Better Health For All

The Faculty of Public Health is a champion for the very people who form the backbone of our nation’s health and wellbeing – our public health professionals. Yet, we are concerned about the risk of a slowly emerging yet persistent challenge – the widening of pay inequities for public health specialists working within the UK public health system.

This is not simply a matter of numbers and spreadsheets. It is a moral failing, an injustice that undermines the very foundation of equity we strive to create in public health. It’s about recognising the worth of every individual, regardless of their demographic characteristics, level, or site of employment.

Consider the facts: women, who now make up a significant portion of our public health workforce, often face pay gaps compared to their male counterparts. The picture worsens for ethnic minorities, where the disparities become even more pronounced.  Pay differences for public health specialists are also emerging dependent upon employer, UK nation and region of residence, and between whether working at national, regional or local levels in the system. Pay equity isn’t just about fairness; it’s about talent retention, recruitment, and ultimately, the effectiveness of our public health system.

When we undervalue a group of professionals, we send a damaging message: their contributions are less important, their expertise less valuable. This not only demotivates individuals but also deters future generations from pursuing careers in public health, further exacerbating workforce shortages. But let us be clear: this is not about pitting groups against each other. It’s about recognising the inherent value in each individual and ensuring that their contributions are rewarded fairly. It’s about building a public health system that reflects the diversity it serves, where talent is recognised and nurtured, regardless of background.

How did we get here?

The Faculty has for many years been concerned by the significant differences in pay and terms and conditions of service between people registered by the GMC and UKPHR. This appears inequitable when the higher specialist training of people registered with the GMC or UKPHR is identical. There are also many differences in the Terms and Conditions of Service (TCS) of doctors and non-doctors e.g. relating to out of hours work, and only doctors being eligible for clinical impact (formerly excellence) awards.

The Faculty is not a trade union, but has taken an active interest in this issue, particularly given our role in supporting the appointment of all Consultants and Directors of Public Health in the country through Advisory Appointment Committees (AACs). Though the Faculty’s dataset on applicants for Consultant posts utilising AACs for Scotland is not as large as it is in the rest of the UK, the Faculty will publish some of our intelligence on advertised pay and expects to provide more published information on AACs in 2024.

The NHS decided many years ago that only medically qualified persons could be paid on medical TCS and that non-medically qualified public health consultants should be paid on a broadly equivalent Agenda for Change band. In Wales, an exercise was carried out a few years ago which determined that the appropriate banding for UKPHR registrants was Band 9 which is similar to the pay of medical Consultants, although if you spent your whole Consultant career in Wales, the lifetime earnings of the medically registered Consultant would still be significantly higher than that of a UKPHR registered Consultant. In Scotland, England and Northern Ireland, non-medically qualified Consultants in Public Health are usually banded as 8d and earn considerably less than their medical colleagues.

What’s being done?

The Faculty has pressed for a similar grading of Agenda for Change Consultant posts exercise to be carried in the rest of the UK as it was in Wales. So far this request has resulted in an in-principle commitment from OHID/DHSC to undertake a grading review. Scotland has not yet responded to the request. One can speculate that the reticence to follow the Welsh example may be in part because the relevant employers are financially challenged and have decided not to take action which could lead to a significant increase to their wage bill.  

The Faculty is also exploring, with the help of the BMA, whether there is a potentially strong case under equal pay legislation to address the unequal pay offered to registrants of the GMC and UKPHR . A request for information under the Freedom of Information regulations was made by the BMA in 2023. A successful challenge to the current pay structure would need to demonstrate discrimination on the basis of a protected characteristic e.g. gender. 

Given the growing numbers of consultants employed by Local Authorities (LAs) in England, the vast majority of LAs currently do not offer medical terms and conditions of service to GMC registrants, which has led to a situation where Consultant salaries appear almost certainly lower than those in OHID, UKHSA and the NHS. Whilst the Faculty only has data on advertised rather than actual salaries, we do know with certainty that a higher proportion of GMC registrants work for OHID, UKHSA and the NHS, and a factor in their choice of employer is the better pay and TCS offered.

Though it may be equitable that Local Authorities pay consultants the same salary irrespective of background, it is unfair that the pay offered is significantly lower than that offered to consultants employed in the NHS, OHID and UKHSA. The Faculty is keen to work with our Local Authority colleagues to raise concerns about how inequity in pay is distorting the labour market for public health Consultants.

With respect to the UK government, a case has been made to the Secretary of State that funding for pay awards for the NHS are not routinely made available to non-NHS employers, even though the COVID-19 pandemic demonstrated beyond doubt that public health is an essential part of a national health service even when it is not part of ‘the’ NHS. If this issue is not addressed it is likely to lead to even wider disparities between public health staff employed by the NHS and other employers.  

The Faculty is producing a long-term specialist public health workforce strategy (2023-30) and is seeking cross-party political support for the strategy which includes a commitment to pay equity.

Conclusions

In summary, addressing pay inequities is not just the right thing to do; it’s also the smart thing to do. It strengthens our workforce, fosters innovation, and ensures that public health reaches every corner of our society. This is not just a policy issue; it’s a call to action, and the Faculty is committed to addressing Consultant pay inequity in the UK on behalf of our members.

We, as a public health community, need to work together. We need to engage in open dialogue, conduct thorough research, and advocate for policies that promote pay equity. We need to hold ourselves and our institutions accountable for ensuring fair and equitable treatment of all professionals. Working with resolve, partnership, and a shared commitment to justice, we can create a public health system where everyone is valued, everyone is empowered, and everyone contributes to a healthier, more equitable society. Let us rise to the challenge and build a public health system worthy of the dedication and expertise of its professionals.

Professor Kevin Fenton CBE FFPH
FPH President

Dr. Ellis Friedman
FPH Registrar

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From pandemics to climate change, the complexities of our world demand a new breed of leader – one who thrives in the face of uncertainty and orchestrates collective action amidst chaos. Let’s explore what this might mean for those of us in public health.

As I travel around the country meeting fellow public health colleagues, I am consistently struck by one consistent message: We are indeed living in interesting and complex times. Whether working within the context of rising pressures on health services, rising tides of infectious and chronic diseases, widening health inequalities, growing poverty, shrinking budgets accelerated by the cost of living crisis, public health is becoming more challenging and the communities we serve are in greater need.

The truth is that we are standing at a pivotal juncture. Our interconnected systems, once seemingly predictable, now are defined by complexity. Pandemics, the cost-of-living crisis, climate change, and rising inequalities are intersecting to create overlapping and unanticipated challenges. Yet, amidst this uncertainty, a critical opportunity emerges: to forge a new paradigm for public health leadership in complex times, one that transcends traditional models and embraces the intricate realities of our time.

This new leadership paradigm demands a multifaceted lens. It requires us to abandon simplistic narratives and embrace the inherent complexity of our systems. As we learned in the acute phase of the COVID-19 response, linear, top-down and heroic models of leadership were unable to effectively respond to the complexities of a rapidly emerging, unknown disease affecting every part of our globally connected society. More recently, the growing realities of child poverty, worklessness due to poor health, and declining economic productivity require different approaches to tackling them. Critical thinking, a systems-level perspective, and a thirst for diverse perspectives become our guiding lights. By understanding the interconnected web of factors shaping our challenges, we can move beyond symptom-based solutions and craft interventions that address the root causes.

Within this increasingly complex environment, equity must be our compass, not a distant aspiration. We cannot afford to be bystanders in the face of health inequalities that scar communities and end lives prematurely. We must champion equity as a core value, dismantling the social, economic, and structural barriers that perpetuate these injustices. I am encouraged by the leadership that public health teams are providing on issues including poverty, homelessness, structural racism, inclusion health among other areas. We bring our commitment to evidence-based action, collaboration, systems leadership, strategy formulation with a resolute focus on delivery. Prioritising resources and interventions for the most vulnerable is not simply a policy choice; it is a moral imperative that demands unwavering commitment.

Collaboration, not isolation, is the key to unlocking transformative solutions. We must foster trust and forge partnerships across sectors and communities. Integrated Care Systems in England, promoting stronger working in place between health and local government, combined with a strong visibility and input of public health experts provide new opportunities for collaboration to improve population health. Public health colleagues are building coalitions for action locally, regionally and nationally recognising that practitioners, clinicians, researchers, community leaders, and importantly, the people we serve, each hold fragments of the solution. By listening with open hearts and minds, we can harness the collective wisdom of this diverse mosaic and co-create interventions that are both effective and sustainable. This was a recurrent lesson in our COVID-19 pandemic response and must now be an enduring legacy.

Agility and adaptability – both professional and organisational – in this ever-changing landscape is essential. We must be nimble, pivoting in response to emerging challenges and opportunities, and be prepared to take full advantage as opportunities arise. Recent opportunities for action on expansion of opt-out HIV testing in emergency departments, tackling youth vaping and progressing smokefree generation legislation in England all highlight the importance of this preparation with agility.  Embracing experimentation, learning from failures, and fostering a culture of innovation within our organisations are essential steps. By staying responsive and open-minded, we can ensure our systems remain relevant and effective in the face of constant flux.

Finally, we must lead with both courage and compassion. We need the courage to challenge the status quo, speak truth to power, and make difficult decisions, even when they are unpopular. Public health teams across the country are leading the difficult necessary conversations on tackling air pollution, climate crisis, structural racism, asylum and migrant health and many other areas deemed politically challenging or difficult given the current funding constraints. Yet, amidst the complexities, we must never lose sight of the human cost of our choices. Leading with empathy, recognising the anxieties and vulnerabilities of those we serve, and demonstrating unwavering commitment to their well-being is the bedrock of effective public health leadership. Ensuring that current and future generations of public health experts have the training, tools and capacity to lead in these new ways will remain a priority for the Faculty of Public Health.

In closing, the paradigm of public health leadership in complexity is not a distant dream. It is the practical toolkit we need to navigate the labyrinth of our present reality. By embracing these principles, we can help to build more resilient health systems, advance health equity, and ultimately, create a world where everyone has the opportunity to thrive. We are not alone in this journey, so let us step forward together, with courage and compassion, to chart a brighter future for public health and the communities we serve.

Professor Kevin Fenton CBE FFPH
FPH President

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