Public health consultants[i] and trainees say the recent health reforms have failed to benefit the public's health and more than half of specialists have considered leaving the profession, according to new British Medical Association (BMA) research.
The Health and Social Care Act 2012 transferred most public health responsibilities from the NHS to local authorities and the newly created Public Health England in 2013, meaning that public health professionals were no longer working within the NHS.
The BMA surveyed public health staff to find out about the impact of these changes and how they felt about the future.
The results highlighted significant problems around:
An impending workforce crisis
- More than half of public health consultants and just under half of those in training, have recently considered leaving public health due to issues around career fulfilment, work-life balance and fears about future changes to terms and conditions;
- There is significant concern that the current workforce is being spread too thinly, with only 12 per cent of survey respondents believing that, in ten years time, there will be enough public health consultants available to serve the increasingly complex needs of the population.
Fragmented and variable public health services
- There is still little support for the public health reforms in England. The majority of those surveyed do not think the reforms have benefited the public's health and believe the level of unnecessary bureaucracy has increased. The report highlights the risks associated with fragmentation of the workforce and of some health care services.
- There was particular concern about a lack of ability to collaborate with other health professionals and to influence commissioners in the planning and delivery of health care services.
- There is wide variation in public health provision across England and signs that local authority public health may become the 'poor relation' of the profession.
Lack of independence and leadership
- Respondents perceived constraints on public health professionals and organisations speaking out and acting independently to protect the public's health.
- There was felt to be an absence of national leadership, linked to both the lack of an independent voice and the fragmentation of the Public Health workforce.
Dr Penelope Toff, Co-Chair of the BMA's Public Health Medicine Committee, said:
"Transferring public health responsibilities from the NHS to local authorities in England has led to considerable ongoing uncertainty and anxiety about the future of public health. That makes the results of this survey all the more important as an indication of the state of the current public health workforce and how they feel about the future.
"It is particularly worrying that so many public health specialists are experiencing unsupportive work environments, where they feel that their skills are not understood or valued. This report leaves us in no doubt that we will be facing a recruitment crisis, worsening the serious public health effects of austerity, such as increasing levels of alcohol and drug abuse.
"These findings demand urgent action. The public has a right to expect strong, independent voices to speak out on issues of importance to their health and all public health professionals should be supported to do the work for which they were trained. Every local authority needs sufficient experienced specialists to ensure both NHS and public health budgets are spent wisely."
For a copy of the full report please click here.