Memorandum by Faculty of Public Health
of the Royal Colleges of Physicians of the United Kingdom (WP
76)
The Faculty of Public Health (FPH) sets and
maintains professional standards for public health specialists.
The Faculty works to improve the public's health through its three
key areas of activity: professional affairs, education and standards,
and advocacy and policy contribution. For further information
visit our website www.fph.org.uk.
In this paper, the Faculty presents its evidence
in response to the three questions raised by the Health Committee's
Inquiry into the Government's Public Health White Paper. In submitting
evidence, the Faculty will concentrate on capacity and workforce
issues for specialist public health. The President of the Faculty
of Public Health, Professor Rod Griffiths CBE, is available on
the day of the hearing to present additional oral evidence if
required.
Will the proposals enable the Government to achieve
its public health goals?
The Faculty of Public Health welcomes the Department
of Health's commitment to a new approach to delivering public
health which is set out in its White Paper: Choosing Health:
Making Health Choices Easier (November, 2004). The Faculty
is impressed by the broad scope of the paper which embraces a
joined-up approach to the delivery of public health. It focuses
on empowering and enabling people to take responsibility for their
own health, and on the development of a public health workforce
to implement its recommendations.
No English government has ever given such a
high priority to public health and the proposals contained in
Choosing Health should support the Government in working
towards its public health goals. Choosing Health addresses
the key issues for health improvement—obesity, tobacco,
sexual health, alcohol and mental health, and, if implemented,
should improve population health.
The Faculty of Public Health sees public health
as three key areas of practice: health improvement, health protection
and health services. It is concerned that the Choosing Health
has focused on health improvement to the neglect of health protection
and health services in and that this will affect the overall delivery
of public health (see enclosed a fact sheet on the Faculty and
its definition of public health for more information).
Choosing Health goes some way to addressing
the recommendations set out by Derek Wanless in his final report,
Securing Good Health for the Whole Population (February
2004). However, in order for public health goals to be met we
need to see:
— an effective delivery plan which
is tightly managed and reviewed;
— a long-term programme of investment
in and prioritisation of public health by government; and
Are the proposals appropriate, will they be effective
and are they value for money?
The proposals contained in Choosing Health are
an appropriate response to the public health needs of the population
and have largely taken into account the recommendations contained
in recent Government and Parliamentary reports on aspects of public
health. However, to answer this question fully we need to ensure
that delivery, evaluation and data collection are embedded within
public health programmes. This will require not only a sea change
in mainstream attitudes but an investment in research capacity—an
issue covered by Securing Health which highlighted the under-investment
in public health research.
The Faculty of Public Health welcomes the Government's
pledged investment in public health research and the announcement
of the development of a comprehensive public health information
and intelligence strategy. We also need to see sustained investment
in academic careers and money made available for evaluative research
in order to monitor the effectiveness of public health programmes.
The Faculty of Public Health welcomes the focus
on competency development in the public health workforce and the
concept of the skills escalator to encourage lifelong learning
and engagement with NHS staff.
However, it has specific concerns about the
following health improvement programmes:
Tobacco
Whilst the Faculty welcomes the Government's
recognition that second-hand smoke is a major public health threat,
there are inconsistencies in its approach to tackling this issue,
such as allowing exceptions for licensed premises that do not
sell food. If we are to protect and improve people's health—including
those who work in these licensed premises—there can be no
exceptions.
Sexual Health
The Government sets out its action plan to tackle
the growing sexual health crisis—which the Faculty welcomes.
However, there is contradiction between this acceptance of the
problem and the timeliness of the solution. The Government recognises
that delay in access to treatment has a major impact on future
health and fertility. How, then, can it justify a four year wait
to implement its goal of 48 hours for a GUM appointment—a
recommendation which was first made by the Health Select Committee
in June 2003. The Faculty believes that serious infectious diseases
such as Chlamydia and HIV should be treated as emergencies and
access to GUM services should be made available within four hours—in
line with other accident and emergency cases.
Do the necessary public health infrastructure
and mechanisms exist to ensure that proposals will be implemented
and goals achieved?
The Faculty of Public Health's survey The
Specialist Public Health Workforce in the UK (March 2004)
concluded that a 40% increase in the current public health specialist
workforce is urgently needed if a safe and effective public health
service is to be delivered. The Faculty made recommendations to
the Choosing Health consultation which have been reflected in
the final White Paper. However, the Faculty seeks assurance that
the extra resources promised for developing the specialist workforce
will be delivered. It is particularly concerned about the following:
— the potential impact of Multi Professional
Education and Training (MPET) budget cuts on public health;
— effective inclusion of public health
into the NHS National Programme for IT (NPfiT) is needed;
— the use of General Medical Services
(GMS) and Personal Medical Services (PMS) contracts to achieve
maximum public health effect in primary care should be promoted;
— local authorities need to be resourced/commit
resources (eg for public health training) to ensure they maximise
their public health role locally;
— that opportunities offered by the
Modernising Medical Careers initiative are used to ensure that
public health is taught in foundation years;
— that effective use is made of the
NHS Careers framework from the Modernisation Agency to map out
careers in public health;
— assurance is needed that Workforce
Development Directorates will rise to the challenge of developing
public health as part of mainstream delivery;
— the Health Protection Agency needs
to have the resource to provide safe front-line services and these
are at risk with the current Arms Length Body review cuts; and
— co-terminosity be considered in any
restructuring of the NHS/local government.
Overall, the Faculty of Public Health is impressed
with Choosing Health and welcomes the opportunity to work with
the Department of Health to support the design and implementation
of the delivery plan.
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