Memorandum by Nottingham Health Authority
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