A study of doctors working in public health and health protection roles has exposed criticism and scepticism with the Government’s plans to reorganise Public Health England, and the opportunities for doctors to help shape any changes.
The survey carried out by the association’s public health committee, further found doctors reporting dangerously highly levels of mental and physical fatigue as a result of battling COVID-19, coupled with resentment with the sense their branch of practice had been overlooked by decision makers.
Influence eroded
Of the 255 respondents to questions regarding plans to replace Public Health England with a National Institute for Health Protection, 42 per cent said the restructure would make the response to COVID-19 worse or much worse. Among PHE staff, this view rises to 55 per cent.
63 per cent said they believed the new organisation would worsen or much worsen doctors’ ability to respond to other public health issues.
Nearly two thirds said they were not confident that they would be able to contribute to the design of the new system.
Almost three-quarters of respondents [72 per cent] say that they have no confidence the successor organisation to PHE will be sufficiently independent or able to ‘speak truth to power’.
‘I don’t have much confidence that there is room for influence based on the way in which the restructure was decided,’ one respondent to the survey said.
‘Working in PHE at that time I don’t think we had any ability to speak truth to power so I doubt that will change – this is dangerous.’
‘We saw the diminishing of independence post Lansley reforms,’ another respondent warned.
‘I fear that all of these negatives will be exacerbated by the new reorganisation, especially given the context of wanting to make PHE the scapegoat for the failings of others.’
Independence fears
News that PHE was to be restructured was confirmed in August last year following revelations in The Sunday Times.
The BMA responded by insisting it was critical public health doctors be able to speak out independently under any new system, while adding PHE should under no circumstances be blamed for ‘wider failings and Government decisions’ made during the pandemic.
Added to concerns with the overhaul to public health in England, the survey also uncovered significant levels of overwork and reports of burnout among public health doctors.
Two-thirds of respondents said they had regularly had to work additional hours during the pandemic, with 75 per cent describing their levels of fatigue and exhaustion higher than normal.
48 per cent reported feelings of depression, anxiety, stress, burnout, emotional distress or other mental health condition that was related to or being made worse by their work.
‘I am completely shattered,’ one doctor told the survey.
‘I have been working flat out non-stop for PHE since the end of January and we have had to continually absorb increasing demands and workloads, which has resulted in working more and more hours to try and complete this work.’
‘It’s just been awful,’ another reported.
‘More and more keeps getting expected of us – not sustainable and we will break.’
BMA public health medicine committee deputy chair Heather Grimbaldeston said reading about the experiences of her colleagues during the pandemic was ‘heart wrenching’, and that the decision to implement a reorganisation of PHE had, to many, added insult to injury.
She said: ‘Public Health professionals are at the forefront of managing the pandemic but remain in their words “invisible”, while many experienced staff who offered to return to work to assist in battling the pandemic faced a challenging and sometime fruitless recruitment process.
‘As key workers, they received little relief between the COVID waves, working tirelessly through and emerged from managing multiple care home outbreaks to supporting universities and schools negotiate return of students.'
She added: ‘This report highlights how there has been little in the way of management or professional support. Many just wanted recognition or a simple thank you, but were instead ignored or blamed worse scapegoated for wider failings.
'Exhausted and demoralised, these staff now face a disruptive reorganisation of PHE, a process which many feel they will have little opportunity to input into.
‘As the country continues to struggle to control this pandemic, it is essential that we do not overlook the needs and vital contributions of those working in public health roles, locally and nationally. To do so would endanger not just the profession but the also the public’s health’