Health and Social Care Bill

Memorandum submitted by Fiona Day (HS 88)

I was a GP who has taken extensive additional training to be a public health specialist. I am fully qualified with the Faculty of Public Health ( of the Royal College of Physicians (the body who oversees the standards and training of Public Health Doctors and Consultants) and the General Medical Council where I am registered as a Specialist in Public Health Medicine. I spent 6 years additional post graduate training after GP training to be a public health doctor and finally qualified to be a public health medicine consultant in 2009, 13 years after leaving medical school. (I should add that this is the normal length of time to train to be a specialist in public health medicine or any other medical specialty such as surgery). My point being that it takes a great deal of time to achieve the level of excellence and specialism required in my practice.

I am very concerned that rather than strengthening the discipline of public health, the reforms will weaken it. I have specialised in the area of public health relating to supporting commissioning decisions, ie ensuring that health and social care services meet the needs of the local population, are evidence based, reduce and do not further inequalities, and are made on the basis of sound financial investment decisions.  This is often referred to as healthcare public health.

I do not believe that being a public health medicine consultant in the local authority is a viable option for public health doctors across the country like myself. We need to be close to the health care commissioning decisions and to do this we need to have legitimacy in the NHS. I believe that being employed by the local authority will weaken commissioning decisions and lead to significant financial waste, increased health inequalities, and result in poor quality health services which are not able to respond to current or future needs. In addition as the Wanless report commissioned by HM Treasury in 2004 under the previous government showed, we must invest in a strong public health approach if we are to prevent a future catastrophe to the health of our population from the consequences of today’s lifestyles and health inequalities.

My request to you is that public health medicine consultants should be employed by Public Health England or the NHS Commissioning Board, and not by the local authority. This is the view of the BMA, as well as the majority of my colleagues.

I would be grateful if the Public Bill Committee for the Health and Social Care Bill would address these concerns, and to highlight and amend the most damaging aspects of this legislation.

I have many other concerns relating to the fragmentation of the NHS and covert privatisation and the way which the current government is basing our NHS on an American model which has been shown to lead to spiralling costs.

Finally, please find enclosed a link to the British Medical Association statement on healthcare public health (my area of responsibility).

March 2011