{"id":37520,"date":"2016-10-05T16:44:07","date_gmt":"2016-10-05T15:44:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=37520"},"modified":"2016-10-06T13:56:40","modified_gmt":"2016-10-06T12:56:40","slug":"chris-packham-the-trouble-with-public-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/05\/chris-packham-the-trouble-with-public-health\/","title":{"rendered":"Chris Packham: The trouble with public health"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-37543\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2016\/10\/chris_packham.jpg\" alt=\"chris_packham\" width=\"150\" height=\"150\" \/>People think public health is\u00a0all (lecturing the masses on) sex, drugs, and alcohol.\u00a0<\/span><span style=\"font-weight: 400\">Even fellow clinicians tend to forget about defined roles such as the public health specialist. These individuals focus on using public health approaches to ensure cost-effective and appropriate planning, commissioning, and provision of NHS services. <\/span><\/p>\n<p><span style=\"font-weight: 400\">They can and do help the NHS and local government on the design, use, and evaluation of effective and efficient health interventions and care pathways.<\/span><!--more--><\/p>\n<p><span style=\"font-weight: 400\">In short, these clinicians embody the fine words about prevention, evidence based healthcare, and reducing health inequalities that regularly emanate from ministerial\u2014even prime ministerial\u2014mouths.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But in an act of bureaucratic self-harm, these specialists are themselves being severely rationed. It is as if the call in the Five Year Forward View for a new focus on public health and prevention might not have happened. <\/span><\/p>\n<p><span style=\"font-weight: 400\">The Health and Social Care Act placed a statutory duty on local authorities to provide specialist public health input into health care planning and commissioning.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Yet our recent review of capacity and capability of healthcare public health provision identified real concerns that local authorities are cutting this part of the specialist workforce. Already, some clinical commissioning groups are turning to private consultants to provide population level health expertise to support their commissioning. <\/span><\/p>\n<p><span style=\"font-weight: 400\">We suspect that as well as the inflated cost of buying in expertise, the quality of this advice is variable, and this approach doesn\u2019t build an internal body of skill long term. <\/span><\/p>\n<p><span style=\"font-weight: 400\">We\u2019re also seeing a rapid loss of more experienced specialist staff that know how the NHS\u2014with it all its glorious foibles, imperfections, and daily acts of minor genius\u2014actually functions. <\/span><\/p>\n<p><span style=\"font-weight: 400\">This is not a local government-bashing exercise here. The squeeze on councils\u2019 income since 2010 almost makes the (justified) talk of an underfunded NHS look like bad form. The public health grant Whitehall generously hands to councils was slashed by \u00a3200 million this year\u2014with further annual cuts of 3.9% due for the next three years.<\/span><\/p>\n<p><span style=\"font-weight: 400\">This is hardly the fiscal environment in which healthcare public health will flourish.<\/span><\/p>\n<p><span style=\"font-weight: 400\">But we will only rebuild our cadre of experienced, insightful healthcare public health professionals when the training of current and future specialists is matched by adequate opportunities for experience and employment. \u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Welcoming the Five Year Forward View, Jeremy Hunt, claimed that we need \u201ca vision\u2026encompassing the move to prevention, not cure, with (a) much bigger focus on public health.\u201d<\/span><\/p>\n<p>It\u2019s fine to have a vision. But they only really make a difference when you will the means for making them a reality.<\/p>\n<p><em><strong>Chris Packham<\/strong>\u00a0has been Associate Medical Director for the last five\u00a0years at a large Midlands NHS Trust. He is also a practicing GP, a public health specialist and Ex-DPH. He chairs the Faculty\u2019s Health Services Committee.<\/p>\n<p>Note: The last line of this blog was changed on 6 October\u00a0following\u00a0the author&#8217;s request.\u00a0 <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>People think public health is\u00a0all (lecturing the masses on) sex, drugs, and alcohol.\u00a0Even fellow clinicians tend to forget about defined roles such as the public health specialist. These individuals focus [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/05\/chris-packham-the-trouble-with-public-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223,236],"tags":[],"class_list":["post-37520","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chris Packham: The trouble with public health - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2016\/10\/05\/chris-packham-the-trouble-with-public-health\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chris Packham: The trouble with public health - The BMJ\" \/>\n<meta property=\"og:description\" content=\"People think public health is\u00a0all (lecturing the masses on) sex, drugs, and alcohol.\u00a0Even fellow clinicians tend to forget about defined roles such as the public health specialist. 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