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 undecided 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