on Public Health Post-2013, Cm 9378) agreed that 'a Cabinet sub-committee is not the most effective way to achieve that unity [for central government as a whole]' (para 10, pages 8-9). But it also believed that creating a second ministerial post with similar duties to the Minister for Public Health in the department 'would run the risk of duplication and inconsistency', so was not in favour of this suggestion.
A model for coordinating public health policy
We proposed that in its report on prevention the Committee consider that governmental public health policy coordination could be modelled on the Office of Budgetary Responsibility, as proposed by the UK Public Health Network. While there are arguments for and against any particular arrangement, the Committee could determine how well the current arrangements that are supposed to be in place are working, and then alternatives could be canvassed if deemed necessary.
With the NHS at breaking point, prevention is likely to be scrutinised very closely in the next few years as one way to address the challenges. This inquiry, if it gets it right, could make a significant contribution to restoring faith in the NHS.
About the authors
- Peter Littlejohns, emeritus professor of public health, King’s College London
- David J Hunter, emeritus professor of health policy and management, Newcastle University
- Albert Weale, emeritus professor of political theory and public policy, School of Public Policy, University College London