Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by Nottingham Health Authority (PH 11)

  I am currently the Director of Public Health at Nottingham Health Authority. I have been in this post for five years and prior to that was a Senior Lecturer in Public Health Medicine at the University of Nottingham Medical School. I have worked in the speciality of public health in the Trent Region since appointment as a registrar in community medicine in 1986. I was made a member of the Faculty of Community Medicine in 1989 and a Fellow of the Faculty of Public Health Medicine in 1998.

  I would like to provide written evidence for consideration of the Health Committee.

  1.  Although based in health authorities, directors of public health do have an important independent function to perform in commenting on the contribution that government policy has in improving the health of the population. Directors of public health must not, therefore, be seen simply as members of health authority boards but as the director of public health for a population, a servant of the public and an independent source of advice on the implementation of government policy and the allocation of taxpayers' resources to improve health. This responsibility is even more important with the development of primary care trusts. Primary care trusts will be both commissioners of primary and secondary care services and the providers of primary and community care. These organisations, therefore, have the potential to transfer resources from other NHS trusts into their own trust and health communities. Public health clinicians have a very important responsibility in ensuring that fair play is done in the planning of services and allocation of resources. They alone have the clinical expertise to understand the details about healthcare provision and also have no vested interest, being neither a provider of primary or secondary care nor a commissioner of services.

  2.  Over the last five years public health departments in health authorities have been considerably strengthened by the ability to recruit and train staff who were exempt from NHS management costs. This has led to an increased focus on the contribution which can be made from public health specialists and their health promotion specialist colleagues. Public health specialists have been responsible for developing the local health improvement programmes and, in the majority of HAZ areas, for the development and management of health action zones. The expertise that is currently found in public health departments will be adversely affected as these individuals are devolved to smaller local PCTs. There is also a significant concern as to whether these individuals will continue to function as part of the public health family in a district or region and will receive the professional support and development that they currently do through their peers and colleagues in health authorities, regional offices and academic departments of public health.

  3.  Public health specialists are in a unique position, placed as they are in health authorities, for monitoring and reporting on the health of the local population and particularly in inequalities in health across the health district. Although there are a number of PCGs who are taking an active role in reducing health inequalities amongst patients registered with local practices, there is still a need for someone to take an overview of inequalities across the district. This may result in re-allocation of resources to meet the needs of people in particular PCGs and a subsequent reduction in resources available to another PCG. Decisions on these funding issues will be impossible to make by PCT boards and should be made by health authorities with advice from their public health specialists.

  4.  Directors of public health have traditionally fostered partnership between local government, the NHS community and the local business and industry sectors. This places directors of public health and their senior colleagues in an ideal position to support the chief executives of health authorities in leading the partnership work required to discharge the responsibilities of the new health authorities.

  5.  At a time when there is a major re-organisation taking place within the NHS and significant changes within local government, it is important that there should be no more re-organisation within health authorities. Staff remaining in health authorities after the development of PCTs will need to be developed and supported in their new roles. It is inevitable that local public health departments will participate in wider consortia working with their colleagues in other health authorities and across government regions. Developing this pattern of working will be threatened by any major re-organisation of the specialty over the next five years.

Dr Sarah Wilson

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Prepared 28 March 2001