South West Public Health Observatory

Health Minister details front-line focus for public health
13 November 2001    

In a speech to the Faculty of Public Health Medicine on 13 November 2001 Health Minister Lord Hunt outlined a new local focus for public health services which will situate them firmly within primary care.

The speech also included information about how public health services are tackling health inequalities and a review of initiatives that involve primary care professionals in improving health and preventing disease.

The new structure will include:

Lord Hunt also announced the establishment of public health networks which will pool expertise and act as a specialist resource to enable PCTs to address wider public health issues.

Extracts of speech by Lord Hunt to the Faculty of Public Health Medicine at the Royal College of Physicians on Tuesday 13th November 2001.

Unedited e xtracts from Lord Hunt's speech :
(from: http://tap.ccta.gov.uk/doh/intpress.nsf/page/2001-0539?OpenDocument )

1. Talking about primary care and public health brings me to Shifting The Balance and its impact on public health professionals. This has not been without its anxiety for many people in this room. Iunderstand that - certainly after meeting the faculty! but I'm confident that Shifting The Balance provides just the platform that public health needs.

2. Earlier this year Alan Milburn set out in a speech how reform must fundamentally change the relationship between patients and the service. He said then that patients should have more information, more influence and more power over the services they receive. He called for the balance of power in the NHS to shift decisively in favour of the patient.

3. That is the basic philosophy behind Shifting The Balance which can only happen if the centre of gravity within the health services itself moves from Whitehall to the NHS front line (something I'm convinced needs to happen).

4. That of course has huge potential for primary care and indeed for public health professionals. Now I'm well aware of the concerns amongst public health professionals of the impact of this on them.

5. Let me respond by saying that I believe these changes create a significant opportunity to re-energise and refocus the public health delivery system. Tonight, I want to set out how this will be achieved, building on our existing strengths but also seeking to put public health at the forefront of modernisation.

6. The public health workforce has always been one of the most committed in our service. But those with public health skills have not always been central to the machinery of delivering improved health for the population and this is where Shifting The Balance makes that connection.

7. So let me make it clear that in future the engine of public health delivery will be at the front line around the primary care trust.

· and that every Primary Care Trust will have a Director of Public Health and support team

· the Directors of Public Health will be board level appointments working at the heart of the new organisations

· the focus of their activity will be on local neighbourhoods and communities leading and driving programmes to improve health and reduce inequalities

· they will also play a powerful role in forging partnerships with, and influencing, all local agencies to ensure the widest possible participation in the health improvement agenda at local level

· the Director of Public Health will not be a remote, strategic figure - s/he will be well known, respected and credible with local people (particularly those in the most deprived communities), general practitioners in the Primary Care Trust, local authorities - a true leadership figure.

· this generation of Directors of Public Health will be from a variety of backgrounds not only medical; this NHS reform offers an opportunity to make multi-disciplinary public health a reality. The process of training, accreditation and appointment will need to be rigorously quality assured as the responsibilities of the position are substantial. There are issues I will return to shortly.

8. So make no mistake, Primary Care Trusts will be the key foundation for public health. but with the audience before me, I am acutely aware that effective local public health action needs to be underpinned by a range of specialist expertise, which cannot be provided in every Primary Care Trust.

Public Health Networks

9. That is why there will also be public health networks.

10. The purpose of the network will be:

11. It is also important to be clear what the public health network will not be. It will not be an additional tier of NHS management. It will not be a vehicle for performance management of the public health function. It will not adhere to a rigid geographical boundary.

12. Public health networks will be flexible, responsive and will almost certainly change and evolve over time.

13. For example, a network will be able to respond to the needs of cities for public health advice and action programmes. The new NHS structures will not be able to 'match' every local authority boundary but a flexible and responsive public health network will be able to support cities like Birmingham, Liverpool and Newcastle upon Tyne in becoming healthy cities. but Sian, it might also support counties like Oxfordshire who wished to take the same approach!

14. The public health network will be formed and managed from the bottom-up. It will require the support and participation of the PCTs. The design of the network and the arrangements for its day-to-day running will be a matter for local decision-making. Because these networks will be a vital element in the new public health infrastructure we have to be sure that we get this right, for this reason the Regional Directors of Public Health will co-ordinate discussion to design the new networks.

Tthis then leads me on to Strategic Health Authorities

15. Strategic Health Authorities will have a distinctive performance management role in relation to the constituent NHS organisations within their boundaries, taking over many of the functions of the existing NHS regional offices.

16. Good outcomes of health care contribute to the health of the population. Successful implementation of clinical governance in NHS Trusts and Primary Care Trusts therefore has an important part to play in achieving public health goals. So too do the funding of cancer and other clinical networks. A successful strategic health authority will lead and performance-manage to ensure that each of the organisations it is responsible for has vibrant clinical governance arrangements and powerful, effective clinical networks.

17. This will mean that each strategic health authority will need a doctor with the appropriate strategic management skills to undertake this function as a member of its executive team.

18. Strategic Health Authorities will also have responsibility for the performance management of the public health function within primary care trusts. So it will make sense for a public health doctor to fulfil this role. However, it will be important that the strategic health authority role in relation to public health does not duplicate the work undertaken by the Directors of Public Health in primary care trusts nor of the Regional Directors of Public Health.

Regional Directors Of Public Health

19. There will be a Regional Director of Public Health representing the Department of Health in each of the nine Regional Offices of Government.

20. The role of the Regional Director of Public Health is potentially an exciting one. They will be uniquely placed to address the wider determinants of health in their regions, working with other government departments and local strategic partnerships. They will also have a lead role for health protection and will have some responsibilities in relation to the NHS accounting to the new Regional Directors of Health and Social Care.

21. In their public health role the Regional Directors of Health will be led by the Chief Medical Officer, for the first time bringing a consistent approach to translating national policy on health and inequalities into practical action. This new arrangement will also allow the Regional Directors of Public Health and their teams to support key national work programmes and provide extra capacity in a unified central public health function.

22. The Public Health Observatories have already proved their worth and they will be an integral part of the nine regional public health functions.

Public Health Workforce - training, capacity and development

23. These structural changes to the delivery of the public health function will significantly improve the prospects for us meeting our goals of improving health and reducing health inequalities.

24. I have already referred to the issues of training, capacity and development which need urgent attention if we are to create a public health workforce fit to meet this challenge several things need to be done:

25. We need to strengthen workforce capacity in public health across the full range of skills. A care group approach is being taken to workforce development. Public health is recognised as a cross-cutting theme and the care group workforce teams will address the needs of the public health workforce. They will develop and take forward a strategy to enable the delivery of the neccesary skills and competencies in the whole workforce. this will be achieved through education and training, dissemination of good practice in skill-mix and team deployment.

26. Taking forward the development of a multidisciplinary public health workforce as an integral part of each care group will ensure that the needs of all staff contributing to public health will be addressed, whether

27. Development will be achieved by establishing standards for practice, a review of education and training with workforce confederations, and leadership development. Many Workforce Development Confederations have already taken on this responsibility and this must continue.

Training

28. We need to ensure sufficient capacity within the training organisations, including PCTs, Government Offices and especially the academic departments of public health and the other university departments involved in the training of the public health workforce.

29. We are already strengthening academic departments of public health to provide the vital training support, as envisaged in the Saving Lives: Our Healthier Nation White Paper

30. Working through the Modernisation Agency's Leadership Centre, we are looking to develop public health leadership skills as part of an integrated leadership approach across the NHS and across all NHS disciplines. This will help incorporate the public health prevention and health inequalities message more generally into its modernisation programme.

31. Health visitors and community practitioners will have a key role in the new PCTS. We will continue to invest in their training and development by building on the £3m national health visitor/school nurse public health development programme.

32. Specific Modernisation Agency programmes, such as the healthy communities collaborative, will help demonstrate new ways of delivering public health interventions. At the same time we are ensuring that public health competencies are embedded in the PCT competency framework.

Standards

33. We need to set the standards for practice which bridge the medical and non--medical public health specialists, and sustain the capacity and the skills for the future development of the public health specialist.

34. We also need to clarify entry criteria and funding support. Currently there is no mechanism by which non-medical public health specialists can be registered as 'specialists'. We are currently examining options to fast track the establishment of a register of specialists in public health through the soon to be established health professions council. together with the faculty and others we are also keen to see the rapid development of a voluntary register as a first step in this process.

35. The Faculty of Public Health Medicine has been a leader in developing new proposals to help increase the capacity of specialist practice in public health and setting standards. and we are grateful for its help.

36. Together with the Royal Institute of Public Health and Hygiene and the multi-disciplinary Public Health Forum, it has worked with Healthwork UK, the national training organisation for the health sector, to produce national standards for specialist practice in public health, which provide a comprehensive framework for public health specialists regardless of professional background.

37. We will need to take this work forward in a wider context, not least in paying attention to the needs of the public health practitioners who have come a poor second in the need to develop a public health specialist. There is an army of practitioners on whom all our efforts are built and we neglect them at our peril.

COMMUNICABLE DISEASE

38. I've been talking about public health in the context of Shifting The Balance . I now want to turn to public health surveillance because I know that this will be of keen interest to many colleagues here tonight.

39. We are fortunate in this country to possess a world class system for public health surveillance, and outstanding public health specialists. the Secretary of State was reminded of this on a recent visit to Washington to meet the US secretary for health Tommy Thompson who expressed considerable admiration for our system for public health surveillance and capacity for emergency planning.

40. The strand of the public health function that addresses the prevention and control of infectious diseases is a vital one. Even before the events of September 11th we recognised its importance, for example, in combating new and emerging infections, in tackling the resurgence of diseases like tuberculosis, and in trying to turn the tide on health care associated infection and antimicrobial resistance.

41. Since September 11th we have once again seen the strength of this element of our public health function in the excellent emergency planning work undertaken to prepare against the possible threat from bioterrorism.

42. We recognise the professional excellence of the PHLS and particularly its Communicable Disease Surveillance Centre. We value the expertise of local consultants in communicable disease centres and their teams. We increasingly see demonstrations of the importance of Regional Directors of Public Health with their overarching responsibility and co-ordinating role in relation to health protection in the regions.

43. In implementing Shifting the Balance of Power , we need to build on these major strengths.

44. we intend to ensure better co-ordination of the health protection function so that there is a clear line of sight from national to regional to local level. this recognises that protecting the population against infectious diseases, has common features with action necessary to protect the public against chemical or radiation hazards: surveillance, outbreak investigation, instigating control measures, utilising diagnostic and treatment services.

This desire to achieve a better coordinated and integrated service is at the heart of the proposals being developed by the CM O . T he details of how this will be implemented will be set out as part of the proposals in the forthcoming infectious diseases strategy which will be published before the end of this calendar year.

This page drafted from  original DOH press release

The Public Health Observatory is part of the South West Observatory, a wider Regional intelligence function, currently supported by the South West Regional Assembly, the Department of Health, the Department for Education and Employment, Government Office South West, the South West of England Regional Development Agency and the Environment Agency.