Health Select Committee report on public health

The Health Select Committee published its report on public health in March 2001. The committee concluded that the large number of new initiatives that had been established and their lack of traction had undermined their effectiveness.

The committee found that there were blurred lines regarding public health responsibilities. Within the NHS, it was unclear whether health authorities or primary care trusts should lead local public health functions. As a result, the committee suggested that there was a risk that public health would 'fall between two stools'.

The committee also described a lack of clarity and disjointedness regarding the different public health responsibilities of the NHS and local government. Recognising ongoing debate over whether the public health function should be returned to local government (having been placed with the NHS during the 1974 health service reorganisation), the committee advised against major structural upheaval. It stated:

'There can be no return to the past. Rather, we believe ways must be found of providing incentives to ensure that the public health function delivers across the entire health system regardless of where it happens to be positioned.'

Instead, the committee supported partnership working between the NHS and local government to overcome fragmentation between services and to avoid inefficient resource use.

Beyond this, the committee suggested that:

• the NHS Plan and discussions about the NHS had been dominated by concerns over acute services and hospital care, leading to insufficient discussion about public health
• stronger leadership and partnership working was needed at all levels
• there was a need for incentives rather than top-down targets
• there was a gap in the evidence base on public health.