Sex, Drugs and …. Silence

Today, I attended a meeting of the Public Health team to which I belong. It was an interesting meeting. We discussed the contracts for Public Health commissioned services that are moving to the Local Authority. These include things like Drug and Alcohol Services, Sexual Health Services, screening and many more. They are, in the main, unsexy but vital. They probably do more for the health of the population than many more ‘sexy’ services.  Just to be clear, these services have until now been commissioned by Primary Care Trusts, but with Public Health moving to the Local Authority this will have to change.

Now, I have no problem with change; indeed, I have a reputation for thinking out of the box and generally disrupting things. But, on the whole, I only do that if I think it will be an improvement and, as important, if I can make an evidence-based case for it. On this occasion, the evidence base is, at best, lacking. We are, however, commanded by our lords and masters that this must happen.

Do you remember the rhetoric that said ‘no decision about me without me’? Forget it. This is a top down decision. These contracts will move. DO IT.

Well, that is as may be, but the truth is that the infrastructure to support this is not there, that there has been insufficient thought given to it and that it is likely that these services will deteriorate. I worry that the services for those who are most vulnerable will not be sustained and that this will not be picked up fast enough. I worry that we will not be able to spot the problems early enough.

I became a doctor to look after patients – in my case a population. I am saddened that I am no longer certain that I can do that.