‘Cut public health initiatives to improve health’

Health advisers need to go back on the frontline, says Michael Fitzpatrick (pictured)

The announcement that the Department of Health plans to sack 1,700 doctors, nurses and other health professionals who have become civil servants to work on public health programmes indicates the sort of boldness in rationalising public expenditure that – if the government holds its nerve – could have beneficial effects throughout the health service.

To adapt an old adage, “those who can, do; those who can’t adopt a strategic role”. This applies to many of the health professionals who have given up working with patients in favour of advising politicians how to pursue campaigns to persuade people to stop drinking and smoking and eating junk food. The government has at least recognised that such activities are a waste of money.

It is readily apparent, for example, that trying to turn the Olympics into an exercise promotion scheme is doomed – the success of Premiership football clubs in selling XL-sized replica shirts confirms that popular engagement in sporting spectacles does not confer fitness on those who wear them.

Unfortunately, the coalition has so far proved inconsistent in pushing through the sort of drastic measures that are required to improve public services.

The government has, for example, baulked at curtailing spending on moralising social engineering projects in relation to parenting, teenage pregnancy, drugs and alcohol, even when academic studies cast doubt on their efficacy.

The improving access to psychological therapies (IAPT) scheme is another programme that could be greatly improved by narrowing its focus: better to provide high quality psychological interventions for people with serious mental illness than dumbed-down psychotherapy for the “unhappy”.

Bold cuts can put an end to wasteful public health schemes, while freeing health professionals to return to proper jobs.

The announcement that the Department of Health plans to sack 1700 doctors, nurses and other health professionals who have become civil servants to work on public health programmes indicates the sort of boldness in rationalising public expenditure that – if the government holds its nerve – could have beneficial effects throughout the health service.

To adapt an old adage, ‘those who can do, those who can’t adopt a strategic role’. This applies to many of the health professionals who have given up working with patients in favour of advising politicians how to pursue campaigns to persuade people to stop drinking and smoking and eating junk food. The government has at least recognised that such activities are a waste of money. It is readily apparent, for example, that trying to turn the Olympics into an exercise promotion scheme is doomed – the success of Premiership clubs in selling XL-sized replica shirts confirms that popular engagement in sporting spectacles does not confer fitness.

Unfortunately, the coalition has so far proved inconsistent in pushing through the sort of drastic measures that are required to improve public services. The government has, for example, baulked at curtailing spending on moralising social engineering projects in relation to parenting, teenage pregnancy, drugs and alcohol, even when academic studies cast doubt on their efficacy. The improving access to psychological therapies (IAPT) scheme is another programme that could be greatly improved by narrowing its focus: better to provide high quality psychological interventions for people with serious mental illness than dumbed-down psychotherapy for the ‘unhappy’.

Andrew Lansley’s U-turn on NHS Direct – after protests against its abolition, the health minister now plans only to change its phone number – reflects the government’s uneven commitment to reforming the NHS. But bold cuts can cut wasteful public health programmes, while freeing health professionals to return to proper jobs.

Michael Fitzpatrick is a GP practising in Hackney, east London

This article is published in the 30 September 2010 edition of Community Care under the headline “Advisers need to go back on the frontline”

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