Letter

Public health teams at risk from reforms

Dear healthmatters – I agree with Tony Jewell (Shifting and unbalanced, issue 45) that public health is going through an unsettling time, as a result of the huge changes in the NHS, the marginalisation of public health strategy, and ministerial criticism of public health medicine.

Although it is welcome news that PCTs are to have directors of public health and that these do not have to be medically qualified, the public health workforce is being fragmented and is very demoralised. In many areas we are seeing skilled health promotion teams split across multiple PCTs.

Many of these staff have led the Health For All movement in the UK, pioneered community development, worked with marginalised communities, developed strategies on transport, housing and anti-poverty action and so on. It is possible that much of this work may disappear.

In all this upheaval many public health staff feel they are not valued and that, despite the rhetoric, the government’s main concern is with illness services.

The NHS is in desperate need of support and modernisation, but we also need a modern, multi-disciplinary PH function, at all levels. The root causes of ill health and inequality cannot be solved by illness services, and a PH function with less than 1 per cent of the overall NHS budget does not have a prayer of major impact.