Public Health Review: Analysis of responses to the engagement paper

7 Maintaining a core public health resource (Q4)

7.1 Question 4 of the Engagement Paper asked respondents: ‘What would help to maintain a core / specialist public health resource that works effectively, is well-coordinated and resilient?’ Ninety-six (96) respondents made comments in relation to this question.

7.2 It was not always clear from respondents’ comments whether the points they made were primarily addressing the first part of the question – i.e. what would help to maintain a core / specialist public health resource? – the second part – what would help the core public health resource to work effectively, be well-coordinated and resilient – or both. Note also that many comments were not restricted to discussion about needs of the core / specialist public health resource (as identified in the question), but also included comment about the wider workforce as well. Moreover, some respondents (including some NHS Board respondents) specifically commented that ‘the core public health workforce’ needs to be more clearly defined.

7.3 Three key themes were raised in relation to this question. These were: action at a national level; workforce issues; and collaboration and networking. Leadership issues were also discussed in relation to this question, but have not been included here as they are discussed in detail in Chapter 5.

Action at a national level

7.4 Respondents identified two main actions which could be taken at a national level. These were: the development of a national strategy and the creation of a national centre for public health.

Development of a national strategy or shared vision for public health

7.5 It was thought that having a shared vision for public health in Scotland would help to join up the efforts of Government, academia and national and local agencies involved in the delivery of public health functions. It would also clarify priorities for action – particularly action to address health inequalities – and bring about better co-ordination of national level functions.

National centre for public health

7.6 The development of a ‘national public health resource unit’ or a ‘centre for public health’ was suggested by some respondents. It was suggested that this national resource should have ‘strong leadership, working at the most senior level’, be ‘well-resourced’ and have an ‘influential and multidisciplinary team’. Its range of functions could include:

• Contribute to the development of local policy and practice (through collaboration with public health practitioners)
• Offer learning and workforce development opportunities
• Provide research and evaluation services
• Support access to literature
• Manage a fund to support the development and dissemination of public health information and education
• Have a key role in the dissemination and interpretation of information (including information about good local practice).

Workforce

7.7 Nearly all respondents made comments related to workforce issues. Within this main theme, there were several sub-themes namely: diversity of the public health workforce; clarity about who the workforce is; creation of a workforce development plan; training; career progression and pathways; and public health registration. These subthemes are discussed in turn below.

Diversity of the public health workforce

7.8 The diversity of the public health workforce was seen to be a strength and an important contributor to flexibility and resilience. Respondents felt this diversity should be encouraged, and that the review should consider not only the core public health workforce, but also the wider workforce and its role in improving public health.

7.9 The diversity stems from the wide range of backgrounds, (both professional and non-professional), which are found amongst the individuals who comprise the public health workforce, as well as the wide range of skills (both specialist and generalist) and knowledge.

The diversity of that core workforce should be acknowledged and supported; …This would encompass roles such as doctors, dentists, health improvement practitioners, environmental health specialists and health visitors, but also a much wider range of roles within and beyond the health service including data analysts, researchers, community development workers, evaluation specialists and strategic planners. (Research / academic, 99)

Clarity about who the workforce is

7.10 At the same time, there was a view that the public health workforce needs to be properly identified. It was thought that the clarification of different roles within public health would help co-ordination; avoid duplication; and ensure quality, efficiency and sustainability. Clarity of roles would also help local partners know what they may expect from public health practitioners and specialists. It was suggested that resilience would come from ensuring that public health has ‘an ongoing sense of its own identity’.

What proportion of Scotland’s early years workforce – from child minders to play group leaders – are either treated or see themselves – as key contributors to public health in early childhood? The likely answer – “very few’ – underscores the need for Public Health to recognize and embrace its already existing (albeit largely unrecognized and unsupported) allies and practitioners. (Third sector, 108)

7.11 There were suggestions that particular groups of experts (for example, health psychologists and health economists) should also be considered as part of the ‘core’ public health workforce.

Creation of a workforce development plan

7.12 Respondents occasionally suggested that a national workforce development plan was needed for the public health workforce and wanted to see this as a recommendation of the review. Two specific points were that:

• Workforce planning should address the capacity of the specialist workforce, ensuring that there is a ‘critical mass’ of specialist staff working at national, regional and local levels.
• Public health roles should be reviewed and job descriptions brought up-to-date.

7.13 Some respondents made reference to the ongoing work of the Public Health Workforce Development Group in identifying the practitioner workforce.

Training

7.14 Respondents saw training as a key component in ensuring that a multi-disciplinary public health workforce works effectively and is resilient. While some called for a nationally agreed and recognised training programme for the core public health workforce, others argued that the strengths of the current Scottish Public Health Training Programme should be recognised. The training delivered jointly by NHS Education for Scotland and Health Protection Scotland for the health protection workforce was particularly singled out for praise.

7.15 Suggestions in relation to training included:

• The need to modernise current training programmes – so that content goes beyond ‘core competencies’ to include exercises that reflect the challenges facing the future public health workforce
• The provision of regular ‘multi-disciplinary training opportunities’, bringing together the wider public health workforce to increase awareness of roles and responsibilities within public health
• Investing resources in specialist public health professional groups
• Supporting Continuing Professional Development opportunities for the wider workforce.

Career progression and pathways

7.16 Respondents repeatedly highlighted the importance of developing career pathways – not only into the profession, but between different public health roles. The point was made that the transition between public health practitioner and specialist is rare, primarily due to a lack of career development support and current arrangements for the regulation of public health specialists. While respondents supported the move towards opening up senior posts to individuals without a clinical background, they also felt this needed to be accelerated. There was a view that without clear opportunities for career progression, the profession will not attract strong candidates, thus putting at risk the resilience of the workforce.

Supporting a professional infrastructure for non-clinical public health staff is key to provision of a sustainable, skilled and affordable workforce to provide the necessary public health function for the future. (National NHS organisation, 46)

Public health registration

7.17 Some respondents wanted to see a resolution to the debate over registration of practitioners in public health roles. The absence of a public health practitioner registration was a concern for some, and there was a call for this to be addressed. Specifically, it was suggested that workforce development initiatives (including the ongoing workforce review) should allow UK public health practitioner registration by individuals working across a range of sectors.

The absence of a PH practitioner registration is a significant concern and should be mandatory requirement in time. Investment in a national registration scheme and associated development support is a priority and requires to recognise the spectrum of experience and expertise within a large group of staff. (NHS Board, 9)

7.18 The issue of registration was raised again in comments at Question 5, and is discussed further in Chapter 8 of this report.

Collaboration and networking

7.19 Respondents focused on the importance of collaboration and networking in relation to maintaining an effective, well-coordinated and resilient workforce. The general comments related to the importance of working across boundaries. There were more specific comments about the importance of linking to community planning, and to strengthening links with academic public health. These are discussed below.

Collaboration across boundaries

7.20 Respondents commented on the importance of collaboration across individual NHS Boards / and organisational boundaries; this could be particularly useful in the context of small NHS Boards and would help to join up the public health effort across local, regional and national levels.

7.21 This collaboration was already in place through existing public health networks. These networks were seen to facilitate the sharing of experience and expertise and the co-ordination of national / regional functions and responses, thus promoting resilience and maximising effectiveness. The Scottish Public Health Network and the North of Scotland Public Health Network were both specifically mentioned as positive examples of cross-boundary collaboration.

There is likely scope for more collaboration with public health teams across Board /organisational boundaries as evidenced by work through the North of Scotland Public Health Network (NoSPHN) and ScotPHN. (NHS Board, 85)

7.22 There was also a suggestion that there should be further exploration of the use of ‘a shared service approach’ (as advocated by The Christie Commission) to increase the capacity of the public health resource, to avoid duplication wherever possible, and to facilitate to co-ordination and delivery of programmes between national and local levels. Examples of successful public health programmes involving national and local co-ordination of services included: the Childsmile Programme in oral health, the national immunisation and screening programmes, the Sexual Health and Blood-borne Virus Network.

To be effective, well-coordinated and resilient, we should be prepared to consider structural and organisational change where that may achieve better national and local identity, quality and sustainability, ensuring a critical mass for essential public health operations nationally and locally where appropriate. This may be achieved under shared services programme or network arrangements. (Senior public health staff groups, 89)

Links to community planning

7.23 The issue of partnership has been discussed in detail in relation to Question 3 (see Chapter 6). In their comments at Question 4, respondents often highlighted effective partnership at a local level as the key to an effective public health resource. The point was made that pressures on public funding, together with demographic and structural changes, created significant challenges to resilience. Respondents therefore saw it as imperative that public health is well connected to local community planning partnerships, which provide the local mechanism for tackling health inequalities in a more co-ordinated and focused way.

Links to academic public health

7.24 Respondents thought that relationships with academic and other research organisations was important in supporting the effectiveness of public health, and in providing independent advice based on academic rigour. The academic public health community was described as a ‘substantial resource with great potential’.

7.25 However, some suggested that academic public health was not always perceived as part of the core public health resource. The point was made that the links between academic research and the delivery of services is ‘patchy’. There was a view that the public health community should support a shift in academic public health towards greater dialogue to ensure that public health research is more relevant and more likely to have an impact.

7.26 Some also wanted to see increased funding for public health research, and it was suggested that greater use of joint posts (part funded by one partner and part funded by another) could potentially help in bringing about better integration between academic and service work.