Intended for healthcare professionals


How family friendly is the UK?

BMJ 2011; 343 doi: (Published 04 August 2011) Cite this as: BMJ 2011;343:d4823

Re:Overpopulation and family health

Caan's editorial (i) highlights five factors identified by the
Relationship Foundation that lead to poverty: family breakdown, economic
dependency and worklessness, educational failure, addiction, and personal
indebtedness. He laments that the public health community has failed to
take effective action against them and goes on to suggest that health and
social care commissioners will need to work differently in the new NHS.

However, in focusing on health and social care commissioners, he
highlights one of the problems with previous approaches. If real change is
to occur, it will require securing commitment from a broader spectrum of
players beyond health and social care commissioners to tackle these
problems, given the complex, multi-factorial nature of these problems.

The Department of Health appears to recognize this in its recently
published Update on the Public Health White Paper (ii) which suggests that
membership of the Health and Wellbeing Boards could include local employer
organisations, Job Centre Plus, Work Programme Providers, criminal and
justice agencies and housing services.

The main challenge will be in the implementation of this strategy.
Lessons from earlier experiments with the cross-organizational Local
Strategic Partnerships (LSPs) may be relevant here. In their evaluation of
LSPs Geddes et al (iii) described two models of Local Strategic
Partnerships (LSPs): a successful 'virtuous circle' model where political
stability and trust between engaged partners results in positive outcomes
being achieved and an unsuccessful 'vicious circle' model where partners
fail to engage, often due to ineffective leadership. It will be important
for the Health and Wellbeing Boards to learn from these models in order to
build on their successes and avoid their mistakes in tackling the roots of
deep-seated social problems.

(i) Caan W. How family friendly is the UK? BMJ 2011; 343:d4823

(ii) Healthy Lives, Healthy People: Update and way forward. HM Government
July 2011

(iii) Geddes M, Davies J, Fuller J. Evaluating Local Strategic
Partnerships: Theory and practice of change. Local Government Studies
2007; 33:97-116

Competing interests: No competing interests

17 August 2011
Ike Anya
Consultant in Public Health Medicine
Jamie Lopez Bernal, ST1 ACF in Public Health Medicine
Inner North West London Primary Care Trusts