Public Health Review: Analysis of responses to the engagement paper

11 concluding remarks

11.1 Responses to the engagement paper were highly diverse, and represented a wide range of understandings and perspectives about the nature of the public health endeavour, the relationships and balance between the domains of public health, and the organisational structures which would best support a strong public health function.

11.2 Many responses were lengthy and complex. The lack of consistency in the use of key terms in relation to the public health function and the domains of public health, and the proliferation of related terminology meant that it was often difficult to interpret exactly what was being said.

11.3 The theme which provided the greatest amount of consistency and coherence, and which resonated with almost all of those who responded was the importance of focusing on ‘reducing (health) inequalities’. There was almost unanimous support for directing the public health endeavour towards this aim and some respondents explicitly said that health inequalities should form part of the formal definition of public health in Scotland. There was agreement across all sectors that reducing health inequalities required action far beyond the domain of the NHS, and that community planning partnerships were the key to this. However, there were different views about what the consequence of this should be in organisational terms.

11.4 On the whole, responses from NHS Boards, other health organisations and the third sector covered all the domains of public health and also discussed the issue of public health intelligence. Many of the professional organisations had a particular focus on the improving health services domain; whereas local authorities and partnership organisations focused to a very substantial degree on the health improvement domain (which they equated with ‘tackling health inequalities’). All respondents agreed that public health intelligence was vital to underpin progress.

11.5 There was a great deal of reflection by respondents about how best to organise the public health endeavour. The question of which parts of the public health function were best dealt with at national, regional or local level were returned to repeatedly, especially by NHS organisations. Although no clear conclusions were reached, there was a widespread sense that coordination between levels was currently weak, and that the status quo could be improved.

11.6 There was a strong call from a range of organisations for better coordination between the national organisations; this was sometimes raised in the context of calls for a ‘national public health strategy’. Occasionally, respondents also suggested there needed to be a single strong national public health organisation. However, there was no clear view of the form a national organisation would take, and where it would be positioned in the broader organisational landscape.

11.7 The advent of health and social care integration was important in setting the policy context for responses. The responses suggested that organisations were at different stages in developing their arrangements locally for integration and this ‘work in progress’ aspect meant that there was no clear sense (yet) emerging of the impacts of integration on public health. However, there were repeated requests to ensure that public health objectives (including reducing inequalities) should be set for the new Integration Joint Boards. The (re)alignment of public health resources to support these partnerships was discussed, but there were also concerns about a perceived lack of capacity within the specialist workforce to fully engage with this agenda.

11.8 The public health workforce was clearly valued and seen as a strength. Respondents repeatedly highlighted the diverse, multidisciplinary, committed and highly skilled nature of the workforce. At the same time, there was also widespread comment that the wider workforce required investment and the development of a clearer identity, together with training and development opportunities.