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Public health plans set to fragment NHS ‘beyond repair’

By Gareth Iacobucci

Government plans to reshape public health services in England are flawed and could ‘damage the NHS beyond repair', the BMA has warned.

The association said the proposals outlined in the government's public health White Paper, Healthy Lives, Healthy People, could lead to a ‘further fragmentation of the NHS' and were causing ‘great anxiety among doctors'.

The warning came as the NHS Confederation said plans to financially reward areas that successfully reduce health inequalities could penalise the areas most in need of extra investment and, in fact, worsen health inequalities.

The BMA's response, published today, said its concerns about the public health white paper were primarily centred on the future structure of public health services and the transition period.

It said public health doctors feared that the proposed new structure would break up the workforce and lead to the fragmentation of services, and urged the Government to instead employ all three areas of public health – a health protection, health improvement and support for commissioning – under a single NHS-based public health agency.

BMA chair Dr Hamish Meldrum said: ‘The proposals for public health are causing great anxiety among doctors who believe the plans are flawed and could lead to the NHS losing the skills and expertise of hundreds of highly trained public health doctors.'

Meanwhile, in its response, the NHS Confederation warned that a ‘one size fits all' plans to introduce a health premium – an annual reward for areas that achieve the greatest reductions in health inequalities with incentives – could mean the most deprived areas are starved of valuable funding.

‘Extra funding for more deprived areas is to be welcomed. However, we are deeply concerned about unintended consequences that are likely to result from the Government's plans to use a health premium to reward those areas that reduce health inequalities with extra money.

‘We fear that this may not fairly reward progress and may lead to areas losing money where there is actually most need.

‘If the current approach to funding allocations continues, this could mean that areas that succeed in reducing health inequalities are rewarded by the health premium but may be simultaneously be penalised by a reduction in their overall public health funding allocation due to the improvement in their deprivation indicators.'

Public health plans set to fragment NHS 'beyond repair'