THURSDAY 23 NOVEMBER 2000

MS YVE BUCKLAND, PROFESSOR RICHARD PARISH, MR ANTONY MORGAN and MS PATTI WHITE

  273. Can I welcome you to the second part of this session. I am sorry you have had a long wait but it was, I am sure you would agree, a very interesting session. There is a fire alarm going on, if we are in any danger we will tell you but until then we will carry on regardless. Can I ask you to introduce yourselves to the Committee.
  (Professor Parish) Good morning. Maybe I should say good afternoon actually. I am Richard Parish, I am Chief Executive of the Health Development Agency.
  (Mr Morgan) I am Antony Morgan, I am the Head of Health Information at the Health Development Agency.
  (Ms Buckland) Yve Buckland, I am the Chair of the Health Development Agency.
  (Ms White) I am Patti White. I am a Public Health Adviser on smoking at the Health Development Agency.

  274. Can I thank you for your co-operation with the inquiry and your presence today. Can I begin by asking a little about the change that has taken place from the predecessor body, which you do not mention in your evidence at all which was rather of interest to us. Can you explain your views on why this change was brought about? What is your feeling as to the purpose of the change? Also, I think there is a concern which has been raised with us about the way in which your budget is not quite what it was for the predecessor body and will that impact on the work that you do?
  (Ms Buckland) Perhaps I could start because I originally chaired the Health Education Authority in its last year. When I was appointed as Chair I think it was fairly clear to everyone, including those in the field and including people inside the Health Education Authority, that there perhaps needed to be a change in its remit. As you know, the Health Education Authority was largely devoted to public education campaigns. There were a number of views around about the efficacy of public education campaigns within an overall strategy for health promotion and their ability to address health inequalities and from the time the HEA had been set up there had been a number of changes, alternative bodies are providing public education campaigns and the new Government, indeed, wanted itself to very directly own and brand some of the big campaigns that had been run by the HEA, including things like immunisation and smoking for example. We engaged in a major process of consultation with the field and what came through that very strongly was the feeling that if there was to be a national resource to help promote and improve health then there needed to be more of a focus on putting together an evidence base for public health, supporting the workforce in putting that evidence base into practice, and in particular looking at health inequalities. Around that time I think there was a view that there might be two separate bodies, something like a Health Development Agency and a re-formed Health Education Authority. As it happened, the view was taken that there ought to be one body and that, in fact, the HEA would be closed down and a Health Development Agency opened from the resources of the HEA we supported this view. The Health Development Agency is a very different body. But I am sorry if we appear to have been diffident about our antecedents.

  275. I wondered if you were rather ashamed of it, but bearing in mind you chaired it as well—
  (Ms Buckland) Not at all. I can only pay tribute to my colleagues in the HEA, many of whom were absolutely instrumental in the transition from the HEA to the HDA. Indeed, in its early stages the HDA has built upon that body of work. Coming on to the budget, as I said the HDA was to pick up the resources of the HEA which at its point of closure were about £23 million. Our current budget is £10.3 million but I have to say this is our first year. We were only constituted in April, launched in June and, indeed, we did not get our Business Plan finally agreed until July. I think we will struggle to spend any more than our £10.3 million effectively and wisely in this first year. In our first year there has been a significant investment in our evidence base. I have to say, however, if we think about future years, and particularly the important role the Health Development Agency has in putting the evidence base into practice, then I think there will need to be access to additional resources or a rethink of what we are currently doing. Of course, we will also have to continue to develop the evidence base. It will be important to raise money from other Government departments for the funding of some of our work (which picks up on the discussion that public health should cross other Government departments) and also find ways to influence other moneys going into regeneration which will have an impact on public health.

  276. I would like to go on from exactly what you have just mentioned. According to your Corporate Plan, two of your early priorities will be fruit consumption, particularly for children, and targeting smoking cessation. Can you give an idea of exactly how the HDA is going to establish an evidence base? You have talked about the need to establish it but how are you going to establish it? What are you going to do?
  (Professor Parish) Thank you very much. These are two of our early priorities, they support both the same lines and some of the initiatives in the National Plan. If I pick up on the fruit and vegetable initiative in the first instance and then my colleague, Patti White, might pick up on the smoking issue. There will be a number of ways in which we are going to try to establish the evidence base. Firstly, to look at the feasibility of establishing an electronic register of the existing research. There is quite a bit of research about what works in terms of improving diet generally, less so around the specifics of fruit and vegetable consumption, particularly with youngsters. Part of our role, providing we have the resources in future years, will be to identify the gaps in that research base and to commission the additional work that might be necessary to fill those gaps. We are in discussion with the Food Standards Agency to ensure that we have a joined up approach. We will then be in the business, of course, of disseminating that evidence base to local planners and, indeed, advising on the inclusion of that evidence as the basis for health improvement programme planning and local community plans where it is necessary. It is perhaps also worth just adding, if I may briefly, that we have an ongoing evaluation of the National Healthy School Standard, which includes healthy eating and as the results of that evaluation become readily available again we will clearly make those results known to people in the field. We are specifically involved in evaluating the three pilot sites for the National School Fruit Scheme for four to six year olds, again jointly with the Food Standards Agency. There are other issues as well. I might just briefly mention that we work with the voluntary sector with an organisation called Sustain to look at the low income food database, so we have increasingly growing evidence about the specific issues around food, diet and low income families. I have tried to give you a bit of a Cook's tour to give you some indication as to how we might tackle that.

  277. Ms White, perhaps you could talk about the smoking side, that is one of your first initiatives.
  (Ms White) Yes, that is right. As the Committee will know from its recent and excellent inquiry about tobacco, there is a plethora of information about tobacco so we are not quite in the position of some other areas of health in that we have to establish a large database, but it is managing it as well. If I can give as a concrete example some work that we have recently produced about looking at smoking cessation guidelines for health professionals. As you may know, two years ago the Health Education Authority sponsored a project that looked at the cost effectiveness and effectiveness of advice to smokers and that was published in Thorax. Because of the changes in the environment since then and because there are constantly new papers published, particularly about the pharmacological treatments for smoking, we have updated those guidelines. The process of doing that was to commission that to three internationally recognised experts in the field who were responsible for the first lot of investigation. But they have gone further than that because they have an expert panel that they have consulted with and also 25 professional bodies in the UK, so they have done the literature review but gone on to consult more widely with other practitioners and other professionals. We are taking that piece of work forward into the field right now by trying to disseminate that information in a series of regional seminars that we are doing in co-operation with the Department of Health and the NHS Executive in all the regions of England to try to promote that information as much as possible.

  278. Do you feel confident that you can get their evidence into practice? Do you think that is what you will be able to do because one of the big things we have picked up is there is lots of research on smoking but actually getting that into practice to change behaviour is the difficult bit? How confident can you be?
  (Ms White) Because the evidence is very compelling, one of the things is to keep making that case in an articulate way. One of the things we do know about general practice is even in England with the very brief advice from general practitioners to 50 per cent of their smoking patients once a year, after a year we could have 55,000 ex-smokers in England. If they also prescribed nicotine replacement therapy or Bupropion that would give us an additional, say, about 27,000 ex-smokers. The evidence on the effectiveness and the cost-effectiveness of these things is very, very compelling. Our obligation is to make that case as clear as possible and also to make it to the practitioners that now there is a whole system through the National Health Service of trying to bring smoking cessation advice at the local level in a very effective way. Our job is to work with those people at the local level, with those practitioners, to give them appropriate information.

  279. Do you actually have links with the Department of Health research programme? Clearly they are doing research as well, so how are you linked up with them to make sure that you are not duplicating or missing information?
  (Professor Parish) We do link very closely with the R&D programme with the Department of Health. I might ask my colleague, Antony Morgan, to refer to that in a moment or two. If I can just make the link between your earlier question and the joining up with the R&D work in the Department. I do think we have to get a lot smarter about pulling the levers for change. It seems to me that we need to get better at building in the incentives and rewards to bring about change. So we provide incentives to encourage the change and then we reward, the money follows the changes that are made. If I can reflect on some of the earlier evidence you had this morning, we do need to get a lot better at defining the indicators for success, building this into the performance management arrangements that exist and, indeed, holding people to account for making the necessary changes. We do actually have a considerable resource out there that is available to enable us to do this. If I think, for example, of the funding that is available within the NHS for education and training and professional development, the NHS spends close to £1.5 billion a year on professional education and training in some form or another. Even if we just took one per cent of that, we are talking about £1.5 million and that could actually make a very significant change. We have got to get smarter at pulling the levers for change.

  Dr Stoate: Actually one per cent is £15 million.