Government health warning

For the past 12 weeks many in the social care sector have been
taking more than a sideways glance at the government’s latest
initiative on public health. But there are fears that the white
paper, to be published in July, will not place enough emphasis on
joint working across health, social care and housing and will
contain some glaring omissions, notably mental health.

The deadline for the consultation on the Choosing Health?
white paper ended on 28 May. While it had worthy aspirations, many
fear it over-emphasises physical health and would put the NHS in
the driving seat for medical model of public health.

The Sainsbury Centre for Mental Health launched the first salvo
before health secretary John Reid’s signature had dried on the
consultation document. It said the document was more concerned with
mortality than ill-health, claiming the subsequent consultation
process picked off the problems that could be targeted and

Angela Greatley is acting chief executive of the Sainsbury Centre
for Mental Health. Although mental health promotion has its own
national service framework standard that calls on “health and
social services to promote mental health for all working
individuals and communities” she says it has not been given enough
attention. “The pay off for investing attention in promoting good
mental health could be enormous.”

She adds that the white paper consultation document should have
been an opportunity to “redraw attention” to the importance of
joint working in mental health. “Setting up community mental health
teams and assertive outreach teams is tangible and can be ticked
off and measured. They have made good progress but there has been
no significant movement on standard one of the NSF.”

Mental Health Foundation chief executive Andrew McCulloch argues
that the government continually ignores the mental health aspects
of public health despite the timeliness of developing mental health
promotion. “This relationship is a complex one mediated by stress,
risk-taking behaviour, exclusion, deprivation and biological
factors. We cannot pretend to understand health unless we can grasp
the complexity of this relationship.”

By not making this link McCulloch sees the government’s latest
attempt at public health as naive. “It shows a shocking lack of
progress since previous public health documents – arguably it shows
a significant regression in terms of the understanding of the
importance of public mental health.”

Greatley calls for a re-emphasis on public health targets “where
area-based regeneration projects have mental health promotion built

The reality on the ground is that community mental health teams are
still fire-fighting and having to deal with people in crisis with
little or no capacity for prevention work. This situation is no
more pressing than in Manchester where health inequalities are the
worst in England. Its suicide rate is the highest in the country; a
baby boy born in the city today will live 10 years fewer than one
born in the south of England; and 72 per cent of people with a
mental health problem aren’t known to the area’s local

However, joint work between health and social care through local
strategic partnerships and local public service agreements is
beginning to make a difference by proactively promoting people’s
mental health.

David Regan is director of the Manchester Joint Health Unit, which
brings together health and social care planning with Manchester
Council. He says: “The NHS can’t turn around the situation alone.
In fact it has failed consistently.”

Public health in Manchester aims to regenerate communities –
improving health means improving jobs, transport and education.
“There is already evidence to show that having a job and staying in
education as long as possible will result in the improvement of a
whole range of indicators,” Regan says. “Having a job is the best
treatment for mild to moderate depression.”

The recently integrated health and social care teams are succeeding
at encouraging teenage mothers back into education. Young mothers
are now referred from health care workers to social workers who
gain their trust and help raise their aspirations. He says:
“Improving education attainment is the best route out of health
inequalities and what is good for the mother is good for the
child.” Since the project started in just one year the percentage
of young mothers returning to education has risen from 30 to 95 per

With statutory mental health teams under intense pressure voluntary
organisations have to approach service provision imaginatively. In
Manchester the Young Adult Support Project was set up by a
consortium of community and voluntary sector mental health
organisations including Turning Point, the Manchester Alliance for
Community Care and social services. It works to get young men and
women, particularly from ethnic minority groups, to refer to
services earlier.

Theresa O’Neil is a family link worker co-ordinator at North
Manchester Primary Care Trust. She says working locally helps her
to prevent social problems reaching crisis – problems that she
would have dealt with in her previous role as a social worker. At
the same time as working on individual cases, North Manchester PCT
plays a role in regeneration by employing people from the
communities it serves. “We recently employed 12 people to take up
health and social care posts, even though they didn’t have the
necessary qualifications. Our recruitment processes have to be
inclusive, putting life experience and location first,” she says.
The new staff are training for an NVQ in Health and Social

Whereas traditional social services are mistrusted in the
community, these new health and social care workers are building up
high levels of trust, signposting people to services or counsellors
before problems arise and reducing the risk of isolation and mental
health problems.

By reducing these risks, local staff are helping to reduce the
crisis work of social services. The PCT is helping to educate and
employ local people.

In neighbouring Salford joint working between social care and
mental health is being set up. Salford Primary Care Trust director
of strategic commissioning Alan Campbell says the decision is in
response to demands from the local community. “Now we will be able
to put social services in GP surgeries, giving advice around
finance and benefits and preventing crisis.”

Julie Higgins, Salford PCT’s director of public health, says hybrid
teams, containing health and social work skills, prevents
duplication of work. “We now have dedicated community development
workers for each neighbourhood. Joint working is making services
more responsive to needs and encouraging regeneration that pays
health and social development dividends.”

It is a message most practitioners believe should be at the centre
of the public health white paper.

The white paper

At the end of May the government finished its “Choosing Health?”
consultation which will form the basis of its public health white
paper to be published during the summer. The white paper will be
launched against a background of increasing health inequalities,
including both physical and mental health. The main focus of the
consultation has been on physical health – the government has been
much concerned with the tripling in obesity levels over the past 20
years, for example – and diet, smoking, exercise, sexual health,
drugs and alcohol have been the priority topics. The consultation
had the following themes each led by a task group:

  • Children and young people.
  • Employment.
  • Consumers and markets.
  • Leisure.
  • Maximising the NHS contribution.
  • Working with and for communities.
  • Focusing on delivery

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