HC 1048-III Health CommitteeWritten evidence from Mr Matthew Ashton (PH 14)

The following provides an overview of issues for consideration as part of the inquiry into public health. These issues are highlighted along with potential solutions in order to suggest ways that current proposals can be improved.

Summary

All public health staff should be employed by Public Health England, with access to appropriate training, development and leadership, and then deployed to where relevant issues are best addressed, for example within a local authority setting.

Medical and Non medical consultants in public health should be employed on the same contract with the same terms and conditions, with no distinction made between medical and non medical status.

The JSNA should be a requirement for all parties, rather than just “joint” in name, with an expectation that public health will deliver it by itself.

Public Health Intelligence, knowledge, and expertise should be developed at a local level, as well as at a regional and national level. Intelligence can only truly be developed and applied at a local level.

1. Public Health Workforce

Wherever their working location (public health specialists have roles in universities and trusts and may in future work in other areas in addition to local authorities and consortia) the public health workforce should have access to appropriate training, development and leadership. There is also a danger that DsPH could become an isolated specialist function in local authorities if they are not able to retain and call upon designated public health trained staff. Without this, it would be difficult maintain an overview of population health needs, outcome performance, intelligence and evidence to inform the role of public health advisor to a wide range of partners.

The separation of roles between PHE (national leadership and population based issues) and local authorities (local needs and solutions) could be managed effectively by employing all public health staff in PHE and then deploying them to where relevant issues are best addressed. As an example, many issues that need to be addressed in local authority areas will be common across bigger footprints and may be better addressed in collaboration through pooled resources and influence. This would also facilitate sharing resources when surge capacity is required. Maintaining the centralised coordination of the specialist training programme within this structure would also be beneficial to enable experience to be gained through placements across all public health delivery agencies, managed by the existing Deanery network.

Consideration should also be given to equalising the contracts for medical and non medical public health consultants. At the moment, non medical consultants in public health are paid less and on a different contract of employment, even though as far as public health qualifications are concerned they are the same.

2. Understanding Needs

Joint Strategic Needs Assessment

The Joint Strategic Needs Assessment process has been a joint responsibility of Local Authorities and Primary Care Trusts. Much of the input to JSNA will have been public health expertise and capacity. The Strategic Needs Assessment process should not be “Joint” in name, but through the requirement on all parties to engage. The current proposal to share responsibility for ensuring the process is undertaken between GP Commissioners and Local Authorities with a lead role for the DPH needs to be underwritten with a requirement for any health and social care funded body to contribute information and expertise, and for Local Authorities to be able to contribute the same in relation to economic, social and environmental determinants of health.

Public Health Intelligence

Public health intelligence is the driver for evidence based commissioning for population health and is required at a local, regional, and national level. Public health provides strong tools for assessment, such as asset based approaches, impact assessment and participatory research. Public health also takes a population view of consultation, engagement and involvement, recognising that health, care and wellbeing are whole population issues, rather than just the population accessing services. Sufficient resource and capacity needs to be retained both at local levels and in PHE to ensure this collation, analysis and interpretation of data can continue to be available. It is essential that the reforms do not block existing access to data from its widest sources that are key to the development of local intelligence that informs commissioning. Robust transfer of data between health and local authorities needs to be established.

June 2011

Prepared 28th November 2011