By Alan Maryon Davis
So now we know the shape of things to come. Barring a major upset with the Health & Social Care Bill, we now have a pretty firm idea of what the new public health system in England will look like. The command paper, Healthy Lives, Healthy People: update and way forward, deals with many of the concerns raised by last autumn’s white paper.
But how well will it all fit together? Will its wheels fall off at the first major outbreak?
In theory, Public Health England (PHE) as an ‘executive agency’ of the Department of Health, with the Secretary of State having ‘a clear line of sight to the front line,’ should make for a stronger, tighter command and control mechanism in times of crisis. But there are downsides.
One is that public health professionals within PHE will find it harder to challenge ministerial diktat than from their current positions in the quasi-independent HPA or public health observatories.
Another is the lack of absolute clarity about who will be responsible for health protection decisions at local level. The DPH will have to ensure plans are in place and will have (so far unspecified) health protection delivery functions, but the lead in most circumstances will be coming from PHE. Quite what circumstances and how this will work in practice (the ‘operating model’) are still being thought through by the PHE transition team. The risk is that something important might fall between the stalls. Or that DPHs could find themselves at loggerheads with their PHE colleagues.
The PH system has to be robust and reliable, functional and effective, flexible and responsive. Standards have to be exemplary. Senior public health specialists make life-and-death decisions affecting thousands. Their competence and leadership skills must be assured. Ultimately, public safety is at stake.
And yet there’s still no decision about the statutory regulation of all public health specialists regardless of professional background. The white paper consultation found massive support for it and the Future Forum recommended it. But Public Health Minister Anne Milton is still not convinced of the need. Risks? she asks. What risks?
Well, let’s start counting shall we – very slowly so the words sink in. E.coli, SARS, pandemic flu, Buncefield, heatwaves, flooding, immunisation, screening – need we go on?
You can bet your boots that without proper safeguards and a solidly regulated public health system, the compensation lawyers, the media and Her Majesty’s Opposition will all have an absolute field day.