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An opportunity for better public health

October 2005

1. Introduction
The current review of NHS structures presents a valuable opportunity for improving arrangements for Public Health, building on the transfer of the health protection function to the Health Protection Agency in 2002. A consensus seems to be emerging with regard to the other two main streams of Public Health: that commissioning teams should be developed to cover a larger population than current PCTs that will include Public Health trained clinicians, and that local Public Health departments should be coterminous with Local Authority boundaries whenever possible.

This paper addresses the value of Public Health in all its functions, considering the case for strong Public Health leadership in the context of Local Authorities and how to achieve this when coterminousity of boundaries does not fit well with economies of scale. Since ‘form should follow function’ we offer an analysis of the functions of Public Health to help clarify a need to properly consider Public Health structures in the current deliberations about SHA and PCT configurations. The Health Protection function is not considered, despite its importance, as it seems unlikely that the Health Protection Agency will be affected by forthcoming structural changes.

The BMA wishes to see stronger, more efficient Public Health departments that can address the determinants of health and commission the delivery of population health improvement (go to SWOT analysis, Appendix A). We would like to see specialist Public Health staff deployed to maximum effect in new structures and measures to ensure the skills of senior specialists are not lost. We are concerned that some PCTs may seek to cut public health capacity as a means to reducing overall costs even though public health consultants and specialists are outside the management costs definition. We hope this paper will help clarify the value of an effective Public Health function that many senior NHS managers may not have experienced on the ground due to less than ideal arrangements in recent years.