The transfer of public health services from the NHS to the local authority will mean many professionals are set for a stark self re-evaluation that could call into question their employment with the NHS, writes Simon Bird.

Public health has been arguably the most successful chameleon over the years. As a profession, it has experienced many changes, with perhaps the most significant being the rapid growth of non-clinically qualified entrants.

This particular innovation was contentious from the start, and has redefined what it means to be a public health specialist. As a result, the profession changed its entry requirements and subsequent career pathways – but the current raft of proposals with which public health is grappling (driven by the Health Bill) has meant that difficult and personal questions are being pushed to the fore for many. These may force them to define themselves anew for the next stage of their career.

As with the rest of the NHS, discussion about the future of public health has tended to focus on structural issues, funding streams and the role of the public health director – most notably the position they should hold at their new home, the local authority.

While the recent Commons health committee report examining the government’s public health reforms has recommended that an appointment at chief level should be a statutory requirement, this is far from a done deal. Some directors of public health have been told very clearly that this will not happen and that they are too expensive to keep at their current remuneration levels within a local authority.

Whatever the resolution on this point, directors of public health are faced with a personal dilemma. The structural changes throughout the service have confronted many senior leaders with potential changes that will affect them personally, their teams and the broader service with which they are connected.

However, it is not unreasonable to suggest that the changes facing public health professionals are even more profound, because they are requiring people to examine their own professional identity and self-image.

Most fundamentally, they are faced with the prospect of leaving the employment of the NHS.

Transfer of services

Their responsibility, however, does not end there – even if they are able to satisfy themselves in relation to their own personal future, they must also help their teams navigate similar dilemmas and work out what, if anything, they are able to build on and consolidate if the transfer of services lies ahead.

Public health professionals have become expert at accommodating changes in their profession and their professional lives. Some 15 years ago, I spent time with a director of public health who was simultaneously incandescent and sceptical about the prospect of those without a medical degree entering the field. Nonetheless, the field now features highly successful professionals from both clinical and non-clinical backgrounds, even though they are recorded on separate registers.

What was really happening, though, was that he was being forced to re-evaluate his own professional identity and what it meant to be a public health doctor for him – and whether this still resonated with his own perception of the profession. 

There remains a lack of clarity about the funding arrangements for public health, transition arrangements, the home of different functions and how, most crucially, the good work that already takes place across the country on integrated health and social care delivery can be protected.

The uncertainty surrounding these issues, the departure of public health from the NHS, and the ongoing requirement to lead teams successfully and deliver the significant agenda, all mean that public health professionals face something of a perfect storm of personal leadership challenges.

  • To stay or go? It would be wrong to underestimate the challenge to some professionals’ self-image and professional identity that the transfer of functions to a local authority will present. While some will successfully transfer, and continue to build on success, others will consider whether this is what they wanted to do when they joined the profession. Even those who do transfer willingly will probably face an uphill cultural transition into an organisation that may be very committed to public health but uncertain how to genuinely integrate with a new director and team.
  • Status challenge? The debate concerning the positional authority likely to be given to the lead professional is significant. The prospect of no longer having a voice at the top table, although it is in a very different organisation, will almost certainly feel as if the service is being sidelined – which some professionals will find difficult to tolerate unless they develop new and creative influencing strategies.
  • Maintaining momentum? One element that differentiates successful leaders from those who are less successful is their ability to deflect some of the most detracting influences from their teams – and continue to foster a positive and productive team climate, even in times of considerable uncertainty and change.

A key challenge for those leading public health services will be how they can work through their own disquiet, maintain an open and honest relationship with their team while also supporting their team as they work through their own dilemmas. This is a significant request of any leader.

Public health professionals have shown many times before that they have the resilience and ability to adapt as the environment around them changes. Let’s hope that this chameleon can once again change its colours.