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Will Public Health England and a new ministerial team help to refocus drug
and alcohol policy, or are they empty exercises in rebranding?
DDN
reports
News focus |
Analysis
IS A GENUINE PUBLIC HEALTH FOCUS FOR
DRUGS AND ALCOHOL ON THE HORIZON?
6 |
drinkanddrugsnews
| October 2012
www.drinkanddrugsnews.com
Amid the gasps that greeted the news that
David Cameron had used his cabinet reshuffle
to appoint Jeremy Hunt as health secretary
–
‘Wow,’ said the
Independent
’s Matthew Norman,
‘that’s somethin’ else’ – few noticed that Anna
Soubry had replaced Anne Milton as parliamentary
under secretary of state. At least that was the case
until her comments about assisted suicide led to her
being branded a ‘train wreck’ and the knives
coming out in the press.
The
Daily Mail
’s Melanie Phillips, however,
chose a different line of attack. She branded
Soubry a ‘drugs policy liberaliser’, based on
comments made to a group of sixth formers six
years ago – before Soubry was even an MP – that
in an open debate the students would likely
conclude that ‘certain types of cannabis are less
harmful than alcohol and tobacco’ – an ‘idiotic and
dangerous view’, said the
Mail
.
When the column was published it was unde-
cided which minister would be given the drugs brief,
although Phillips stated that, if those were still
Soubry’s views, giving her any health brief would
signal ‘a truly dire absence of due diligence’. In fact
– after a few days when it looked as thought the
brief would go to Dan Poulter – it was confirmed that
Soubry’s portfolio does include drugs and alcohol.
Some in the sector had been hopeful about
Poulter’s potential appointment, as he had done
work on behalf of disadvantaged populations in his
capacity as a GP. Whether Soubry does turn out to
be a ‘liberaliser’ remains to be seen but as her brief
also includes ‘relationship with Public Health
England, [the] public health system and finance’,
could we be looking at a new era characterised by a
genuine public health approach to substance
issues, or is the switch to Public Health England
nothing more than a change of name?
‘I am optimistic,’ says Gerry Stimson, former
Harm Reduction International (HRI) executive
director and now programme director for
City health
2012
, a conference organised by the London Drug
and Alcohol Policy Forum (LDAPF) to be held later
this month. ‘To have a body called Public Health
England sends a strong message that drugs, alcohol
and related issues need to be dealt with in a cross-
cutting way. It’s all still shaping up, but certainly the
intent is there – that you need to join up the health,
welfare and social responses – and that’s good.’
The conference will provide an opportunity to
question Public Health England chief executive
Duncan Selbie, while its overall aim is a
broadening of approach, says Stimson. ‘The way
things are beginning to shape up with Public
Health England, it’s interesting to look at health
issues in a cross-cutting way. The conference aims
to explore a lot of the good things in the public
health arena that are done at a city level, often
despite
what’s going on at a national level.’
One example is around housing, he says.
‘There is growing evidence that if you can sort out
people’s housing needs then the drug and alcohol
aspects sort of fall into place, so initiatives like
Housing First are interesting. Obviously it’s a long
way off yet, and it’s a bit optimistic because there’s
such a shortage of housing in this country, but it’s
a step in the right direction. Alcohol is also an
interesting example – you can argue for taxes to
go up, or for laws to change, but what do you do
now on a day-to-day basis at a city level to reduce
nuisance and harm?’
Alcohol treatment has historically been seen as
the poor relation to drugs, and while NTA chief
executive Paul Hayes told delegates at
DDN
’s
Seize
the day
conference that the move to Public Health
England offered the chance to ‘right this historic
wrong’ (
DDN
, 7 March 2011, page 10), others worry
that the shift – when combined with spending cuts
and changes in commissioning – just adds to overall
uncertainty about the future of service delivery. There
are also concerns, as Hayes himself conceded, that
not all directors of public health will see drug and
alcohol treatment as a priority for their area.
Despite treatment funds no longer being ring-
fenced, expectations for service delivery will remain,
which will ‘add some uncertainty’, says Stimson.
‘It’s like saying “you can do what you like with the
money but you still have to deliver X”. We need to
keep the right balance between public health and
treatment needs. We need to ensure that public
health protection continues – needle exchange, HIV
testing, hepatitis C testing, overdose prevention –
we need the mixed package. That’s the message
that’s got to come through, and there will be a steep
learning curve at local authority level. It’s keeping
the balance of public health protection and
individual treatment needs.’
Ultimately, however, the fact that Public Health
England will be around at time when the rest of the
health service is undergoing such a dramatic
overhaul can only be a good thing, he believes. ‘I
hope it keeps a public health vision alive and
prominent. In a way it’s going back to a much earlier
version of public health, when it was the municipal
authorities who had the responsibility rather than
the health authorities.’
As co-founder of the Public Health Alliance Geof
Rayner told
DDN
’s
Together we stand
conference
earlier this year (
DDN
, March, page 9), ‘It’s back in
local government now. How well this works will be
down to you making your case.’
City Health takes place in London on 22-23 October
www.cityhealth.org.uk
‘Few noticed that
“drugs policy
liberaliser” Anna
Soubry has replaced
Anne Milton as
parliamentary under
secretary of state.’
Yui Mok/PA Wire