Published: 30/09/2004, Volume II4, No. 5925 Page 24

While welcoming the progress that has been made by public health in developing a wider vision of the nation's health, I am concerned that public health as a discipline is incomplete, that epidemiology is not being used as a practical tool in the shaping of healthcare delivery.

The broad health planning function that used to lie within the remit of public health professionals in the regions has fragmented and critical parts of it seem to have totally disappeared.

The rational overview based on the scientific analysis of data, the assessment of trends and the aim of satisfying the essential basic philosophies of the NHS no longer seems to be a function of public health.

In its absence, the systematic organisation of health services is a process in disarray and subject to local whims and short-term political expediency.

At a more detailed level I deplore the decline - indeed virtual disappearance - of the role of public health specialists in planning hospitals.Here I confess to a direct personal interest. I have been involved in hospital planning for most of my professional career. I see a continuing need for this kind of expertise to be applied to new developments if each is not to be a 'one-off ' evocation of the local clinician's prejudices and ambitions.

The arguments about hospitals not being the be-all and end-all of healthcare delivery have been well rehearsed and are soundly based. Nonetheless, major hospital developments at multimillion-pound cost are going ahead and - because of their size and cost - are creating the nuclei of future health services configurations.

At this time there is no formal training process that provides for the continuing development of medical planning skills, and much of what was for long recognised as an important medical contribution has disappeared, leaving the function largely in the hands of architects, who have limited access to medical planning skills.

Dr Ronnie Pollock MPA Health Strategy and Planning, and former regional medical officer for Oxford regional health authority