Features: July 4th, 2003

Taking Control

By Derek McAuley

Reproduced by permission of the Public Management and Policy Association.

Health inequalities are no longer hidden in the attic like an embarrassing relative and the issue is now central to the policy agenda of the New Labour Government. However, despite five decades of NHS provision, health inequalities have widened and not narrowed.

There is a need for innovative and exciting community-based solutions drawing upon themes of dialogue and participation. The NHS should merely be one partner; albeit with lots of potential, for example, as an “engine of regeneration”. The challenges that this approach poses for health professionals, and also the Government with their target driven approach to health improvement, are primarily cultural and require new ways of working and a move away from saving lives to promoting health.


The recently published NHS Leadership Qualities Framework (NHS Leadership Centre) includes a cluster of qualities surrounding the setting of direction. An outstanding leader will set a vision, drawing upon his or her political awareness of the health and social care context. An understanding of health inequalities needs to be central to this approach, particularly given its recent inclusion in the priorities and planning guidance for the next three years and as it, for the first time, forms part of the performance management regime.

Development programmes for public sector leaders should address the serious gaps in knowledge and understanding across sectors, and far too often there has been a focus upon “business” skills to the detriment of a wider social perspective. Healthcare managers are accustomed to engaging with disparate staff groups in a highly political environment, but need to develop the skills to transfer this experience and knowledge to the wider public health arena. Participative approaches require a management style underpinned by, for example, some basic facilitation skills.

Partnership working

The WHO has argued that inter-sectoral collaboration is central to the achievement of greater equity in health but an Expert Meeting in 1998 found that there was a danger that the rhetoric surrounding such processes was stronger and further developed than the practice. This is a warning to those preparing Local Delivery Plans.

One service area where managers and clinicians are engaging with the users and carers in innovative and challenging ways is mental health. There is now a consensus around the need to address housing, employment and social needs, as well as clinical, and where health and social care are increasingly integrated.

More fundamentally health inequities highlight issues of shared values in a diverse community. How do we find consensus across the boundaries of age, mobility, faiths, ethnic origin or economic disparities? This leads us to governance concerns and Labour’s “New Localism, particularly the controversy surrounding foundation trusts and the benefits of decentralisation as an underpinning theme of Government policy. It is only by engaging with local communities that the NHS and local government will shift public perceptions away from health to health services.

Derek McAuley, who is with the Mersey Care NHS Trust, represents the Institute of Healthcare Management on the PMPA Advisory Board but writes in a personal capacity.