Health CommitteeWritten evidence from Greater Manchester Directors of Public Health Group (ETWP 114)

The 10 Directors of Public Health in Greater Manchester (GM) work together when appropriate to complement local action as part of the NHS Greater Manchester, and also as independent advocates for Public Health in the conurbation.

Summary

This submission looks at the Government’s proposals in relation to the public health workforce and the wider public health workforce. To create sustained health improvements and tackle health inequalities, the Public health workforce needs to be part of the healthcare training and education system.

Key Recommendations

1. Public Health England (PHE) needs to be represented on the board of Health Education England (HEE). This would provide PHE with a strategic influence on national training and education. It would provide a mechanism to ensure preventative medicine/healthcare is embedded in all healthcare’s professions education and training.

2. PHE needs to have a specific remit for public health professions in other organisations such as local authorities and NHS organisations. PHE will in effect be the “guardian” of public health workforce in terms of training, education and workforce planning. It is essential that there is a co-ordinated approach of education, training and workforce planning for the public health workforce (specialist and practitioner workforce).

3. There needs to be public health representation (Director of Public Health) on the local skills network; ensuring local education commissioning decisions reflect local health priorities and needs. They will be the local advocate for the education, training and workforce planning of the public health workforce.

4. As a multidisciplinary profession, the registration mechanism needs to be robust.

5. Public Health Knowledge and skills need to be embedded in the training and education of professional healthcare groups. This needs to be at a local level through the skills networks.

6. The Government must guard against a reduction in public health capacity.

7. New training locations will need to be established in Local Authority, PHE, NHS Commissioning Board (NCB) and Clinical Commissioning Groups (CCGs).

8. Accurate, robust and up to date national and local workforce data is essential to effectively workforce plan. A minimum Public Health workforce dataset is needed that relates to expected Public Health outcomes and essential Public Health functions.

9. The Centre of Workforce Intelligence’s data needs to be fit for purpose.

10. A co-ordinated approach forecasting the workforce needs of the public health workforce (Specialist and practitioner workforce). We would envisage PHE fulfilling this role aided by the local PH teams.

1. How the public health workforce will be affected by the proposals

1.1 The Public Health workforce is multi disciplinary but also multi professional. There are three recognised groupings of staff in the public health workforce—the specialist, the practitioner and wider public health workforces.

1.2 The Specialist workforce—posts such Directors of Public Health (DPH), Public Health Consultants and specialists. These posts would carry out a strategic PH function and are the PH leaders. These posts hold professional registration for medical staff via the General Medical Council (GMC) and for the non medical staff via the UK Public Health Register (UKPHR).

1.3 The public health practitioners—these roles deliver a public health function, eg health protection practitioner’s role would investigate and prevent outbreaks of infectious diseases or a Public Health Intelligence Analyst.

1.4 The wider workforce is those who are able to influence the health of the population through their roles. This wider workforce can be found in a range of organisations and professions such as clinical staff and social care staff. In many cases, they would not identify themselves first and foremost as working in public health but rather by other professional category such as a respiratory nurse.

1.5 In the new public health system, local authorities will be responsible for the three domains of public health. There is a danger that the involvement of local authorities, PHE and the NCB in various facets of public health commissioning will produce a lack of coordination and cohesion in public health services. This lack of cohesion will impact on the present and future Public Health workforce.

1.6 There is also a concern that a large proportion of public health workforce will be outside the healthcare system which will have major implications for accessing education and training. Public Health experts and leaders have to maintain their skills in order to effectively serve the public and their organisations. In the workforce planning and guidance so far released, there is no commitment to continuing professional development for public health teams transferred to local authorities. Continuing Professional Development is within the NHS constitution and may not be replicated in local authorities. CPD is seen as an essential part of a professional’s duties and an important aspect of quality assurance, decreasing risk and revalidation for Public Health Specialists.

Recommendations

(1)PHE needs to be represented on the board of HEE. To provide strategic influence on national public health training and education and ensure preventive medicine/healthcare is embedded in all healthcare professions education and training.

(2)PHE needs to have a specific remit for public health professions in other organisations such as local authorities and NHS organisations. PHE will in effect be the “guardian” of public health workforce in terms of training, education and workforce planning so there is a co-ordinated approach.

(3)There needs to be public health representation on the local skills network, ensuring local education commissioning decisions reflect local health priorities and needs. They will be the local advocate for the public health workforce. Ideally this would be a local Director of Public Health.

(4)As a multidisciplinary profession, the registration mechanism needs to be robust.

(5)Public Health Knowledge and skills need to be embedded in the training and education of professional healthcare groups. This needs to be at local level through the skills networks.

2. Plans for the transition to the new system, up to April 2013

2.1 In the North West, three skills networks have been declared (Greater Manchester, Cheshire and Mersey and Cumbria and Lancashire) and named Network Leadership Groups. The Greater Manchester Network Leadership Group, includes representation from a Director of Public Health (DPH) representing the 10 Greater Manchester DsPH.

2.2 Across Greater Manchester, public health workforce capacity has been lost and continues to be lost. This is seen both in the specialist and practitioner workforce. The losses have been felt across the three domains of public health; health improvement, health protection and preventive healthcare.

From June 2011 to October 2011, 9% reduction in health protection workforce of Greater Manchester was noted. This poses significant risks to the resilience of the PH system to respond to infectious disease outbreaks across the conurbation.

2010 and 2011 has seen a decline in advertised consultant public health posts. This has resulted in speciality registrars have taken short term appointments or locum positions. These consultants will be the future Public Health leaders.

Across the North West, the total number of public health analysts appears to have fallen by nearly 50% compared with the public health intelligence workforce assessment carried out by Liverpool John Moores University in March 2010. The decrease is particularly evident in posts at Agenda for Change Bands 6 and 7.

2.3 The current NHS Transition presents new opportunities and challenges to the speciality registrar training for public health, in respect of where training takes place; where consultants are employed; and the organisation of training and education for health professionals as a whole. Public health training is aligned with other postgraduate medical training. Currently specialist registrar training takes place in Primary Care Trusts and Strategic Health Authorities (SHAs) which will cease during 2012–13.

2.4 Local Directors of Public Health are completing transition plans to be scrutinised by the SHA.

2.5 Healthy Lives, Healthy People—the new public health system released on 20 December 2011 states that PHE will be a new, integrated and expert public health service to support the new public health system. One of its key functions will be: Developing the workforce—by supporting the development of the specialist and wider public health workforce.

Recommendations

(1)Public Health membership is essential to development of the local network skills group.

(2)The PCT transition plans must include intentions for PH education, training and workforce planning.

(3)The Government must guard against a reduction in public health capacity.

(4)New training locations will need to be established in Local Authority public health teams; PHE local teams; NCB and CCGs.

3. The proposed role, structure, governance and status of Health Education England (including how it will take on the roles of Medical Education England and the Professional Advisory Boards), and its relationship to professional regulators and to the other parts of the new NHS system architecture

3.1 The proposed new system brings challenges and opportunities. We support the proposed role and over-arching accountability of HEE. We believe the four functions of leadership, responsive, scrutiny and allocation are crucial to the success of the skills network and overall system.

3.2 We see PHE as its key partner in advocating for specialist and practitioner public health workforce training, education and workforce planning. In relation to the new architecture, PHE and Local Authorities will be the principal employers of public health professionals at specialist and practitioner level. Both being integral parts of the new public health system. PHE would provide national leadership for the public health workforce which is a multidisciplinary profession.

Recommendations

(1)It is essential that HEE, that has an overarching role for education, training and workforce planning for Healthcare professionals in England.

(2)PHE needs to be represented on the board of HEE.

(3)PHE needs to have a specific remit for public health professions in other organisations such as local authorities and NHS organisations.

4. The proposed role, structure, status, size and composition of local Provider Skills Networks/Local Education and Training Boards, including how plans for their authorisation by Health Education England will address issues relating to governance, accountability and potential or perceived conflicts of interest, and how the Boards will relate to Clinical Commissioning Groups and the Commissioning Board

4.1 Greater Manchester Skills Network is in its early stages of development. Structure and composition are taking form, which includes membership of a DPH. The advantage of this representation will ensure local education commissioning decision reflect local health priorities and needs and embed public health in the local training and education plans of healthcare staff.

4.2 The local authority is currently represented through the DPH. As the integration of health and social care becomes a reality, the LA as the main employer of social care staff will need to be represented on the skills network.

Recommendations

(1)There needs to be public health representation on the local skills network.

5. The role of the Centre for Workforce Intelligence (CfWI)

5.1 The Centre for Workforce Intelligence is currently the only national body that collates and publishes comprehensive workforce data on the medical specialties, including public health. Recent statistics published by CfWI regarding public health posts were seriously flawed. For example, CfWI reports claimed a considerable number of “public health associate specialists” in Acute Trusts across the North West. These posts do not exist.

5.2 Currently the Centre for Workforce Intelligence is not able to collate sound, up to date and accessible data on the public health workforce (specialist and practitioner workforce). In the absence of accurate national data, the North West region has created a local Public Health workforce database to aid the region and sub regions with workforce planning.

Recommendations

(1)Accurate, robust and up to date national and local workforce data is essential to effectively workforce plan. A minimum workforce dataset is needed.

(2)The Centre of Workforce Intelligence data needs to be fit for purpose.

6. How future healthcare workforce needs are being forecast

6.1 In forecasting future workforce needs, it is necessary to understand and identify the present workforce. The current NHS Electronic Staff Records can not accurately identify the current PH specialist and practitioner workforce. This is due to the difference in job titles and the background of the staff members. For example, a Public Health Consultant from a medical background will be categorised under Medical, whereas a Public Health Consultant (Non Medical background) will be categorised as Administration and Clerical or a senior Manager.

6.2 This identification of staff could be made potentially more difficult under the proposed new public health system, as the workforce will be employed predominately in either PHE or in a Local Authority. Staff in the Local Authority will therefore no longer be employed in the NHS and will sit outside the healthcare system and its staffing records system. To plan future workforce needs, the whole of the workforce needs to be considered. Regular public health workforce audits are already in place in some Public Health Directorates in the UK, giving an accurate and rapid picture of current capacity and loss of skills.

6.3 The Healthcare workforce has a pivotal role in public health. The level of complexity and subjectivity involved in measuring the wider public health workforce is great. This would involve estimating the proportion of time given to public health functions, where this is a secondary or tertiary role.

Recommendations

1.A co-ordinated approach forecasting the workforce needs of the public health workforce (specialist and practitioner) is needed. We would envisage PHE fulfilling this role aided by the local DPH.

2.At a local level, Public Health Directorates should take part in a regular workforce audits. These will provide an accurate and rapid picture of current capacity and areas of risk.

7. The impact of people retiring from, or otherwise leaving, healthcare professions

7.1 On 17 February 2011, Sir David Nicholson wrote to NHS Chief Executives stating that:

“uring the transition year 2011–12 the NHS must continue to lead on improvements to public health, ensuring that public health services are in the strongest possible position when responsibilities are devolved to local authorities. As we deliver the very significant cost savings required of us, it is important that our plans reflect the need to retain staff with scarce specialist public health skills.”1

7.2 The financial climate within the NHS has created significant threats to public health capacity and capability in some local areas. Greater Manchester and the North West have already noted losses in public health capacity. If Public Health outcomes are to be delivered with a significantly reduced workforce, then getting the right people, with the right skills and competencies fulfilling the right role is paramount. Effective PH education, training and workforce planning will aid this process.

Recommendations

(1)The Government needs to be aware that public health capacity and capability has been lost contrary to David Nicholson’s pledge.

December 2011

1 Sir David Nicholson 17/02/2011 Equity and Excellence: liberating the NHS- managing the transition. Gateway 15594 1553.

Prepared 22nd May 2012