Health Service Focus

Pursuing the best possible health for the people we serve

Professor John Middleton (pictured), president of the Faculty of Public Health (FPH), looks at the opportunities and challenges facing public health reform in the UK.

The FPH is the standard-setting body for specialist public health in the UK. We define public health as “the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society”. When I talk about ‘public health’ I tend to split it into two distinct but related areas: ‘the health of the public’ and the ‘public health system’. 

The Faculty has a key role in the public health system, developing the professionals who work in it. But we are also advocates for improving and protecting the public’s health. Our ethical code requires us to pursue the best possible health for the people we serve, according to the best standards of evidence we have. We describe three domains of public health: health protection – control of communicable disease and environmental risks; health improvement – healthy public policy and health promotion; and service improvement – assessing the effectiveness of clinical and social care services.  

There is a substantial evidence base to all these domains. In the field of health improvement, there is now a massive evidence base on inequalities in health. It has grown from the Black report through two Marmot reports: unequal economic, environmental and educational opportunities cause inequalities in health. We have published a report on the role of public health in preventing violence, recognising that it has not been given the priority it requires and recognising the new evidence around adverse childhood events. 

In our 2017 election statement, we called for the next government to make meaningful policy changes which will seriously reduce inequalities in health, rather than add to them. In health protection, there has been a long and celebrated history of the sciences of infectious disease and epidemiology enabling us to mount effective responses to outbreaks and control and monitor the more common preventable infections. The appalling terrorist attacks in Manchester and London and the Grenfell Tower disaster have led us to review the public health role in emergency preparedness. The public health implications of Brexit are also greatly exercising us – all the rights to health that have been built over many years are at risk – in consumer protection, soil, air, food quality, workplace health and safety and working conditions, and environmental protections. These may be lost in new trade deals unless we argue for better protections, not a race to the bottom. 

In the field of healthcare evaluation, our members have been at the forefront of the evidence-based medicine and evidence-based policy agendas over many years. Population health insights help us to decide how health and social care can work together better and how to create the best care pathways. Critical appraisal of high-cost drugs and new technologies helps to decide which treatments are affordable and effective. Comparative analyses help us to interpret where some health systems are working better – in terms of patients living or dying, or in terms of patients being treated better for less time in hospital, less intensive care, less unnecessary care.  

Condemnation of cuts to public health 

The move of public health to local authorities in England is a historic one. Many local authorities have welcomed and embraced public health services and adopted a ‘health in all policies’ approach. However, even for the best, there is still the imperative of national government budget cuts so it is tough everywhere. Health service commentators have been united in their condemnation of cuts to public health and preventive care. This criticism has come not just from the public health community but from the King’s Fund, Local Government Association, NHS Confederation, the Health Select Committee and even the chief executive of NHS England. One of our priorities is to demonstrate the massive return on investment potential of public health interventions and to influence national spending priorities for health at the next comprehensive Spending Review. We estimate around 18% of public health consultant capacity has been lost through the UK health changes in the last three years at local and national levels. 

We want to ensure that the skills of our members in healthcare analysis are rebuilt, and we are working with Public Health England, NICE and others to develop training programmes and accredited attachments where public health specialists can hone their skills in critically assessing which health services work, which provide the best value, and which have unacceptable levels of side effects and harms. In relation to the English health system reforms, we are arguing for the full and effective use of public health analysis and priority setting in the sustainability and transformation plan process. Whilst there are notable examples of good practice in tests, with clear commitments to preventing illness, they are not generalised across the NHS and won’t yet be delivered at sufficient scale to make a real reduction in demand on the health service.   

The potential of public health skills to contribute to reducing ill-health and reducing pressure applies whatever the health system – similar problems are being experienced in all four nations of the UK and elsewhere across the world. Our international members grapple with even worse resource constraints and demonstrate often heroic achievements in preventing and controlling disease. The challenge for all of us is to improve and protect the public’s health. It is everybody’s business, but it will always need the catalysts, the stimuli for that collective action, through the expertise that my members have. If you are interested in public health, do join us.

FOR MORE INFORMATION

E: [email protected]

W: www.fph.org.uk