The impact of PCT reorganisation on health

promotion practice

Judy WhiteLeeds Metropolitan University

The context

• Introduction of full healthcare markets in NHS

• Splitting commissioning from providing• Health promotion becoming part of multi-

disciplinary public health• Domination of the ‘medical model’,

behaviour change and short term outcomes/targets

• No overview of what has happened to health promotion since re-organisation

Northern regional workshop

• Held December 10th in Leeds• Attended by 55 people – most of

who were working in public health/health promotion

• Survey completed by total of 76 people – those attending workshop + some MSc students studying health promotion

Views of the 42 people working in PH/HP in PCTs in

North Some positives and ‘wait and see’ but

most expressed: • Uncertainty and concern re future• Loss of identity/recognition as discipline• Fragmentation/loss of critical mass• Many leaders/commissioners unaware

and unsupportive • Dominance of medical model• Increasingly hard to work across all HP

areas as per Ottawa Charter

Re-organisation has ‘made …..working a product! I’m under pressure to meet too many targets……there’s no interest in the community/health promotion model at all.’

This and subsequent quotes are from Health Promotion Specialists now in provider units

‘the internal market is currently about saving costs and unfortunately very medicalised. Almost against some of the principles of HP/PH…….to meet the target/agenda there is a need to go down the medical model’

‘too many people who have never delivered grassroots work making decisions based on statistics’

‘commissioners without much clue about the detail of the services they are commissioning……..I’m writing commissioning bids when working in provider services’

‘I feel uncomfortable being taken out of public health (into a provider service) – public health increasingly fragmented’

‘I feel as health promotion is long term and doesn’t provide a direct service that is tangible to provider services, health promotion could be a nice chunk to cut out when money is tight’

Health promotion needs…

• Investment and dedicated staff at national, regional and local levels + training and development

• Better data and research on effectiveness

• Strong management and performance assessment.

Healthcare Commission and Audit Commission 2008

Discussion

Key themes and issues

Recommendations for further action