Save the NHS: Public Health

Public Health, the discipline, is under threat. Why do I say this? And does it matter? Well, I say this because it is being fragmented and bowdlerised. And, yes, I think it does matter. Read on, if you are interested.

The dismemberment of public health is less immediately threatening than other things that are happening to the NHS, but I would contend that it would have really bad consequences for the health of the public in England. Public Health is concerned with health promotion (looking at healthy lifestyles etc), health protection (epidemics, infectious diseases, screening etc) and the commissioning of health services.

If the plans go ahead, health promotion will be in Local Authorities, health protection will be split between them and Public Health England (PHE) and the commissioning will be wherever anybody bothers to remember it. In other words, despite what we are constantly told, there will be no coherent PH service. PHE is supposed to provide this, but in reality it only provides the equivalent of the present Health Protection Agency (HPA) plus some rather random bits of general PH. This is not coherent policy - it is a disaster waiting to happen as nobody has control or accountability for health protection at a local level. When we had the flu scare, it was not the HPA that organised the local distribution of vaccine, nor of talking to the public. That was PH in the PCT - which will be abolished. Who will do it next time?

Equally dangerous, the parts of PH that currently do the commissioning of NHS services are being ignored or disbanded. We are told that PH 'advice' will be given to Clinical Commissioning Groups (CCGs) from the LA. But 'advice' is not the point. We in PH actually do the work, make the decisions, talk to clinicians and patients, make ourselves unpopular and end up in the press. Who will do that now? Where will that be based? It certainly will not be at the National Commissioning Board, because we have been told that PH is not wanted there. CCGs will not have extra money to buy public health services. Some will be provided from the local authorities to CCGs, but this will be at the discretion of the local authority department, and subject to other demands. We are told that the GPs will do it - but they already have full-time jobs and they do not have the training in population medicine that PH people do.

And did you know (or does Mr Landsley know) that every time a GP comes to a meeting we have to pay locum costs? You don't pay for PH advice over and above the salary. But you do for GPs. Think about it.