The chief medical officer for England has revealed that he was given just two hours to insert a reference to public health into the Department of Health's key policy document, Commissioning a Patient-led NHS.

The chief medical officer for England has revealed that he was given just two hours to insert a reference to public health into the Department of Health's key policy document, Commissioning a Patient-led NHS.

Professor Sir Liam Donaldson said last week that when he was eventually told about the existence of the document - which ordered the wholesale restructuring of primary care trusts and an increased market in primary care -he was dismayed to find out that it had no reference to public health or health inequalities.

He told a session at the Association of Directors of Public Health annual conference last week: 'I had two hours to draft something to be put straight in to the document.'

The changes to the resulting document were 'very rushed', he said, but 'there was no time for it to be amended' ahead of its publication in July last year.

Sir Liam's addition to the document set out the need for a public health director for every PCT - a requirement that he acknowledged was creating recruitment difficulties now.

'I took the decision that unless there were public health directors at local level, [in PCTs] public health would not be meaningful; the downside of this decision was that it has left us with too many public health posts to fill,' he added.

Sir Liam's comments echo criticisms previously made by outgoing DoH workforce director Andrew Foster, who said Commissioning a Patient-led NHS was produced by 'a very small group of very senior people' which excluded him, and 'sprung on an unsuspecting NHS' (news, page 14-15, 27 April).

In his speech last week, Sir Liam acknowledged that it had been a difficult year for public health directors but urged them to get to know their community.

'Lunch with the head of the local authority's education committee is probably more valuable than sitting looking at e-mails.

'We need you to be local figures in the community because it does make a difference,' he said.