Manipulated Media - the Faculty of Public Health Makes Sure Its Views Are Heard, Again - Literature review Example

blank for your cover page) Manipulated Media: FPH Makes Sure Its Views Are Heard, Again Introduction A “placed” news article is a common result of public relations activity, and while we as consumers of the media usually cannot tell with absolutely certainty whether news items are “placed,” or whether they are presented as the result of objective journalistic work, there are several characteristics of “placed” articles that suggest their origins. For example, an article that presents the point of view of a single organisation, and which follows a press release or other publicity on the same topic by the organisation itself is, in all likelihood, a “placed” article. Such is the case of two articles about the current debate over reforms to the National Health Service; one article appeared in The Telegraph on 5 March, and the second appeared in The Guardian on 18 March, and both present the position of the Faculty of Public Health, which the latter first announced in a press release on 8 February (Campbell, 2012; Smith, 2012; Faculty of Health, 2012). This report will present a summary of the two articles, followed by an analysis of the “plant” by the FPH and the aims and objectives of the organisation in its public relations approach. The two articles will be analysed in-depth in the context of applicable theoretical concepts of media and communication, and the similarities and differences between the two articles will be compared. Finally, an overall assessment of the effectiveness of the two articles is presented. Summary of the Articles The first of the two articles is written by Medical Editor Rebecca Smith of The Telegraph, and appeared under the headline “Public health could be ‘devastated’ by NHS reforms warn doctors” on 5 March 2012. The second article appeared in The Guardian approximately two weeks later on 18 March; it is entitled “Doctors make last-ditch warning over NHS shake-up,” and carries the by-line of health correspondent Denis Campbell. For this assessment, the online versions of the articles were examined, and these are included as appendices at the end of this report. From The Telegraph, 5 March 2012: The lead of the story, which is presented in heading-style text above the accompanying picture and author’s by-line, gives a statement by “doctors” that the NHS’ programmes could be “devastated” by the proposed reforms, because local councils may divert money intended for health care to other expenses. Health care programmes that are “under threat,” according to the sources – who are not specifically identified until the second half of the article – include immunisation, cancer screening, mental health, and smoking cessation programmes (Smith, 2012). The sources of the information are identified as Professor Martin McKee of the London School of Hygiene and Tropical Medicine, and Dr. David McCoy, author of the report on which the article is based, which was written under the aegis of “The Public Health for the NHS network - made up of former Presidents of the Faculty of Public Health and more than fifty Directors of Public Health” (Smith, 2012). Both experts are directly and indirectly quoted in the article. In the last three paragraphs of the article, an unnamed spokesperson for the Department of Health is quoted, offering a counterpoint, but in an indirect way, to the assertion of the doctors that the health care funds will be misspent, saying that “...councils will be able to decide what the most important public health concern is for them and spend the money appropriately.” (Smith, 2012) From The Guardian, 18 March 2012: The article from The Guardian focuses on the shift of key health care services from the NHS to the private sector under the proposed reforms, and says that an assessment by “leading doctors” found “...the changes will result in worse care for millions of patients, with serious conditions such as cancer, wider health inequalities and poorer patients being disadvantaged.” (Campbell, 2012) The source of the assertion is identified as “an assessment by the Faculty of Public Health (FPH)” in the third paragraph of the story. The expert quoted for this article is Dr. John Middleton, Vice-President of the FPH, whose comments explain in some detail how the reforms – according to the FPH’s report – will create confusion for patients and health-care providers, and present obstacles to poorer or less-informed patients being able to find and afford needed medical care. As in the article in The Telegraph, the essential point is made that it is the position of the FPH that the reform bill should be scrapped. At the end of the article, in the last paragraph-and-a-half, Health Minister Simon Burns is quoted to provide a counterpoint to the FPH’s assertions, most notably with the direct quote that “This report is scaremongering.” (Campbell, 2012) Evidence of a ‘Place’: The FPH Press Release On 8 February, the Faculty of Public Health issued a press release entitled, “Faculty of Public Health calls on government to withdraw Health and Social Care Bill ‘in best interests of everyone's health’,” in which it presents the results of a survey of FPH members in which 93% of the respondents “...said that the Health and Social Care Bill, if passed, would damage the NHS and the health of people in England. Three-quarters of our members called on FPH to demand the complete withdrawal of the health bill.” (FPH, 2012) The statement, which contains a few quotes from FPH President Dr. Lindsey Davies, points out that it is the FPH’s judgment that “...the bill will lead to a disorganised NHS with increased health inequalities, more bureaucracy and wasted public funds.... There are major concerns about how emergency planning, screening and immunisation services will work.” (FPH, 2012) There are several indications that this press release resulted in the two stories being placed in The Telegraph and The Guardian. First, this is the most recent “assessment” of any sort published by the FPH; a search of the organisation’s website did not reveal any more recent reports or statements on the NHS reform issue. Second, both articles address the salient points made in the press release in much the same terms, albeit in greater detail – health inequalities, harm to specific health services like screening and immunisation, and funding risks. Third, in the “Notes to Editors” at the end of the press release, “editors” are invited to contact the organisation for further information or for interviews with Drs. Davies or Middleton; the latter was interviewed by The Guardian. Furthermore, a review of links provided on the FPH website about media attention to their statement of 8 February shows that news immediately after it was released did not highlight the FPH’s position perhaps as much as they would have liked. For example, an article in The Guardian on 9 February mentioned the FPH statement, but focused on the position of the government and was entitled “No alternative to NHS reforms, say coalition” (Wintour & Jovit, 2012). Finally, the best piece of evidence is found on the online version of The Guardian’s article: a hyperlink (assessment by the Faculty of Public Health) included in the article text points to the FPH’s homepage, where readers are immediately greeted by a statement (which itself features a link to the press release) on “FPH’s position on the Health and Social Care Bill” (Campbell, 2012; FPH, 2012). Analysing the FPH’s Aims & Objectives The obvious overall objective of the FPH is to prevent the NHS reforms through the Health and Social Care Bill, but what is the aim of placing stories in newspapers with large print and online circulations? There are really two audiences for the FPH’s position. The first is the immediate one, the news-reading public, who also happens to vote in elections. The essential point made by the FPH’s press release and repeated in the two news articles is, “the proposed reforms will be harmful to peoples’ health.” This is an example of a use of media in a constructivist paradigm, where the intent is not only to determine what people think about with respect to politics or a particular political issue, but also how they feel about it; in other words, the media “constructs” politics for the readers (Street, 2005: 23-26). The second audience are the “elite” decision-makers, in this case, primarily government officials who will be the ones to ultimately decide whether or not the NHS reforms push through, are discarded, or are modified; because the action which the FPH wishes to prevent is in their hands, they are a rather more important audience (Davis, 2003: 674-675; Dinan & Miller, 2009: 250). By obliging the “elite” audience to respond to their point of view, the FPH – which is another “elite” actor – frames the issue as an elite discourse, essentially asking the public reader to decide which authority he wishes to trust on a matter concerning his health, the doctors or the government (Simon & Xenos, 2000). The particular ways in which the two articles help the FPH do that is discussed in the following sections. Analysing The Telegraph’s Article: Agenda & Target Audience The target audience of The Telegraph article is primarily the heath-care consuming public, which can be seen by the article naming specific health-care issues that will be affected by the reforms, such as immunisation and screening programmes (Smith, 2012). The agenda of the article clearly is to encourage support for the FPH’s position on the NHS reforms, an issue bias that can be explained by a number of factors. First, we can see here Chomsky’s and Herman’s third filter of the propaganda model at work, the reliance on information from “experts” and other agents of power (Chomsky & Herman, 1988; Davis, 2000: 39-40). Second, print journalists in particular have a slight natural bias against politicians as sources compared to equally-credible sources; the bias is subtle, but perceptible, according to studies conducted on media bias (Patterson & Donsbach, 1996: 466; Page, 1996). Third, there is the old axiom that “bad news is more interesting than good news”; by framing a political debate on an issue as a kind of crisis, the issue attracts more attention. The way this is accomplished is best explained by the techniques used in the article. Techniques Used by the Article The article in The Telegraph employs a narrative, hard-news technique to reporting the story, making the treatment of the issue of the NHS reforms more like that which would be given to an event in two ways: First, by using the occasion of the FPH “report” as an event context, and second, by adopting a lead-dominated format; the threat to health-care services, in the sense that some which exist at the present time may become unavailable, is treated as a “normative breach”, which justifies the tone of the article that implies a crisis (White, 1997: 104). Analysing The Guardian’s Article: Agenda & Target Audience The target audience and agenda of The Guardian article is generally the same as that of the article in The Telegraph. It is addressed to people who are concerned with efficient health-care services, and presents a decidedly negative view of the proposed NHS reforms (Campbell, 2012). If anything, The Guardian is more direct than The Telegraph in promoting the FPH’s agenda; the article contains a direct link to the FPH website, and extensively quotes one of the FPH officers named by the press release issued by the organisation in February. Techniques Used by the Article The article takes a similar hard-news, narrative approach to the story as the one in The Telegraph, but it is slightly modified, relying on more detailed explanations to build credibility (Simon & Xenos, 2000). The weight of credibility to the article’s primary source – the FPH, represented by Dr. Middleton – is reinforced by the none-too-subtle bias against the government’s opposing view, expressed by the “scaremongering” dismissal of the FPH’s views by Health Minister Burns (Campbell, 2012). Another way in which the article makes an appeal to emotion is with the picture that accompanies it: Which bears the caption, “The document echoes previous warnings on child health and the protection of children from abuse, partly due to weaker information sharing.” (Campbell, 2012) The implication, of course, is that the proposed reforms will be harmful to helpless little babies. Similarities & Differences Between the Two Articles The two articles are similar in their narrative approach, treating an ‘issue’ more like a hard-news ‘event’, although they do so in different ways: The Telegraph relies on a dominant lead – in quite an obvious fashion, as it is printed in boldface directly below the headline – while The Guardian does so more subtly, providing an emotional image to accompany the article (White, 2007). Both are similar in following a “public information” model of public relations; the articles are very one-sided, with the opposing viewpoints only given cursory attention and relegated to the end of the articles (Grunig, 1996: 464; Dinan & Miller, 257). The articles are also similar in being forms of elite discourse; while the initial audience is the public, the message is ultimately intended for the audience which can directly act upon the issue at hand, the government, which is another elite (Davis, 2003: 673). One area in which the articles differ to some degree is in the level of media literacy each of them addresses; The Telegraph article is written in simpler language, with shorter, less-detailed paragraphs for the benefit of content-literate audience, while The Guardian relies on more extensive, and at times complex text for the benefit of both a content- and grammar-literate audience (Meyrowitz, 1998: 97-100). The particular focus of each of the articles matches this pattern; The Telegraph primarily addresses health concerns, a topic that is likely understood by a greater number of readers than The Guardian’s focus on more financial and organisational issues. The Guardian, however, tempers this approach with the choice of image for the article, while The Telegraph does the opposite, using a generic image of an NHS facility’s sign. Critique: Did The Articles Achieve Their Purpose? It is difficult to judge objectively whether or not the articles achieved their purpose of adequately publicising the position of the FPH on the NHS reforms; the issue is yet to be decided in the government, and when it finally is, it will be difficult if not impossible to show cause rather than just correlation between the articles and the outcome. On this question, the author can only offer a personal observation: Without much foreknowledge of the NHS reform issue, and even recognising the constructivist nature of the news articles, I now view the matter with some concern, and consider that the reforms might not be in the public’s best interests. In that respect, it seems the articles are effective, and did achieve their purpose. Conclusion The two articles in The Telegraph and The Guardian present the negative views of the FPH toward the proposed reforms to the National Health Service, presenting a selective reality of a current issue (Chomsky, 1989: 151; Herman, 2000: 106), and doing so quite effectively. They are follow-ups of a press release issued by the FPH, and reveal sufficient evidence to make the presumption that they can be considered “placed” stories. They appear to fit not only Chomsky’s and Herman’s (1988) propaganda model, but also the constructivist model of media in politics (Street, 2005), which seeks to shape the readers’ perceptions of political issues. References Campbell, D. 2012. Doctors make last-ditch warning over NHS shake-up. The Guardian [online], 18 March 2012. http://www.guardian.co.uk/society/2012/mar/18/doctors-warning-nhs. Chomsky, N., and Herman, E. 1988. Manufacturing Consent: The Political Economy of the Mass Media. New York: Pantheon Books. Chomsky, N. 1989. Necessary Illusions: Thought Control in Democratic Societies. Boston: South End Press. Davis, A. 2000. Public relations, news production, and changing patterns of source access in the British national media. Media Culture & Society, 22(1): 39-59. Davis, A. 2003. Whither mass media and power? Evidence for a critical elite theory alternative. Media Culture & Society, 25(5): 669-690. Dinan, W., and Miller, D. 2009. Journalism, Public Relations, and Spin. In: K. Wahl-Jorgensen and T. Hanitzsch (eds.), The Handbook of Journalism Studies, 250-264. New York: Routledge. Faculty of Public Health. 2012. Faculty of Public Health calls on government to withdraw Health and Social Care Bill 'in best interests of everyone's health'. Press Release, 8 February 2012. http://www.fph.org.uk/media_centre. Grunig, L. A. 1996. “Public relations.” In M. B. Salwen and D. W. Stacks (eds.), An integrated approach to communication theory and research, 459–477. Mahwah, NJ: Erlbaum. Herman, E. S. 2000. The Propaganda Model: a retrospective. Journalism Studies, 1(1): 101-112. Meyrowitz, J. 1998. Multiple Media Literacies. Journal of Communication, 48(1): 96-108. Page, B.I. 1996. The Mass Media as Political Actors. PS: Political Science and Politics, 29(1): 20-24. Patterson, T.E., and Donsbach, W. 1996. News Decisions: Journalists as Partisan Actors. Political Communication, 13: 455-468. Simon, A., and Xenos, M. 2000. Media Framing and Effective Public Deliberation. Political Communication, 17: 363-376. Smith, R. 2012. Public health could be ‘devastated’ by NHS reforms warn doctors. The Telegraph [online], 5 March 2012. http://www.telegraph.co.uk/health/healthnews/9122052/Public-health-could-be-devastated-by-NHS-reforms-warn-doctors.html. Street, J. 2005. Politics Lost, Politics Transformed, Politics Colonised? Theories of the Impact of Mass Media. Political Studies Review, 3: 17-33. White, P.R.R. 1997. Death, Disruption and the Moral Order: the Narrative Impulse in Mass-Media Hard News Reporting. In: F. Christie and J.R. Martin (eds.), Genres and Institutions: Social Processes in the Workplace and School, 101-133. London: Cassell. Wintour, P., and Jowit, J. 2012. No alternative to NHS reforms, say coalition. The Guardian [online], 9 February 2012. http://www.guardian.co.uk/society/2012/feb/09/no-alternative-nhs-reforms-coalition. FPH Press Release Article link: http://www.fph.org.uk/media_centre Media Centre Contact details: FPH Policy and Communications 020 7935 3115 Latest press release: 8 February 2012 Faculty of Public Health calls on government to withdraw Health and Social Care Bill 'in best interests of everyone's health' Since the NHS reforms were first announced, the Faculty of Public Health (FPH) has been lobbying hard for changes to ensure people’s health is properly protected at all times. We recognise that the government has addressed some of our concerns about the public health aspects of the Health and Social Care Bill. However, the results of our latest survey of members found that 93% of those responding said that the Health and Social Care Bill, if passed, would damage the NHS and the health of people in England. Three quarters of our members called on FPH to demand the complete withdrawal of the health bill. Professor Lindsey Davies, President of FPH, said: "We are now calling on the government to withdraw the bill in its entirety because it would be in the best interests of everyone's health. "Our 3,300 members – experts in planning and providing for people's health – have been closely involved in trying to make the government's proposed reforms work since they were first introduced. Based on our members' expert views, it has become increasingly clear that the bill will lead to a disorganised NHS with increased health inequalities, more bureaucracy and wasted public funds. "The bill will increase health inequalities because there is the real danger that vulnerable groups, such as homeless people, will not be included when health services are being planned. Clinical commissioning groups and service providers will be able to pick and choose what procedures they perform and which services they put in place." Unless the bill is withdrawn, FPH's concern is that the NHS will lack the strategic leadership needed to deliver an effective and integrated service. There are major concerns about how emergency planning, screening and immunisation services will work. The bill does not make it clear what costs the NHS will be expected to cover if private providers go bankrupt. Professor Davies continued: "We also face increasing costs for health services as the private sector will need to make a profit out of commissioning and running NHS services. This will use more taxpayer's money that could be used for patient care. At a time when the NHS needs to save £20 billion, this is an unaffordable and unnecessary burden on the NHS. "Like our members, we make decisions based on the best available evidence, and we have a clear mandate from them to take this position. We do not do this lightly. We will continue to do all we can to take make sure this bill is fit for purpose." NOTES TO EDITORS About the Faculty of Public Health (FPH) FPH is the standard-setting body for public health in the UK with more than 3,000 specialist public health members. FPH is a registered charity and advocates for better public health in the UK and around the world, by stimulating debate on promoting, protecting and improving the public's health. Almost 40% of our members took part in the survey: we had 1,286 responses to the electronic survey, representing 39% of the membership. We also had 78 responses to the postal survey. The full results will be available on our website, www.fph.org.uk. Please contact us for further details or to arrange an interview with Professor Davies or John Middleton, FPH's Vice President. Liz Nightingale, Media and PR Officer: tel 020 7935 3115, email liznightingale@fph.org.uk, mobile 07773 350833 or Mark Weiss, Policy Officer, tel 020 7935  0243, email markweiss@fph.org.uk  Summary of the survey results: Do you: Consider that the Health and Social Care Bill, if passed, will damage the NHS and the health of the public in England? Yes: (1247)  92% No:  (57)  4% Don’t Know: (50) 4% Call upon the Faculty of Public Health to demand complete withdrawal of the Health and Social Care Bill? Yes: (999) 74% No: (225) 17% Don’t Know: (124)  9% Call upon the Faculty of Public Health to seek an alliance with the RCGP, other medical Royal Colleges and other bodies to oppose the Bill? Yes: (1207)  89% No: (225)  17% Don’t Know: (124)  9% In the event that FPH adopts a position calling for the withdrawal of the Bill, do you consider: That FPH should continue to engage with parliamentarians, in both the Lords and the Commons, to seek amendments to the Bill? Strongly Agree    777    58%    Agree    373    28% Neither agree nor disagree    85    8% Disagree    58    4% Strongly Disagree    40    3% That FPH should continue to engage with ministers and civil servants on matters related to the Bill and its implementation? Strongly Agree    714    54% Agree    382    29% Neither agree nor disagree    98    7% Disagree    75    6% Strongly Disagree    62    5% Article from The Telegraph Article link: http://www.telegraph.co.uk/health/healthnews/9122052/Public-health-could-be-devastated-by-NHS-reforms-warn-doctors.html Public health could be 'devastated' by NHS reforms warn doctors Public health programmes could be "devastated" by the Government's controversial reform of the NHS, as councils take money set aside for much-needed projects, doctors have warned. Leading public health experts said the NHS will become fragmented and confused Photo: ALAMY By Rebecca Smith, Medical Editor 7:00AM GMT 05 Mar 2012 Services under threat include immunisation programmes, cancer screening, mental health, tobacco control and smoking cessation, a report said. Leading public health experts said the service will become fragmented and confused. They called for the Health and Social Care Bill to be withdrawn saying it is "disastrous" and not needed. Under the reforms, responsibility for much of public health will pass to local authorities. But these authorities they are already planning on spending the funds on other things because they are facing enormous budget cuts, it was warned. Related Articles Health Bill will 'make doctors' work harder' 01 Mar 2012 BMA calls for 'active stand' against health bill 01 Mar 2012 Smear tests raise chances of beating cervical cancer to 9 in 10 02 Mar 2012 The Public Health for the NHS network - made up of former Presidents of the Faculty of Public Health and more than fifty Directors of Public Health - today say said public health commissioning should remain within the health service. Prof Martin McKee, professor of European Public Health at the London School of Hygiene and Tropical Medicine, said although Health Secretary Andrew Lansley has said that public health funding will be ringfenced it is difficult to ensure that in practice. He said councils were already planning to use public health funds to fix roads on the basis that potholes are a hazard for cyclists. Others want to use the money to pay for insulation subsidies because cold, damp homes make people ill. “This is what will happen when the budgets are transferred, anything that is remotely connected to health is being used to take the money. There will be nothing left for core public health work.” He added: ‘The principles of the Bill we all agree on, more involvement of GPs, power devolved closer to the patient, but it is when you get down to the detail you see that the BIll is absolutely disastrous. “We are still puzzled why it is needed in the first place.” The report raises concerns that many local authorities will simply contract out the public health responsibility to private firms, leading to expensive and fragmented planning. Author of the report, Dr David McCoy said: “Health professionals and the general public already know that the Health Bill threatens to do terrible damage to the National Health Service. But until now, the extent of the potential damage to vital public health work has not received the attention it deserves. “Public Health work is vital to tackling some of the biggest health problems we face, including diabetes and heart disease caused by obesity, lung cancer and many other illnesses caused by smoking, and AIDS and other diseases and conditions related to sexual health. "But the Government’s “reforms” will lead to increasing health inequality, and make it more difficult for us to address these health challenges.” A Department of Health spokesperson said:"Bold changes are needed to meet the public health challenges of the twenty-first century - and the role of local authorities in public health have been widely welcomed. "We are giving local councils the money, the power, the right expertise and information to build healthier communities. Every area of the country is different so councils will be able to decide what the most important public health concern is for them and spend the money appropriately. "We have already strengthened the Health Bill following the listening exercise and have responded directly to the points raised by the Faculty of Public Health. "  Article from The Guardian Article link: http://www.guardian.co.uk/society/2012/mar/18/doctors-warning-nhs Doctors make last-ditch warning over NHS shake-up Bill poses 'significant risk to patients and public' says study by public health specialists Denis Campbell, health correspondent guardian.co.uk, Sunday 18 March 2012 22.20 GMT The document echoes previous warnings on child health and the protection of children from abuse, partly due to weaker information sharing. Photograph: Paul Box/Reportdigital The coalition's health reforms could lead to the NHS ceasing to provide key services and may make tragedies like the death of Baby P harder to prevent, leading doctors have warned. Their analysis of the health and social care bill found the changes will result in worse care for millions of patients, with serious conditions such as cancer, wider health inequalities and poorer patients being disadvantaged. The dramatic warnings by leading doctors are contained in an assessment by the Faculty of Public Health (FPH) of the risks involved in the forthcoming overhaul of the NHS in England. The bill poses "significant risks … to patients and the general public" and could well damage "people's health and patients' experience of care," according to the faculty, which represents 3,300 public health specialists in the NHS, local councils and academia. "It is likely that the most vulnerable who already suffer the worst health outcomes will be disadvantaged as a result of the enactment of the bill," the document states. Poorer people are unlikely to be able to use the greater patient choice that the bill entails, it adds. "Operation of choice in an environment of multiple providers will disadvantage those who are less educated, have reduced access to resources such as the internet, or for other reasons are less able to navigate the healthcare market." Whole areas of healthcare provision may disappear and patients could be forced to go private because clinical commissioning groups (CCGs) – the new groups of local GPs who will become responsible for agreeing and paying for patients' treatment from April 2013 – are only tasked with deciding what services are needed in order to "meet all necessary requirements" of the populations for whom they are responsible. "As such, it is possible for CCGs to cease to commission services which are currently available through the NHS if they do not consider them to meet a reasonable requirement. Access to such services in the future might be available only through private healthcare," the FPH claims. Handing GPs the right to decide what care is and is not provided "will also lead to an increase in geographical variation in service provision – the postcode lottery," and such variation may become "more overt" owing to doctors or patients lobbying CCGs. Imposing "a competitive market" on the NHS will make it difficult to provide joined-up care for the rising number of patients with long-term conditions, as separate organisations collaborating to provide care "may be seen as anti-competitive and incur substantial financial penalties," the assessment adds. Dr John Middleton, vice-president of the FPH, which recently joined other medical organisations in calling for the bill to be scrapped, said: "Patients with long-term conditions such as diabetes need co-ordinated care between GP, community and hospital. Under the current system they go to the primary care trust if any aspect of their care is at fault. "Under the new system they may need to go to the NHS commissioning board for GP or optometrist care, the CCG if their hospital service or chiropody causes them a problem, Public Health England for their eye screening and the local authority public health service for their weight management and lifestyle services – it's a recipe for unco-ordinated care and everyone passing the buck. The current reorganisation is a recipe for things getting worse, not better." The document echoes warnings about the perils of the overhaul of child health already made in some primary care trust risk registers. "Of particular concern are the risks identified around safeguarding children from abuse and neglect. The loss of designated professionals and weaknesses in information sharing between organisations poses an increased risk to the safety of children," the analysis says. Middleton added: "After several years of relative stability, this unwelcome and unnecessary reorganisation is disrupting services and splitting apart professional relationships which are needed to protect patients and the public." NHS arrangements for emergency planning, screening and immunisation programmes are also "unsafe" because of flaws in the bill, Middleton said. "The FPH remains concerned at the risks to public protection in emergency planning. NHS commissioning board directors of emergency planning cover huge geographical areas: from Land's End to Dover, from Yarmouth to the Welsh border, and from Cheshire to Northumberland, and London. Each of these areas is huge and covers multiple Local Resilience Forums around which blue light services are organised, so NHS directors of emergency planning face extraordinary difficulties covering their sectors. "Directors of public health at local authority level will 'assure' the system, but will have no powers or resources to enforce what needs to be done to make the systems safe," he said. The FPH also warns that allowing private operators to provide more state-funded health services, together with the increased competition between NHS organisations, will increase the amount of money spent on administering the system and incentivise hospitals to treat patients needlessly. "The market environment will increase transaction costs and lead to the loss of economies of scale as large providers could be broken up. Market incentives will lead to supplier-induced demand where hospitals perform unnecessary and potentially harmful treatments to generate income. Management costs will also increase as the new GGCs will need to buy in legal and procurement expertise to support them in fulfilling their new commissioning responsibilities", the risk assessment report states.Health minister Simon Burns said: "This report is scaremongering. The reality is if we choose to ignore the pressures on the NHS, it will face a financial crisis within a matter of years. The bill means for the first time ever there will be a duty on all parts of the health system to reduce health inequalities, and the public health budget will be ringfenced from 2013. "Far from preventing integration, the health and social care bill will introduce legal duties to promote it throughout the health system. Failure to act will threaten the very values we hold so dear – of a comprehensive health service, available to all, free at the point of use and based on need and not the ability to pay. We will not allow that to happen." © 2012 Guardian News and Media Limited or its affiliated companies. All rights reserved. Read More