Making Life Better 2013-2023: Strategic Framework for Public Health

Ministerial Statements – in the Northern Ireland Assembly at 12:15 pm on 24th June 2014.

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Photo of Edwin Poots Edwin Poots DUP 12:15 pm, 24th June 2014

With your permission, Mr Speaker, I wish to make a statement on the publication of the new strategic framework for public health 'Making Life Better 2013-2023'.  The framework will provide strategic direction for reinvigorated action to achieve better health and well-being for everyone and to reduce inequalities in health.  It has been informed by a number of key reports and bodies of evidence including 'Fair Society, Healthy Lives', the Marmot review of health inequalities in England; Health 2020, the European policy framework and strategy for health; the consultation response to the draft framework 'Fit and Well: Changing Lives 2012-2020'; and a report on health inequalities by the Health Committee. It has also been developed through cross-departmental and cross-sectoral engagement.  In addition, feedback from colleagues in the World Health Organization has confirmed its alignment with Health 2020. 

In relation to population health generally, we have made progress.  We are living longer than previous generations, and we are keeping healthy and active for longer.  This is good news. However, we also know that we continue to face real challenges.  Good health is not evenly distributed.  Some vulnerable groups and communities, including those living in deprived areas, continue to face worse health outcomes than the Northern Ireland average.  We have a growing and ageing population, with the prospect that many more people may live longer with chronic conditions.  This leads to ever-increasing demands on the health and social care system.  It is vital not only for the future sustainability of our health care system but for our vision of a vibrant, flourishing society that we rise to these challenges.  However, the health service alone cannot do this alone. 

Health is an outcome of a whole range of influences on everyday life and the accumulation of those influences over the life course from the very early stages through to later years.  This includes community, social and environmental conditions, which are in turn influenced by wider circumstances.  It is clear that many inequalities in health arise because of inequalities in the conditions of daily life.  Population health also impacts on other societal outcomes.  For example, we stand a better chance of achieving economic growth through improved health and a productive workforce.  Working together to secure improvement in the health of the population, especially if targeted at those most in need and with most to gain, is the right thing to do and an essential priority if we are to limit the growth in the cost of avoidable ill health to our society and economy.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

The Programme for Government acknowledges the inter-relationship between health, disadvantage, inequality, the social and physical environment and longer-term economic growth. 'Making Life Better' is, therefore, a building block towards the achievement of a number of the priorities identified in the PFG and, in turn, is affected by the achievement of other Programme for Government commitments.


'Making Life Better' is a 10-year overarching framework designed to provide strategic direction for policies and actions to improve health and well-being and address inequalities in health.  It aims to create conditions that are supportive of good health and in which people are enabled and supported in achieving their full health and well-being potential.  To achieve that, it is not just about action at government level, important though that is; it will require strengthened collaboration and partnership work at all levels of society to address the issues influencing the health and well-being of individuals, families and communities.

Based on learning from the previous strategy, Investing for Health, and on international evidence, including the recommendations of Health 2020, the new public health strategic framework will take a whole-system approach to improving health.  It recognises the need to collaborate around the wider societal influences that impact on health, such as education and literacy, employment and working conditions, income and housing.

I recognise that DHSSPS needs to continue to build strategic alliances across all parts of government in tackling many of the public health issues and inequalities that we face.  The ministerial group on public health has been the focal point for such work under the Investing for Health agenda.  Connections with the public health agenda are also made through a wide range of interdepartmental groups on issues such as Delivering Social Change, employment, neighbourhood renewal, fuel poverty and rural issues. Beyond Departments, local government and the voluntary and community sectors have been and will continue to be key partners in delivering the framework.  The reform of local government presents an opportunity to strengthen collaboration with councils, particularly on addressing health inequalities.  The Public Health Agency is working closely with local government to ensure that public health remains firmly on its agenda during and beyond the process. Many other organisations, including trade unions, professional bodies, advocacy and philanthropic organisations and funding bodies, and organisations in the private sector, make important contributions to public health, and we need to make and maintain effective links with them.

The framework sets out implementation and governance arrangements that will ensure a strong strategic lead at ministerial level and secure a joined-up approach across Departments. We have agreed that a ministerial committee for public health will be supported and informed by an officials' group from all Departments.  It is important that we provide a visible signal to the public at large of a commitment to strategic and coherent leadership at government level in relation to the health and well-being of our population.

A regional project board led by the Public Health Agency will drive delivery at regional level in collaboration with other key stakeholders, including local government and the community and voluntary sector.  At local level, partnerships will align with community planning arrangements over time.  We recognise that those groups also need to make effective links with other strategic groups, such as the Children and Young People’s Partnership.  Clear lines of communication between the levels of the system will be required, and processes will be developed to ensure effective communication and support arrangements within that overall structure.

The issues to be addressed in the framework are wide-ranging, so we have adopted a thematic approach.  The actions committed to in the framework are grouped around six themes that reflect a life-course approach and a focus on the wider factors influencing health.  Within each of those themes, there are particular outcomes that lend themselves to a cross-sectoral or thematic approach across Departments and organisations.  I have already described the need for joint working across government to address the wider structural, economic, environmental and social conditions impacting on health at population level.  That is recognised in the theme on creating the conditions.

The proposal to make a priority of giving every child the best start in life was supported strongly in the consultation on Fit and Well.  It is retained as a key theme, with a strong emphasis on empowering and supporting parents. National and international findings in relation to early years and the importance of parenting have reinforced the need for a specific emphasis on positive early years experiences as the foundation for realising the potential of children and young people and the best route out of poverty.

On top of what already is being spent through mainstream programmes by several Departments, including mine and the Department of Education, the £5 million funding from the OFMDFM Delivering Social Change framework to deliver increased direct family support and support for parents strengthens our capacity to intervene early in children's lives.  Making Life Better will promote a collaborative approach to bring about the incremental development of universal and targeted programmes to include antenatal and postnatal care and parenting programmes.

A further example of the commitment to early years intervention is the establishment of a cross-departmental early intervention transformation programme, with contributions from the Delivering Social Change programme, Atlantic Philanthropies and a collective of Departments:  DE, DEL, DOJ, DSD and DHSSPS.  DHSSPS will lead on the implementation of the programme.  Within the framework, there is also a focus on supporting individuals' transitions into and through adulthood and older age, highlighting the need to work together, for example, to provide the skills and support for employment and lifelong participation in society, and to enable older people to maintain active independent lives, fully engaged in society and their local communities.

A further focus is to empower people of all ages to identify the risks to their health, choose healthy behaviours and make informed decisions about their health.  As well as being taken forward through health promotion strategies, this is about an increased emphasis on improving health literacy, providing accessible and tailored advice and information, and embedding prevention across Health and Social Care services.  Legislation has been an effective mechanism to secure health improvements, for example, in relation to tobacco and road safety.

Importantly, there is emphasis, too, on building social capital — the links that connect people within communities, which can promote resilience against difficulties and give people a feeling of control over their lives.  It is also protective of health.  We want to see thriving, united communities.  That can be achieved only through a societal approach in full partnership with local communities to build on the assets we have in our communities, and to work in partnership with local government and other key agencies to address community issues.

The theme of developing collaboration identifies strategic and local actions to enhance collaboration, such as through the governance and implementation arrangements to ensure that health and health equity are considered coherently across ministerial and departmental policy in a health-in-all-policies approach.  As I said, we need action at local level as well.  Three issues are identified on which we are seeking to generate a collaborative response from local level up.  They relate to food, the use of space and the promotion of social inclusion.  The use of physical space is one example where collaboration for public health is needed.  Many reports identify how the quality of the natural and built environment impacts on physical and mental well-being.  The promotion of active travel, age friendly towns and cities, access to green spaces and to local services and the general appearance of our neighbourhoods are issues to which many sectors can contribute.  There is scope for creative solutions to address the many factors that influence health and health inequalities through better use of space, from local neighbourhoods up to strategic regional initiatives.

As an overarching principle, the framework recognises that addressing inequalities in health is not just a question of targeting the most disadvantaged in our society.  There are differences in health status right across the social spectrum.  Therefore, action needs to be taken right across the whole population, but with varying degrees of intensity according to need.  That is what the Marmot review calls "proportionate universalism".  The principle applies to many of the factors that influence our health.  The framework identifies some groups for which targeted action is needed, but it also recognises that decisions about targeted action should be taken at local level, depending on the health issue being addressed, local circumstances and need.

Funding from across local government is already committed to supporting the strategic actions identified in the framework.  For my part, I am continuing to progress the PFG commitment to increase the percentage of the overall health budget being directed to public health.  Not only will that support the framework in its aim of improving the health of the population and reducing inequalities, but the shift to prevention and early interventions is crucial to the sustainability of the health service.  Taking a whole-systems approach, I am alert to the opportunities to identify other funding sources, be they other Departments, philanthropic organisations or European funding sources.  I am also alert to exploring opportunities to pool resources where appropriate so that we optimise the public health benefits of spend from every source.

In conclusion, changes in population health and in health inequalities are a long-term goal.  For example, it will take at least a generation before we reap the benefits of our concerted efforts on early childhood development and support for parenting.  The capacity and efficiency of health and social care systems undoubtedly also has a key role to play in keeping people well.  It is vital that public health and well-being be placed at the centre of our healthcare systems, with increased emphasis on prevention and early intervention and on addressing health inequalities.  That is what Transforming Your Care and this framework, Making Life Better, seek to reinforce.  However, the health system on its own cannot tackle the root causes of poor health and well-being.  We must also look beyond health to a societal approach, requiring national leadership, strategic and local alliances and coherent collective and individual participation and action.

I thank ministerial colleagues for their support and cooperation in formulating the framework and look forward to working together to take it forward.  I also thank the Health Committee, whose inquiry report on health inequalities has helped shape the new framework.  It is vital that politicians, policymakers, health professionals, local government, other agencies and the public at large be aware of the impact on health and well-being of the economy and of the social and physical conditions in which we live and age so that, collectively, we can participate in making progress towards a healthier, more prosperous society.  That is what Making Life Better strives to do, and I call on you all for your support.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin 12:00 am, 24th June 2014

Go raibh maith agat, a LeasCheann Comhairle.  I thank the Minister for his statement and welcome it.  I think that it is a step in the right direction of developing cross-departmental priorities on public health and an outcome framework.

Given the high levels of health inequalities that exist, can the Minister explain how the whole-system approach will effectively target and eradicate the problem?  Will he also explain the roll-out of the £30 million early intervention fund and tell us whether the shift to public health aligned under TYC will mean that more money will be going to public health?

Photo of Edwin Poots Edwin Poots DUP

The fact that we meet as Ministers and representatives across Departments on the ministerial group is a demonstration that we are committed to a whole-system approach at Executive level.  I find those meetings very useful because I hear all the time about things that different people are doing in different Departments.  When we refer to the whole-system approach, it is good that we include local government, the voluntary sector, the lobby groups and, indeed, the business sector.  I have had meetings with various businesses that, for example, organise for some of the cancer organisations to come in and carry out work on-site.  So where you have 500 people employed on one site, you can get the Action Cancer Big Bus to come there.  You can get other organisations to come in.  A lot of companies are involved in doing pound-for-pound weight loss so they will sponsor people who are engaged in weight-loss programmes.  We have good support from the business sector as well as from the wider voluntary and community sector and other aspects of government, and that is what it is all about.

We in the Department of Health will respond to people's healthcare needs.  People can proactively avoid using the Department of Health and health services so much by taking actions.  We can work together to ensure that more people take those actions.  That is what the whole-system approach is about.

I welcome the £30 million of additional money that is coming in.  We will target a lot of that towards the early intervention transformation programme.  That will lead to investment in young children that will hopefully deliver better outcomes and truly challenge inequalities.  We have children who are being brought up in circumstances that will almost inevitably lead to them not doing as well in life as others.  If we can intervene to provide a greater level of support to those children, we will give them a much greater opportunity and ensure that they have an equal chance in life to the rest.  That is something that I wholly support.

Photo of Jim Wells Jim Wells DUP

The Minister has frequently highlighted the problem of obesity and the impact it is going to have on the health service in years to come.  Will he outline what action the strategy will take to deal with that very important issue?

Photo of Edwin Poots Edwin Poots DUP

Obviously, obesity causes a huge challenge to all of us.  Sadly, around 25% of children aged two to 10 are classified as being either overweight or obese.  Unfortunately, many of those children will never lose that.  It is something that they will have all their life.  I think that tackling obesity needs to be started from the earliest days, encouraging parents to manage their children's diets better, ensuring that more exercise is taken and so forth.  Some 62% of adults were classified as either overweight or obese.  A quarter of adults were obese, with a further two fifths classified as overweight.  Males are more likely than females to be overweight, so that is a message to all of us gentlemen.

Obesity causes all sorts of problems.  It is a major issue for diabetes and cardiovascular disease.  Its consequences are that many more people end up having to give up work early, and many more people end up reliant on the health service and on benefits because they have not taken enough control of their weight.  So, again, the public health agenda is critical to ensuring that we have a healthier population.  I referred to the businesses that are doing the pound-for-pound scheme.  It is an absolutely brilliant scheme.  One of them, I think, is in your area — B/E Aerospace actively engages with its workforce.  Business in the Community has been driving that.  I encourage more businesses to get involved in ensuring that they have a healthier workforce because, while they invest in all of that training and so forth, it is good to ensure that they will have their workforce there for a long time and have fewer problems with sickness.

Photo of Seán Rogers Seán Rogers Social Democratic and Labour Party

Thanks to the Minister for his statement, which I welcome.  I also welcome your commitment to tackling health inequality.  Given that the health service alone cannot address inequality, can you outline a strategic action plan for the proposed ministerial committee of public health?

Photo of Edwin Poots Edwin Poots DUP

I referred to the early intervention transformation programme.  We also have Delivering Social Change.  Both of those programmes are particularly important to us because they will ensure that we make a difference to people who are in areas of deprivation and perhaps have less opportunity.  Obviously, people need to engage themselves.  We cannot force people to participate, but, for example, we have directed £3 million for direct family support through the establishment of the 10 family support hubs to coordinate that early intervention service.  We have directed a further £2 million for support for parents, which will provide additional high-quality support to new and existing parents living in areas of deprivation.  On top of what is already being spent through mainstream programmes by several Departments, including mine and the Department of Education, the £5 million funding from OFMDFM's Delivering Social Change framework to deliver increased direct family support and support for parents strengthens our capacity to intervene early in children's lives.  I think that that is the one that will make the big difference. 

For some people, it will be much more difficult to change, but I think that, if you get in there at the early point with young children, provide that support and help and help them to make the right choices in life, we will reap a significant dividend in a generation to come.  So it is a long-term investment, but it is well worth making.

Photo of Roy Beggs Roy Beggs UUP

I, too, thank the Minister for his statement.  He has recognised the need for links to strategic groups such as the Children and Young People's Strategic Partnership.  I welcome that recognition of the importance of supporting children and young people in improving health outcomes, along with his recognition of issues that are related, such as education, employment and others that can create health inequality if they are not addressed.

I declare an interest as the chair of the Carrickfergus locality planning group of the Children and Young People's Strategic Partnership.  Does the Minister agree that the new councils, particularly with their increased planning powers, community planning role, local knowledge and contacts, will also be key players that a range of Departments, including Health, should be working closely with to bring about better outcomes by combining and making better use of departmental funding?

Photo of Edwin Poots Edwin Poots DUP

Absolutely. The Member is 100% right.  The PHA, for example, has partnered with DRD to commission the active school travel programme in the Belfast and south-eastern areas.  That programme is delivered through Sustrans, and the PHA invests around £70,000 a year in it.  In addition, the Belfast Strategic Partnership for Health and Wellbeing, which is led by the chief executive of Belfast City Council, the PHA and the Belfast Trust and includes representation from DRD, is exploring ways to make Belfast more cycle-friendly.

That is a demonstration of how it is being done in one council, but there are so many opportunities in a range of areas in which local government can engage not just with one Department but with a number of Departments.  To me, that is what community planning is about.  People maybe dismissed community planning in the early days when we talked about powers being transferred to councils, but it can make a real and fundamental difference if it is embraced and carried out properly.  We in government need to be prepared to work closely with local government to ensure that we can truly engage in community planning and make that difference for people on the ground.

Photo of Kieran McCarthy Kieran McCarthy Alliance

I welcome the statement.  There is a lot in it that we know about and that is already there.

There is a lot of hypocrisy going on.  The Health Minister talks about health inequalities, and our Committee is investigating that.  There is a glaring health inequality in that Northern Ireland, which is a part of the United Kingdom, cannot access over 39 cancer drugs.  The Minister has it in his power for that to be corrected.  We visited the cancer diagnostic centre last week, and it was unbelievable how —

Photo of John Dallat John Dallat Social Democratic and Labour Party

Order.  I am frantically searching for the question.

Photo of Kieran McCarthy Kieran McCarthy Alliance

When will we see equality in Northern Ireland with what they have across the water in relation to cancer drugs?

Photo of Edwin Poots Edwin Poots DUP

The question does not have much relevance to today's public health statement, but I will answer it in any event. 

The power lies with the House and the Executive to ensure that we do this.  I am committed to doing it. Those drugs are not NICE-recommended and are not part of the deal that has been done with the drug companies.  New drugs are coming onto the market that are NICE-approved, and we are buying them.  Let us be very clear:  we are talking about drugs that are not NICE-approved.  The Prime Minister has decided to go down a particular route in England.  We are buying drugs that they are not buying, but they are buying cancer drugs that we are not buying.  How do we resolve that, given that there is a £160 million gap between what I have to spend and what I need to spend?  Let us make it very clear: I do not have the money to buy those drugs.  Others choose to spend money on welfare, for example.  There is £120 million, which, if we signed up to welfare reform, would be in the Northern Ireland Budget.  That would quickly deal with most of the problems that I have and give me more freedom to do things in health.

In the absence of the money, I want to charge something for prescriptions.  Remember, in England, which the Member referenced, there is an £8 charge for every prescription.  I want to charge something.  It could mean a few pounds on the old scheme, in which only 11% of prescriptions were paid for, with a maximum cap or a charge of as little as 50p for all prescriptions, again with a maximum cap of £25 a year, for example, which would be 50p a week.  I am firmly of the view that the vast majority of people in Northern Ireland want to support those with cancer and would be prepared to do that.  I am firmly of that view.  I need the support of the House to deliver cancer drugs, and I implore the House to give me that support to buy the cancer drugs instead of putting me in some sort of chained-up position where I cannot do it and then condemning me for not doing it.  Give me the support to do it, and I will certainly buy the cancer drugs. I will buy them straight away if the House gives me the support to do it.

Photo of Pam Cameron Pam Cameron DUP 12:45 pm, 24th June 2014

I thank the Minister for his statement to the House, and, indeed, I support him in his impassioned plea for the support of the House for the cancer drugs fund.  What progress is being made in tackling teenage pregnancy?

Photo of Edwin Poots Edwin Poots DUP

Teenage pregnancy has been talked about a lot over the years.  I am glad to say that teenage pregnancy figures have been coming down, and that is good.  It is good that we have more awareness of sexual activity, and, consequently, that is the case.   In Northern Ireland in 2013, there were 937 births to teenage mothers under the age of 20, and there were 90 births to teenage mothers aged under 17.  The rate in the most deprived areas is around twice the Northern Ireland average, so, obviously, there is work to be done there in education, which, again, goes back to early years and working with young people throughout school to encourage them to learn more about what comes from sexual behaviours and therefore be able to take actions to avoid unwanted pregnancies. 

As I said, our rates of birth to teenage mothers have reduced, but I do not think that we can be complacent.  The Public Health Agency, through the sexual health improvement network, has been asked to seek to reduce rates of teenage pregnancy further.  Programmes such as the Family Nurse Partnership provide intensive support to assist young parents through those early years, so that it does not happen again very quickly and there is greater support for them.  It also encourages young men to take responsibility for the children that they bring into the world. Far too often, young men bring children into the world and take nothing to do with them.  That is one of the things that Family Nurse Partnership engages proactively in.  It gets the young dads involved, and it is amazing to see the positive responses that we get from the young men and the changes that it can make in their attitude.  It is absolutely critical that we continue to do that.

Photo of Michaela Boyle Michaela Boyle Sinn Féin

Go raibh maith agat.  I thank the Minister for the statement to the House.  Minister, yesterday in the Long Gallery, you were present when we met parents and staff involved in palliative care for children.  Of course, we also met little Blake, who made an impression on everybody.  They were there lobbying for much-needed investment for proposals coming out of the review of palliative care for children and young people.  How will the new strategy complement what is already there to increase cancer awareness and address the issues that the parents raised yesterday about palliative care for children and young people?

Photo of Edwin Poots Edwin Poots DUP

The review of palliative care is close to my heart, and you could not help be touched by the stories that were told by the parents.  Indeed, young Blake was quite a star, particularly with the ladies.  He seemed to be very fond of the women, and they all seemed to be very fond of him too.  He was an absolute star. 

The recommendations that have been made are rational and sensible, and we need to look at how we can provide the support that is needed for them.  One of them, for example, is to provide a key worker for when someone gets the awful news their child has a condition that will shorten their life and they need a lot of support.  Their entire focus will be on providing support and care for the child, which often leads to the point where they are so dedicated to helping the child that they do not get the support and help that they need, and it is important that they get that. There is a lot of work to be done on that. 

How that ties in with this document is quite loose.  This document is about people taking the right steps to ensure that we have a healthier population.  Unfortunately, many of the young people involved have been born with long-term conditions that will lead to their early passing.  If there is a means of tying it up, we certainly will, but we also need to look at how we can provide the support and the funding to ensure that we can support the parents of children who have those long-term conditions and have palliative care requirements.

Photo of David McIlveen David McIlveen DUP

I thank the Minister for his statement.  He will be aware that, when it comes to our rural communities and the promotion of health services, it can, at times, be quite challenging to get the message into our more isolated rural areas.  Can the Minister give us an indication of how his Department plans to deal with that issue specifically?


Photo of Edwin Poots Edwin Poots DUP

Some good work has been going on.  In the Member's area, the Northern Trust has done a lot of work.  It has gone out to farmers' markets, for example.  When you get a couple of pleasant-looking nurses, the farmers seem very keen to go in and get a check up, for whatever reason.  Taking the case to the people, as opposed to expecting the people to come to it, is working.  We identified issues where people had particularly high cholesterol levels, and recommendations were made immediately.  We also identified mental health issues and cardiovascular disease — a whole range of issues.  That work has been hugely beneficial.  The Northern Trust is engaged in work on mental health as well. 

I would welcome that type of activity throughout the other trusts that have a rural reach.  It is important, particularly as we have quite an older population in the rural community who tend not to bother with doctors too much until it is too late.  We want people to have those interventions carried out early, and, as a consequence, the outcomes will be considerably better.

The sitting was suspended at 12.52 pm.

On resuming (Mr Deputy Speaker [Mr Beggs] in the Chair) —