The first year of Health Improvement Programmes; views from Directors of Public Health

The White Paper The new NHS, modern, dependable gave the strategic lead at the local level in the new National Health Service to Health Authorities (Boards in Scotland and Northern Ireland). They are expected to lead the development of strategies that will identify the health needs of local people and what has to be done to meet them. These Health Improvement Programmes (HImPs) will be the local strategy for improving health and health care and the means to achieve national targets for each Health Authority or Board area.

To assess the strengths and weaknesses of HImP production for 1999, a questionnaire survey was carried out of Health Authorities or Boards throughout the United Kingdom. Participants were all district Directors of Public Health (DsPH) or Chief Administrative Medical Officers (CAMOs). The main outcome measures were the opinions of DsPH or CAMOs on the successes and failures of their local HlmP process.

Ninety-three (83.8 per cent) DsPH responded. In just over half of all Health Authorities or Boards (56 per cent) the DsPH had taken the lead in producing the HlmP. Many aspects of the HlmP process went well, including multiagency 'stakeholder' involvement and partnership working, good project management, and agreeing a limited set of priorities for action. Key problems included: the short timescale and late Departments of Health guidance; difficulty in obtaining commitment from some local 'stakeholders'; linking HlmP aspirations with service and financial planning and securing funding for HlmP priority developments. Action plans to improve health and health care services were well developed in 40.5 per cent of HlmPs. This was less so for social services (8.3 per cent). It was too soon to assess the impact of HlmPs on the public's health.

DsPH or CAMOs and local 'stakeholders' have been on a learning curve for HlmP production during 1999. Lessons learnt will translate into better HlmPs for next year. DsPH urged the Departments of Health to fully support HlmPs through resources and management processes so that HlmPs can realize their potential benefits for local populations.