HC 1048-III Health CommitteeWritten evidence from Shamsher Diu (PH 190)

I am writing you as I am extremely concerned about the Government’s proposals for public health. I feel that the Government has sidelined public health. This is demonstrated by the fact that none of the NHS Futures Forum workstreams included any reference to public health (there was only one representative from the entire profession). I believe that this was a serious omission.

Public Health England

I support the creation of Public Health England (PHE) if:

1.PHE is independent from the Department of Health. Having PHE in the DH is not liberating NHS from political control and it is unlikely to have the public’s trust as it will be viewed as an arm of the Government. PHE needs to be out of day to day control of politicians.

2.PHE encompasses all the domains of public health:

Health protection and resilience (infectious diseases, environmental hazards and emergency planning);

Health improvement (lifestyles, inequalities and the wider social, economic and environmental influences on health); and

Health services (service planning, developing clinical care pathways, commissioning, audit, investigating Serious Incidents, efficiency and evaluation).

Public Health Intelligence (information and analysis)

This will prevent the fragmentation of PH functions and produce efficiencies through synergy.

3.PHE acts as the employing body for all public health specialists. This will ensure that a critical mass is achieved by pooling resources. The staff can then be seconded to other organisations e.g. Local Authorities, GP Consortia, Acute Trusts, Mental Health Trusts or Community Providers. This will prevent the fragmentation of the workforce and assist in the training of new PH specialists.

Director of Public Health (DPH)

The role of the DPH is fundamental to the success of the implementation of PH locally. This individual needs to be qualified in PH and to be a registered specialist in PH. The DPH must be able to give independent professional advice across all three domains of public health and supported by a comprehensive public health team that needs to include health analysts. The DPH must be accountable directly to the Chief Executive of a Local Authority and be jointly appointed by Public Health England.

Public Health (PH) Staff

PH staff need to report to the Director of Public Health. However, the staff need to work closely with all the stakeholders. There should be a duty of cooperation placed upon all stakeholders, as the success of PH depends on joined up working.

Training of Public Health Specialists

Training of new PH staff into a new public health system needs to be attractive to recruits and retain high quality staff. Medically qualified individuals are likely to be deterred from entering the profession if there is not a clear training pathway which has equivalency with the rest of the medical profession. Organising training is a complex task that will be complicated by the fragmentation of the profession.

Statutory Regulation

This is the best mechanism for providing effective protection of the public. All specialist public health staff must be appropriately qualified and should be appointed through a statutory Advisory Appointments Committee.

Accountability

The accountability for the functions and delivery of PH need to be more clearly defined. At the end of the day who is going to be held accountable?

In summary, I feel that the Government’s proposals are an unnecessary disruption, with no clear advantages being outlined—but with plenty of disadvantages.

Unless the Government modifies its current proposals for PH, as indicated above, there will be a fragmentation of public health which will lead to an ineffective and inefficient PH service which in time will impact on the public’s health. A co-ordinated, flexible public health service within the NHS e.g. special health authority will bring advantages of outlined above and indeed reduce costs too by reducing duplication and fragmentation.

I would be grateful if you took these comments into consideration in your deliberations on Public Health.

June 2011

Prepared 28th November 2011