Chairman of the Committee for Public Health Medicine & Community Health
Dr Eddie Coyle
Tuesday 2 July 2002
This has been a critical year for the craft.
We have been working hard to resolve all outstanding issues that enable the merger of our terms and conditions of service with those of other crafts.
The next task will to develop effective arrangements for the future representation of doctors in public and community health. I hope we will be able to bring agreed proposals to next year's ARM.
The main issue for the CPHMCH has been dealing with the Department of Health's hasty and often inept implementation of Shifting the Balance of Power.
The implementation of STBOP has been a sorry mess. The consequences have been, in some areas, nothing short of chaos. Staff are demoralised, progressive policies on working life have been ignored, in short the Department has shown a reckless disregard for its workforce, its most valuable resource.
The DoH makes much of leadership in the new arrangements but this experience has tarnished its credibility to lead.
I say this more in sorrow than in anger.
The saddest part of the reorganisation has been the missed opportunity to build a genuinely robust public health service. The words "public health" are barely mentioned in the legislation, and it has been treated as third order issue in NHS restructuring.
The government has a narrow view of public health, equating it with initiatives to address inequalities in health. Pursuing this singular view has led to the break up of 100 integrated public health departments in health authorities, including health protection and needs assessment. Until the Health Protection Agency is in place reorganisation continues for public health in England ... And that may be another 2 years.
So much of the structure in England seems dependent on, as yet, unspecified networks, with lines of accountability diagrams looking as though they have been drawn by "Jackson Pollock".
Ministers characterise these departments to Select Committees as dens of unreconstructed reactionary doctors, blocking the development of multi-disiplinary public health.
Throughout this campaign we have been clear that this is about how the existing workforce is treated, not opposing multidisciplinary public health. We have always welcomed a public health service based on the community of public health professions.
This government I believe cares about public health and we must work with it, ..... but it fails to master the detail required to implement its policy aspirations.
Its policies have a made up on the spur of the moment feel driven by the "drop in paragraph" in ministers' speeches rather than thought out policy. This is seen in other areas such as the amalgamation of regulatory bodies such as CHI.
It does not demonstrate the self belief that one would have thought its two massive majorities engender, to take political struggles out of the public health service by creating a modern legislative framework for the health of the public through a new public health act as supported by the RB.
In contrast to England, public health has prospered in the other home countries, following devolution with more measured and organised change. Public health seems to prosper when has it has a link to elected bodies at the right population size. It may be that the development of regional government in England will offer a better, more open public health system at that level, linked to elected assemblies, rather than the relatively closed process coordinated by officials in out-offices of a Whitehall ministry.
New multidisciplinary public health will need considerable support and funding, an infrastructure for professional development of all professions within the public health team, and must not be seen just as a management cost for PCTs.
The current transitional period towards the Health Protection Agency carries a high risk of a similar public health failure.
It was failure to be clear about accounatbilites that led to the Stanley Royd Hospital outbreak, which in turn provoked the Acheson Enquiry in the 80s whose recommendations started the revival of public health.
The DoH writes policy about "organisations with a memory" but it is people who have memories. Organisations if stable provide a context for that memory to learn from the past.
However, we were reassured when we met with the minister Yvette Cooper that no regional director will sign off a deficient public health system in their region.
We must hold them to that commitment.
The implementation of STBOP has implications for the profession as a whole.
The new NHS structures will have the responsibility to manage the planning and development of the service and the spending of the new monies on whose wise stewardship the NHS as an institution will depend.
We have new contracts for GPs and consultants whose delivery requires a higher quality of management than the medical profession has been used to - we can only hope that the new structures are up to it.
My greatest concern is what has happened may have an effect on recruitment into public health, particularly of doctors, and that we might see a slow attrition in recruitment over the next few years.
The BMA has taken a major step to prevent such an attrition by the inclusion of public health doctors in the new consultant contract and I thank the CCSC negotiators for including us in their discussions from the start.
Public health doctors are used to reorganisations and to making less than ideal arrangements work to improve health - it's almost part of the job. This particular reorganisation has been the most bruising yet, when it should have been a key opportunity for renewal.
The ARM is an opportunity to take stock and share with the wider profession the particular concerns of different groups within the profession. One of the motions today calls for us to revisit the contribution of doctors to public health and this will be an important debate. We need to take the lead in defining our role.
Strengthening negotiating arrangements at local level, in trusts and PCTs, will benefit our community health doctors, who remain some of the most vulnerable groups of doctors in the NHS. There is a need to strengthen the current contractual status of community health doctors.
Despite the recent difficulties I hope the ARM will reaffirm the importance of public health to the profession as a whole so that we can move forward in setting the agenda for improving the populations' health rather than fighting to preserve the way it is delivered.
I wish to thank the BMA at all levels for its support to our craft. We have worked on ministers, on managers and, through our IROs, guided many members through considerable personal difficulties. Finally, my thanks to our secretariat, Chris Hartley and Anna Whiskin, who have supported us so well.
Chairman, I move.