MPs warn corporate 'responsibility deal' to tackle public health will fail

MPs investigating the government's reform of the public health system in England have warned that its much criticised 'responsibility deal' with industry will not solve major problems such as obesity and alcohol abuse.

MPs are calling for the introduction of a minimum price on alcohol

Launching a report into the reforms, health select committee chairman Stephen Dorrell MP (Conservative, Charnwood, Leicestershire) said: ‘With regard to the national policy dimension of health improvement, we remain unconvinced that the new responsibility deal will, by itself, resolve major issues such as obesity and alcohol abuse.

He said the DoH must explain how progress will be monitored, and when more stringent measures will be taken if ‘nudging’ does not work.

The report warned: ‘Those with a financial interest must not be allowed to set the agenda for health improvement.’

Dr Vivienne Nathanson, the BMA’s director of professional activities, said: ‘Responsibility deals that allow the food and alcohol industry to dictate public health policy are not the answer to either the obesity epidemic or the alcohol misuse crisis that the country is facing.

‘These issues are complex but the government needs to have the courage to make tough decisions like introducing a minimum price on alcohol and mandatory food labelling.’

The government’s responsibility deal advocates dialogue with industry partners to encourage voluntary changes to food and alcohol contents, such as salt reduction and calorie labelling, rather than intrusive regulation.

But campaigners had criticised the approach for not being tough enough on the food and drink industry. In March, six leading health groups include the BMA, refused to sign up to the alcohol deal in protest.

The MPs’ report also expressed deep concerns about the independence of the new Public Health England (PHE) body, which will incorporate the Health Protection Agency (HPA) and several other public health bodies from April 2013.

Mr Dorrell said PHE must be ‘visibly and operationally independent of ministers’, and be able to demonstrate it can and does speak 'truth unto power’.

He said questions about how best to improve public health involved facing ‘uncomfortable questions’, which he suggested governments found it ‘easier to avoid’ than to deal with.

‘Those questions are likely to become even more difficult at a time when the NHS faces an unprecedented financial challenge,’ he added.

Whereas the HPA is currently a special health authority and independent of the DoH, PHE will be formed as an executive agency of the department.

In its report, the MPs’ committee it believed ‘that the principle that PHE must be visible and operationally independent of ministers is more important than the precise bureaucratic formulation’.

Earlier in the year, a DoH spokeswoman told GP that making PHE a special health authority – only present in England – was ‘not an option’ because the health secretary was to take on responsibilities that were UK-wide.

BMA public health committee co-chair, Dr Richard Jarvis, said: ‘We have stressed to the committee, and to the government, that in order to protect public health, it is essential that PHE has genuine independence and the resources to make decisions free from the constraints of central government.’

MPs’ concerns about the independence of PHE were shared by the Royal College of Physicians.

The report also found:

  • The lack of statutory duty on local authorities to address health inequalities is a ‘serious omission’.
  • ‘Concern’ over a decision to reduce weighting for health inequalities in resource allocation to local authorities, which reports have shown will cut funding to poorer areas over the next 20 years.
  • There is a ‘significant risk’ that the proposed ‘health premium’ to reward efforts on health inequalities will target resources away from the areas with the most significant continuing problems and ‘undermine their ability to intervene effectively and thereby widen health inequalities’.
  • Local authorities may start ‘gaming’ the system and ‘effectively raiding their public health allocations by 'redesigning' services’, as warned by public health experts in July.
  • MPs welcomed the enhanced powers of the health secretary and roles of local directors of public health in the event of an emergency

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