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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