We need strategic leadership for island’s health promotion

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I write concerning the article by Jackie Turley in the Manx Independent of the February 11 concerning a ‘new direction’ for the Department of Health with a refocus of health services from ‘providing cures to prevention and early detection’.

For the last 40 or so years the focus on the British National Health Service has steadily gone from primary to hospital-based secondary care led service provision with increasing costs being incurred by the latter.

It is therefore right that some balance of care is now being restored and that the Minister of Health commented that the department ‘optimise our resources and target the areas that will be most beneficial to our population’.

He went on to give details of some of the possible new priorities and their ‘delivery within the community if there were professionals to provide it’. I would like to comment mainly on the latter.

The minister is quite right in attempting to develop care from secondary back to primary care and to go from health treatment or maintenance back to that of prevention. As he states, this is not a new message. The problem that the department will face however is how to get this message across to the population and with the appropriate qualified and led staff to do so.

When I joined the Directorate of Public Health within the healthcare division of the Department of Health and Social Security we had both a director of health promotion and a joint director of public health/chief administrative medical officer. In 2001 there were also separate budgets for both these quite specific but related functions within overall public health.

The first director of health promotion retired in January 2003 and her successor, due to internal directorate problems, left two years ago. Both the latter and your correspondent were qualified in both general specialist health promotion and specialist public health respectively at postgraduate masters level as would be expected for appointment in other health regions within the British Isles. However, since 2009 there has been no health service graded replacements in the Directorate of Public Health for either a director of health promotion or a general specialist in public health.

Operating within the field of general education the Life Education Team based at Santon was also drastically reduced in 2010. Both the Life Education Team and other health education and promotion officers based in the mental health and drugs and alcohol areas partnered and complemented the overall health education and promotion provision previously spearheaded by the joint Directorate of Public Health throughout the island.

While the promotion of health is ‘everybody’s business’, health behavioural change initiatives, that can alter lifestyle risk factors and reduce ill health and disease and their related costs, has to be to strategic, led at an appropriate qualified level to allow the other medical, nursing and other health practitioners to effectively fulfil their role.

We should all welcome ‘A Strategy for the Future of Health Services in the Isle of Man’ as a long-delayed first step in how our health services will be run, but likewise, we should insist that the necessary strategic leadership and appropriately directed staff are provided to implement its recommendations – otherwise it will fail.

ROBERT LOUDON BROWN

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