Wednesday, June 22, 2011

Some time ago we wrote a widely cited Lancet paper setting out what we considered a reasonable way forward for public health in England. However, it was clear that the Secretary of State rejected our arguments and he said so, very clearly, in a letter to the Lancet in response to our paper. We then responded to his letter and expected to see both in print very soon. unfortunately he has decided to withdraw his letter, so neither will appear in the pages of the Lancet. Obviously we can't publish his now withdrawn letter, but we thought you might like to read our reply:

Dear Editor,

We were surprised by the Secretary of State‟s summary dismissal of our arguments for an alternative approach to public health in the reformed NHS in view of the government's decision to “pause, listen and engage”. Mr Lansley states that our concerns around fragmentation of the service as a consequence of his plans are unjustified. Yet our apprehension is supported by detailed evidence and our proposals have been endorsed explicitly in responses to the Public Health White Paper consultation by professional bodies, 1,2,3,4 all raising specific concerns about fragmentation. The Secretary of State provides no evidence as to why all these concerns are wrong; nor does he clarify how his plans overcome the problems we describe arising from the division of public health between the Department of Health, local authorities and, potentially, commissioning consortia.

Although he re-affirms the independence of Public Health England, he does not respond to the widespread scepticism this claim has generated or explain how it will be achieved.

His assertion that public health budgets will be ring-fenced within local government is difficult to reconcile with the speech by his cabinet colleague Eric Pickles that the government is “scrapping ring-fencing”.5 We know that some councils, such as Westminster, have already identified cuts from 2012-3.

We are disappointed that he has not „engaged‟ with our clearly thought through concerns about the capacity of public health teams in small local authorities, the trading activities of the Health Protection Agency, training and loss of workforce expertise.

In grasping “the unique opportunity to prioritise public health and work in partnership with [the government] to realise it,” we have built upon the government‟s proposals to suggest modifications to address the adverse consequences we have highlighted.

We hope to continue to engage constructively in this process.

Yours sincerely,
Martin McKee
Robert W Aldridge
Rosalind Raine
Louise Hurst
Ingrid Wolfe

1 Academy of Medical Sciences. Response to the consultation on the public health
white paper ‘Healthy lives, healthy people’ URL: (accessed 3rd May 2011)
2 UK Faculty of Public Health response to Healthy lives,
healthy people: our strategy for public health in England URL: (accessed 3rd May 2011)
3 Association of Directors of Public Health – response to consultation on White Paper
Healthy Lives, Healthy People: strategy for public health in England URL:
P.pdf (accessed 3rd May 2011)
4 BMA response to Public Health White Paper URL: (accessed
3rd May 2011)
5 Eric Pickles: We will let councils make their own decisions. URL:
_make_their_own_decisions.aspx (accessed 3rd May 2011)