Why is this issue important?
In recent years, there has been a significant increase in senior ‘population health’ roles which do not seek the same formal professional standards as senior public health roles.
For example, since the advent of Integrated Care Systems (ICSs) in England, although some Integrated Care Boards (ICBs) have ensured that their senior population health roles (including Consultants, Associates and Directors of Population Health) are registered public health specialists and meet the appropriate professional requirements, others have not.
This inconsistency can lead to:
- Appointments of individuals to senior roles without the full breadth of public health knowledge, qualifications and expertise.
- Weakening of professional standards in senior roles.
- Potential for harm to patients and communities, if strategic decisions are made without the advice and input of trained/qualified public health professionals, undermining health outcomes and increasing avoidable risk.
- Lack of individual accountability to a regulated profession, and consequently limited routes for redress where demonstrable poor performance occurs in roles designed to provide professional public health advice.
- Lack of access to specialist public health skills to support system-level decision-making on value and prioritisation, increasing the risk of inefficient use of resources.
- Lack of clarity over roles, responsibilities and accountability, leading to gaps in provision, duplication and weakened public trust, based on assumptions that technical advice is being provided by qualified public health professionals.
- Devaluing of the public health profession.
While many people and professions contribute to public health, senior public health specialist roles such as Consultants and Directors of Public Health require expertise across all domains of public health, including epidemiology, health improvement, health protection and healthcare public health. These professional public health roles have strict eligibility criteria, including formal training, qualifications, professional registration and regulation, and ongoing appraisal and revalidation requirements.
Improving health is a collective effort, as acknowledged in the Faculty of Public Health’s definition of public health as “the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society”. While FPH welcomes the scaling-up of the NHS’s focus on health at a population level and recognises that some Directors of Population Health from a non-public health background will be carrying out duties within their scope of practice, assurance on public health matters depends on advice being provided by individuals with appropriate specialist public health skills, training, registration and professional accountability.
What do we want to achieve?
- Recognition of the unique skillset of public health specialists and the profession.
- That senior population health roles (including Consultants, Associates and Directors of Population Health) should meet the same professional standards as senior public health roles, and clarity over which senior roles should meet these standards.
- That any job description for senior population health roles that is open to applications from a non-public health registered specialist should not include duties which require specialist public health competences, training and/or registration. These competences are laid out in FPH template job descriptions, an example here.
What actions can local teams take?
- Ensure job descriptions for senior population health roles align with professional standards for senior public health roles.
What actions will FPH take?
- Formally state our position that we consider ‘public health’ and ‘population health’ to be synonymous.
- Advocate for senior population health roles (including Consultants, Associates and Directors of Population Health) to have the same professional requirements as those for senior public health roles.
- Work with other Medical Royal Colleges, Faculties and appropriate organisations to agree model job descriptions for posts that are open to applications from non-public health registered specialists, and an appropriate job/role title that is not misleading.
- Engage with national NHS and ICS leadership to embed these standards into recruitment and governance frameworks for all senior population health leadership roles, at Agenda for Change Grade 8d and above.
- Share examples of best practice where these professional standards have been upheld.
- Develop guidance to inform integrated health and care systems where a post would be best filled by a registered public health specialist.
How will FPH monitor and measure progress?
- Systematically monitor and report on senior population health job advertisements and appointments to assess alignment with professional public health standards and use this data to advocate for change where inconsistencies persist.
