Published: 11/07/2002, Volume II2, No.5813 Page 18
'Yessss!' That wasn't me cheering a goal by the England team, but my roar of triumph after achieving something through the power of the pen.
The spring of 2002 marked a watershed in NHS history: the appointment of non-medics to the post of director of public health. Four years ago I launched a campaign from these pages to replace those medics to whom one of my former colleagues persists in anachronistically referring as 'drains doctors'with administrators and statisticians.
That article brought a firestorm of criticism from disgruntled public health practitioners. But I guess the truth hurts.
I have nothing against public health personnel; I certainly wouldn't want to suggest that they are mere drains doctors with nothing better to do than tip bags of lime down the sewers. They have probably contributed more to our general wellbeing than any other branch of the medical profession. Dammit, we British are probably the best in the world in this field of medicine.We should be, having virtually invented the specialty in 1854 when John Snow, the father of public health medicine, removed the handle of a polluted public water pump in London's Broad Street and, at least in legend, saved the capital from an epidemic of cholera.
Though the story has been embellished by posterity (the cholera epidemic had, after 700 deaths, already burned itself out by the time the parish council, not Snow, closed the pump) but the statistical method and detective work which led him to Soho's Broad Street were a critical turning point in medical science. It was a pity it took until 1872 for a Public Health Act to get round to legislating in favour of clean drinking water.
Public health has saved more lives and contributed more to our longevity than any other branch of medicine. Campaigns ranging from 'now please wash your hands', to slogans like 'coughs and sneezes spread diseases', and 'do not die of ignorance' have been branded into our collective consciousness with remarkable effect. Immunisation campaigns have made an even greater contribution.
Well, thanks, guys - we owe heartfelt thanks to John Snow and his successors - but now the party's over. Sorry, but you really are not needed any more. Sure the work still needs to be done, but it doesn't need a medic to do most of it. Public health is essentially about number crunching. Only the original decision about what numbers are worth collecting requires any medical input. Then the system can function with only minimal input from a highly qualified medic. And, well OK, maybe if some predetermined statistical anomaly arises it might then need further intervention.
But even, for example, in the event of the statistics showing up the sudden reappearance of an epidemic like the black death, there is no need for highly paid clinicians to intervene - an epidemic action plan should have already been written up by some now long-gone public health practitioner that can be implemented with minimal, if any, medical input.
The science and methodology of public health is so well understood that it can be reduced to a set of systemised instructions and actions that makes it pointless to employ large numbers of costly doctors.Qualified managers with an administration background are surely better equipped for this.
Does that leave anything for the poor displaced public health practitioners? Sadly for most, no; but there are lots of jobs where medical talents are in demand - such as in general practice, treating real patients with real illnesses.
And there will always be some demand for research posts in public health.As for the kind of jobs in the NHS, I envisage half a dozen or so regional appointments, doctors who tour their patch certifying annual health reports and occasionally conducting audits to ensure the statistics are being monitored and emergency action plans are up to date. Perhaps a little light staff training could be thrown in.
Since I value public health doctors' past efforts so highly, why not let them play golf on the other four days of the week?
Surely they deserve a reward for all that they have done? As poet John Betjeman put it: 'Think what our nation stands for... Democracy and proper drains.'
Though 'drains doctors'may soon share the fate of the England football team, I hope we never forget our debt to them.
Steve Ainsworth is a former primary care manager.