Going public

It emerged with a whimper rather than a bang, but chief medical officer Sir Kenneth Calman's work on strengthening the public health function could put public health at the heart of The New NHS reforms.

His interim report, published in the form of a 'Dear colleague' letter to public health and medical directors, calls for an increase in the 'skills, capabilities, people and other resources involved in improving population health'.

Nationally, it says, there should be a new public health forum with staff drawn from the NHS and Department of Health, and a three-year rolling public health development plan for training and organisational development.

Public health directors should have a stronger role, they should have a clearer statutory role with local authorities, and they should ensure the delivery of a health improvement programme for each 'shared population of interest'.

There should, says the report, be a review of the evidence on involving the public, work on what people understand by 'public health' and how it can be developed, and research to evaluate the effectiveness of such interventions.

'This is really the third leg of the public health stool, along with the NHS white paper and Our Healthier Nation,' says Sian Griffiths, public health director for Oxfordshire and co-chair of the Association for Public Health.

'It is very good in that it raises the issue of how to explain public health to people. And, perhaps most important of all, it talks about sustainability. We have always been bedevilled by short-termitis in the past.'

She also welcomes talk of more resources, but adds: 'It's a bit short on where the resources are going to come from. The final report needs to be clearer on that and on how some of the changes are going to be taken forward.'

Jackie Spiby, public health director for Bromley, comments that the process leading to the interim report has been 'very democratic - lots of us have been involved, so there is a lot of support for what it says'.

She is pleased the report endorses joint health and local authority appointments - Bromley HA is coterminous with its local council and there are already a number of such posts.

'Developing our health action zone bid encouraged us to do a lot more work together, and we are thinking of producing a joint health report,' she says.

According to Sir Kenneth's letter, work on the interim report has already involved more than 200 people from national and local government, the NHS and academic centres - and the next stage looks set to involve even more.

A steering group is to be set up to oversee the work of a range of working groups which will be charged with taking forward the priorities set out in the report, and detailed plans will be drawn up for the national forum.

Work will begin on preparing a 'resource map' of specialist public health skills, with gaps identified and fed into a workforce plan.

All of this is due to end in the summer, when a final report will be written. Dr Griffiths says: 'I hope that will happen alongside the public health white paper. One of the strengths of this report is that it is identical to the green paper.'

A note of caution is added by Dr Spiby, however, who points out that Sir Kenneth is due to retire this year. 'We badly need someone in that role who is going to take this forward and not just let it drop.'

Chief Medical Officer's Project to Strengthen the Public Health Function: report of emerging findings. Available from the DoH web site at http://www.open.gov.uk/ doh/cmo/cmoproj.htm