Standards for effective public health teams
To inform the current discussions around the future of public health, a paper has been developed that describes the various domains of public health practice, proposes related public health outcomes and the characteristics of the public health team and resources required to achieve them.
The Public Health Standards and Knowledge Committee (PHSKC) of FPH has undertaken an exploration of standards that have already been published and/or used in public health practice in the UK and has attempted to describe how the various public health functions carried out currently by the teams locally and regionally might be delivered in the future through the public health service, through local authorities and through GP consortia.
The objectives of the paper are to:
- describe the current role of public health professionals at local, regional and national levels
- establish the link between the role of public health and various health outcomes
- recommend how the various public health functions carried out currently can be sustained in the future
- indicate the resources which are required to achieve the public health outcome, including the composition of public health teams at local, regional and national levels to deliver the public health outcomes in the future.
This paper is envisaged as a working draft and consultation will continue with the public health community in order to establish a definitive document over the coming months. It will be used by FPH and ADPH to help the government shape the design of the English Public Health Service.
RDsPHs, DPHs, public health consultants and specialist registrars are encouraged to debate the issues raised by this document and use pertinent information to inform local decision-making but also to feedback to FPH in order that the paper is a living document, reflective of the needs of the population.
“Protecting investment in health is not just important, it is essential to sustaining our health service” (1)
Adequate specialist public heath staffing is essential to achieving the ambitious targets for improving health and reducing health inequalities set by the Government. It is also central to securing the “fully engaged” scenario of the Wanless report (2), without which the NHS alone faces preventable increased expenditure of ₤30 billion by 2022. In spite of this, overall consultant numbers, which have remained static since 1998, look set to decline as a direct consequence of the current restructuring of SHAs and PCTs, in spite of reassurances given by Health Ministers and the Prime Minister that “…. the Department of Health is working to ensure that the overall numbers of the public health workforce are not reduced .” (3). This clearly makes neither health nor economic sense, and the Faculty is issuing these guidelines to assist Chief Executives and Directors of Public Health make adequate provision to meet the public health challenges that they face. In 1988 the Acheson report recommended a staffing target of 15.8 consultants per million population. Since then public health responsibilities have expanded enormously following key government policies:
- wider health protection, including bio-terrorism and resilience planning (4);
- effective commissioning for health and social care, including clinical effectiveness and clinical governance, and the development of managed clinical networks (5);
- working with local government, communities and the NHS to achieve improved health and reduce health inequalities. (6)(7);
These challenges can only be fully addressed by adequately resourced and staffed public health departments, but central to these must be capable specialised leadership. As a result, in 2004 the Faculty recommended a minimum target of 25 service public health consultants per million population. The detailed justification for this target was set out in the Faculty's 2004 report (8) which synthesised a number of studies and surveys adopting both “top-down” and “bottom up” methodologies. The table below sets out how this overall target can be disaggregated between organizations to meet the needs of a hypothetical 5 million population of a “typical” Strategic Health Authority.
These guidelines are illustrative, not prescriptive: actual disposition between organizations will reflect local circumstances. However, the overall numbers are what is needed, although there may be trade-offs, for example between PCTs and trusts in order to cover the quality agenda. The staffing for PCTs needs to reflect the number of Local Authorities, (each of which needs an identifiable DPH), and relative population size and need, with additional consultants required in areas of poorer health status.
|No. of Consultants||Comments|
|SHA/ Regional Office||12||includes PH Observatory, networks, registries and PG education and training|
|Health Protection Agency||25||To cover full range of HP duties but does not include PCT support|
including joint working with local government
Health improvement - 35
Health service quality - 25-30, complementing PH staff in trust
Health protection - 10
|Trusts||5-10||The eventual aim should be to have the equivalent of a consultant in every trust working on service quality improvement/clinical effectiveness and governance|
|Central||6||The 25/m target includes staff in central organisations with PH responsibilities, including DH and the HPA|
The Faculty's workforce report and target did not include academic public health. This is obviously crucial and requires further consultant staff to meet the challenges identified in the Wanless report (2)
- CMO Annual report 2005
- Wanless, D, Securing Good Health for the Whole Population, 2004
- Letter from Tony Blair to President FPH 6 th September 2006
- Department of health, Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection), 2002
- Department of Health, Commissioning a Patient-led NHS, 2005
- Department of Health, Choosing Health – Making healthy choices easier, 2004.
- Department of Health, Our Health, Our Care, Our Say, 2006
- The Specialist Public Health Workforce in the UK - a Report for the Board of the Faculty of Public Health, March 2004