Description

Jewell and Griffiths article¹ is interesting and important. It covers central issues that face Public Health Specialists in the NHS at the moment. While it is sometimes trite to refer to articles as “essential reading”, it seems to me that it would very helpful if all Public Health Specialists in England were to read it article.

Having said that, there are a few points which I think need some expansion or clarification:

1. It would be more helpful to talk about the kinds of issues which should be handled by a Managed Public Health Network in terms of criteria, rather than in terms of their content. These criteria would include:

Issues where the required population base in larger than one PCT.

Issues where it would be desirable to have a common approach across PCTs/local authorities.

Issues which require specialised skills, knowledge or experience. In practice, this is a very pragmatic point about how Public Health Specialists are used most efficiently.

The examples given in the paper will meet these criteria but having criteria would at least help us to judge whether any future topics should be handled by the proposed networks.

2. There are some important and difficult issues around the accountability of Public Health Networks. The view I take is that they should be seen in just the same way that the Cancer Networks are seen. That is, accountability is to the stakeholder organisations. Most Cancer Networks do this through a formal board and this is one model within Managed Public Health Networks. Clearly, other models could exist such as a lead PCT and/or a user forum. These details will need to be sorted out over the next few months and there will doubtless be different ways of handling things across the country. In doing this it is important that we learn from the successes and failures of these different methods.

3. Managed Clinical Networks require leadership and management. This is equally true for Managed Public Health Networks. Leadership will need to be provided by a lead Public Health Specialist presumably one of those on the Boards of the constituent PCTs of the network. Again, there are difficult issues such as how such a person is appointed. It seems to me that we would do well to learn from Managed Clinical Networks in taking this forward. The organisational issues are equally important. Ensuring that networks work, means that a resource is required to do this. Quite what this resource would consist of will vary from place to place depending on what functions actually sit within the network. My view is that it includes an administrative function and that it requires someone to do it.

4. Finally, Figure 1 suggests that there will be several networks supporting PCTs in an SHA area. I think that the key thing to note here is that the exact configuration of networks should be decided locally and approved by the Strategic Health Authority. Small Strategic Health Authorities may only have one network – while larger ones may have two or more.

Since the article appeared, Lord Hunt, the acting Minister for Public Health has clarified some of these issues-but many of us will still need to make local decisions about the precise operational strategic arrangements for Public Health Networks.

Reference

1. Jewell T, Griffiths S. Shifting the balance of power and managed public health networks. Public Health Medicine 2001; 3(2): 74-76.