Public Health Conference Speech - 21 May 2008

"As Minister for the East Midlands this relates specifically to our region and impacts on our vision to become a top 20 region in Europe by 2010.

"It is heartening indeed to see so may people here today who are involved on a day-to-day basis in leading that drive to tackle inequalities and improve health and well-being among the people of our region. 

"And I am particularly interested and impressed with the innovative approaches that are being taken by you and your colleagues to make a real difference.

"This region has a proud tradition of innovation and social justice – from Robin Hood’s “redistribution of wealth” to the great pioneers of the industrial revolution such as Richard Arkwright’s work in the East Midlands.

"Perhaps the one thing those pioneers didn’t realise was how the great industrial and economic advances they made then would impact on our futures – many positive but some negative, such as those associated with climate change. 

"With those industrial, social and medical advances, the health and well-being of people in the East Midlands began to improve markedly.

"During the 20th century, this country made enormous progress in improving the health of its people. Social and economic developments, together with increasingly effective health-care, have had a major impact.

"Average life expectancy rose by 30 years between 1901 and 1999, and it continues to rise.  Life expectancy in the region is now the highest it has ever been – 77.3 years on average for males and 81.3 years for females.

"But in the 21st century, we face new health challenges that require new solutions.  I want to work with you and your colleagues to pick up those challenges and to make a real difference for and with the East Midlands communities where we live and work.

"David tells me that elements of today’s programme are based on the findings of a review of the East Midlands joint health strategy, due to be published shortly.

"I am particularly pleased to note the emphasis on addressing health inequality and on taking action on climate change.

"Too many communities in the East Midlands, including Corby - my own constituency - suffer poor health by comparison with the wider population.

"And the opportunity to tackle big issues like climate change was one of the reasons I became an MP.  So the issues you are discussing today are very high on my list of priorities.

Improving Health
 
"The Government takes health very seriously indeed. That is why we have invested heavily in the NHS, its staff and facilities. It is also the reason why we established NICE, the National Institute for Health and Clinical Excellence, to ensure that patients have fair access to cost-effective health technologies.

"But you know better than I do that improving health is not just about providing high quality health-care and health services. 

"There are significant socio-economic factors, such as:

• Employment
• Housing
• Education
• Poverty, and
• Not least social exclusion

"All of these factors impact directly on health and poor health impacts directly on all of these issues as well.  We need to do all we can to break the chains of poor health, housing and education, which lead to social exclusion, worklessness and poverty so that the advances we make as a region – as a society – benefit all of our citizens.

"Again, I’m sure you all know that environmental factors like climate change, air pollution, access to safe green space and affordable public transport can impact adversely on health and well-being.

"That’s why I am delighted to be able to join you at this conference today, which has such a strong focus on sustainability.

"It is both a noble aspiration and a pointer to the future that the Conference will measure the carbon footprint of delegates’ transport to and from this event. I would urge you to contribute the minimal amounts requested to offset the carbon emissions relating to your transport to and from this venue.

"In due course, I feel certain this will become standard practice and it is true testament to all of you in the public health community that you are leading by example and advocating for positive changes in attitudes and behaviours that will benefit both the region and the planet.

"In the wider context, but at an individual level, behavioural factors related to smoking, alcohol misuse, poor diet and a lack of exercise significantly affect people’s health.  You don’t need me to tell you that, I’m sure.

"But, on its own, the NHS cannot possibly address all of the “wider determinants” of health. 

"To maintain our progress requires action by the public, the private and the third sectors; by communities; and by families and individuals.
We realise that Whitehall is not the place where all of this is going to happen. It will happen in our cities, in our urban and rural communities, and in the way in which we as individuals choose to live our lives.

"And that is why, over the last three or four years we have been progressively placing the accountability for decision making, and the responsibility for delivering change, firmly with local areas and with regions.

Local Area Agreements

"Local Area Agreements are the main mechanism for making this change. They represent a fundamental shift in the balance between central and local decision-making.

"They recognise that local people and organisations are best placed to know their local needs, to identify local priorities, and to implement local solutions. Ministers and Parliament continue to set the overall strategic vision, but how that vision is delivered is now, and predominantly, a matter for local decision.

"LAAs do not just represent a shift in the balance between central and local Government.  They represent a new way of working locally, based on partnerships that really work and that are not just talking-shops.

"They encourage a cross-cutting and collaborative approach to delivering public services, where it is outcomes that matter, not organisational boundaries.

"That is, I know, a challenge for some public sector organisations used to being closely monitored, not to say managed, by Whitehall.  I have also to admit that it is a challenge for Ministers to give up some of their levers of control.

"I have already noted the fact that improving health requires a cross-cutting partnership approach.  LAAs offer just the right environment for those partnerships.

"They include the key local public, private and third sector organisations, and they are increasingly effective in adding value to the delivery of local services and outcomes.

"I do believe that, as the LAA process becomes more and more embedded, its role in improving health will become even more important than it already is.

The Regional Dimension

"I would like to move on to say a few words about regions and their role.  The current configuration of nine English regions dates back to 1998. 

"Most central departments have a presence in each of the Government Offices of the Regions, whose role is to ‘join-up’ the various cross-government regional functions, including health.  Since 2006, strategic health authorities have been co-terminous with the Government Offices.

"The introduction of LAAs has resulted in a significant transfer of responsibility from Whitehall to the regions.

"It became clear that staff based in the regions were better placed to support and monitor the development and delivery of LAAs, as they are more likely to understand local conditions.

"Regions are also charged with wider strategic planning in areas such as economic development, spatial planning and sustainable development etc.

"The region’s health strategy is a key element of that integrated regional planning process and I am pleased to note the degree of commitment from regional bodies to delivery of the strategy.

"In turn, I am sure it will play an important part in the Single Regional Strategy, the development of which is also part of my portfolio as Regional Minister.
      [DN - elaborate as required]

"What about my role?

"I was appointed by the Prime Minister as the new Minister for the East Midlandsin January 2008.

"My role is to champion the region, making sure its interests are heard at the heart of Government and to ensure that policies and services are joined up to deliver the best possible outcomes for the people of the East Midlands.

"I’m also the Minister responsible for the Third Sector, which includes charities, voluntary groups, social enterprises and other organisations.

"I am delighted to have been appointed Minister for the East Midlands, a region that has so much to be proud of. 

"I intend to be a strong voice and advocate for the region, building on the excellent work of my predecessor Gillian Merron. 

"Our towns and cities boast many individual strengths and qualities but have also forged a powerful collective bond which puts us in a unique position to prosper.

"I want to help build on this success and am ambitious for what we can achieve together.

"We have made enormous strides in the last ten years in creating new jobs, attracting inward investment and raising living standards and the quality of life for people in the region.

"However, more remains to be done if we are to stay competitive and meet the social, economic, health and environmental challenges that lie ahead.

"We can best achieve this if we resolve to work together. And that is where I come in.

"I can be the link between Government and the region, ensuring that East Midlands’ specific needs are taken into account in policy making and helping each part of Government work together with the people, giving them the support and the services they need and deserve.

"My message to the people of the East Midlands is that I am here to take on their causes.
My message to you is that I am here to support your aspirations for health and well-being in the region.  I want to work with you and I will do so with relish.

Health Inequality

"I want to return now to the issue of inequality.

"Addressing inequality and its causes lies at the heart of Government policy and my own political philosophy.

"In addition to my role as regional minister, I have responsibility within the Cabinet Office for a number of national policy areas. In particular I am responsible for the national delivery of Public Service Agreement (PSA) 16.

"For those of you who cannot recite all of the PSAs off by heart [pause],    PSA 16 aims to ‘increase the proportion of socially excluded adults in settled accommodation, and employment, education or training.’

"Socially excluded adults include:

• people leaving care
• adult offenders under probation supervision
• adults in contact with secondary mental health services
• and adults with moderate to severe learning difficulties.

"I am sure that you will recognise those groups as amongst those likely to suffer from health inequality as well as social exclusion.

"PSA 16 is not led by the Department of Health, although health is a key partner in its delivery.  But I think there are a number of common themes which emerge from my experience of this area and which are very pertinent in attempting to address inequality, of whatever type.

"If we are really to make progress in addressing inequality, we need to:

• clearly identify and define the groups or communities at risk
• understand their specific needs
• plan to meet those needs
• work together, across organisational boundaries, to implement our plans
• constantly review whether what we do is working

"I was very interested to hear from David about the Regional Support Team model that has been developed in the East Midlands to help our health and social care communities tackle entrenched health inequalities.

"I understand that action to address health inequalities has been identified as a priority work stream for all local health economies within the East Midlands.

"It is also, I understand, a central theme of all the regional work streams of the NHS Next Stages Reviews [a.k.a. the “Darzi Review] and I know that the regional clinical vision for the future - the work that has been taking place across the region over the past year - is due to be launched in early June.  I am sure we all eagerly await that vision, which will set the direction for health and well-being in the region over the next decade.

"The Regional Health Inequalities Support team was established in October 2007 with the aim of driving improvements in the delivery of reductions in Health Inequalities.

"The model has been developed in line with comments drawn from, and guided by, the East Midlands PCT Chief Executives' Project Group on Health Inequalities.

"I have been told that the Regional Support team is providing support - not performance management - to PCTs and their partners in the East Midlands through a series of visits, the most recent of which was to Northamptonshire.

"Again, this is an area where East Midlands is leading the way and I know that other regions are already looking at this as a model of best practice that may shape their regions’ approaches to reducing health inequalities.

"Health inequality is perhaps the most fundamental inequality.  It is just not acceptable that in a modern, affluent society such as ours, people in our most deprived communities die, on average, as many as ten years earlier than those living in our most affluent areas. 

"That is why I am so pleased to hear that the revised regional health strategy will be placing the highest priority on addressing health inequality and I am confident that you and your local partners will grasp the opportunities that LAAs offer and commit yourselves to working together to make a real difference.

Climate Change

"I would like to conclude with some remarks about climate change.

"In 2004, Sir David King, at the time the Government’s chief scientist, said that ‘climate change is the most severe problem we are facing today’. The scientific evidence continues to reinforce that view.

"My Cabinet Office colleagues have recognised that climate change poses great challenges and it is important to plan ahead for the consequences - not the least of which are the risks to future health and well-being.

"Actions are being taken across Government and the NHS to reduce emissions contributing to climate change. 

"The UK is at the forefront of preparing for climate change by putting in place a clear and credible emissions reduction pathway to a statutory goal of a 60 per cent reduction in carbon dioxide emissions by 2050.

"Mandatory targets for energy efficiency for the public sector are being set and work is continuing across the NHS at regional and local levels to mitigate the projected impacts of climate change.

"One of the effects of climate change already encountered in this country is the increased frequency of heatwaves. The devastating heatwave across Europe in 2003 led to us launching the National Heatwave Plan in 2004, in which a Heat-Health Watch system operates in England during the summer months, with four levels of response and appropriate advice.

"And last year, of course, we witnessed unprecedented levels of flooding across parts of this region and the other areas of the country. Work is being encouraged at a regional and local level to deal with the possible health effects of climate change.

"Key areas include adapting the health and social care infrastructure to be more resilient to the effects of heat, gales and floods, and developing local plans to cope with disasters.

"We are increasing awareness of how people can adapt to changes in climate but let's not forget that society also has a role to play - we can all do our bit to help the environment through consumer choice, reducing carbon footprints and recycling waste.

"Climate change threatens, directly or indirectly, the health of everyone on the planet.

"In this country and this region we could be faced with the prospect of increased levels of skin cancer, increased prevalence of water-borne diseases and the risks of what were once deemed “tropical” diseases spreading to our part of the world.

"There may be greater numbers of deaths due to heatwaves and higher temperatures generally and food poisoning may become more common as a result.

"That’s why we all need to look at the impact we are having as organisations and individuals alike.  Others may already be reaping the consequences of our recent actions but it may well be our harvest tomorrow.

"You may already be aware that my Ministerial colleague, [Public Health Minister] Dawn Primarolo, announced recently that health workers and local authorities throughout the country were being encouraged to play their part in tackling the health effects of climate change. 

"Climate Change guidance documents were issued to provide advice on tackling climate change and promoting sustainable communities, in order to further improve health and reduce health inequalities.

"The aim is to help public sector workers - particularly those working in health and social care - to plan how to mitigate and adapt to climate change.

"I would like to support this whole-heartedly as you can be key agents for change, making a positive impact for the region and for the planet.

"The guidance documents give advice on how to:

• design buildings that stay cool in the summer, warm in the winter and flood-resilient
• reduce your carbon footprint and encourage others to do so
• protect the public further through continuing public awareness campaigns such as ‘The Heatwave Plan’
• raise awareness of climate change and the health effects

"Local health professionals are asked to consider the health impacts of climate change and are informed about how we can adapt, as a society, to the most severe impacts – such as heatwaves and flooding - with adequate planning. 

"It also explains how to minimise the future effects of climate change by reducing emissions, both in the workplace and at home.

"The guidance documents were published two months after the Department of Health and the Health Protection Agency published the ‘Health Effects of Climate Change’ which outlined some of the effects that climate change could have on the health of UK citizens if no action is taken.

"At a World Health Organisation Executive Board Meeting in January, the UK put forward a resolution on the impacts of climate change on health and health systems which received overwhelming support from other countries. The W.H.O. Director General congratulated the UK on achieving an unprecedented level of consensus.  This has now gone forward for consideration by the World Health Assembly.

"Health and local authority professionals are key to communicating the health risks of climate change so I would urge you to play your part. You, and the organisations for which you work, are concerned with improving and protecting health. That is why I am sure you will want to take away from today a clear personal and organisational commitment to take action on climate change.

"I am sure today’s conference will provide you with plenty of healthy (!) food for thought.

"I know you are already contributing a great deal to making a difference to the health and well-being of the people of the East Midlands.

"I commend your efforts and the innovative ways you are finding, in sometimes challenging circumstances, to make a positive difference to the health and well-being of people in the East Midlands.

"Finally, I would like to reiterate that I am here to support you in any way I can.

"Thank you for your time.
 
I hope you enjoy your day."