Public Health is Heaemorrhaging

I make no apologies for returning to the vexed subject of Public Health and the impact of the recent Health and Social Care Act on that discipline.

Public Health (PH) is being moved out of the NHS and into Local Authorities. Our lords and masters tell us that this will work better, and so it might for some aspects of PH. I am perfectly happy to accept that the health improvement parts of PH, those things that relate to lifestyle and the wider determinants of health (e.g. housing and occupation etc) are very likely to find advantages and synergies in local authorities. Unfortunately, however, there is rather more to PH than that.

PH comprises three strands: the health improvement I have discussed above; health protection (that branch of PH that deals with communicable diseases, environmental threats and so forth); and health services PH, the branch that deals with commissioning of NHS services, with assessing proprieties, with commissioning pathways of care, with dealing with unusual requests for non-commissioned treatments. I have no expertise in health protection, and would not presume to speak for those in that field, but they are, in any event, being moved to Public Health England, not to the Local Authority.

Which leaves those of us in health services PH. I admit that we suffer from the fact that it is difficult to really explain what we do in simple terms. This may be because what we do is not simple. All I can tell you is that it is vital to the NHS. The NHS is facing a chronic shortage of funds and an increasing pressure to ensure that we only commission treatments that are evidence based and effective. And at this crucial time, those of us who are trained in this field have been written out of the picture. We are told that GPs will be commissioning leads, but this is patently ridiculous: they have neither the time nor the expertise. I would rather have my GP in surgery, available to treat me, than sitting in meetings trying to do not very well what I was trained to do. And it will be extremely expensive, since we have to pay locum fees for every meeting they attend.

As a direct result of all this, health services PH experts are leaving. We are a tiny sub-speciality, certainly less than 100, probably closer to 50. Yet in the last week I have heard of one person going to Canada, another to New Zealand's South Island ("as far as I can get from Richmond House" in his own words), two more taking early retirement. There are many others looking for ways out. We cannot afford or sustain this attrition rate. This needs to be acknowledged and addressed by the Department of Health before we are past the point of no return.