By Alexander W Macara
The National Background
It seems to have taken a long time for everyone to realise that "public health" means no less than the health of the public. Its function is to deal with every actual or potential threat to health by seeking to define and analyse the causes of disease and to devise and support the most relevant and effective means of promoting health, preventing disease, and delivering care.
If our clinical colleagues feel bruised and baffled by the constant structural changes in the NHS, spare a thought for our public health colleagues whose existing jobs repeatedly cease to exist and who have to compete for new posts which may require new knowledge and skills. The most recent reorganisation is the most radical yet. The functions of the 15 Regional Health Authorities in England have been subsumed within 9 Regional Government offices and the District Health Authorities have been replaced by 28 Strategic Health Authorities (SHAs) and some 200 Primary Care Trusts (PCTs). The work of consultants in communicable disease control (CCDC) has been relocated in the new Health Protection Agencies (HPAs) local units where their roles are greatly expanded.
The Regional Background
The Regional Director of Public Health for the South and West, Gabriel Scally, is the Department of Healths man in the governments Regional Office, located in Bristol, with a multi-disciplinary staff of about 20 and a remit to "work across a broad public health agenda". The Region has a monthly e.Bulletin.
The role of the Strategic Health Authorities, which must also have at least one public health doctor, is to "monitor health", i.e. the work of the PCTs. They are accountable to Region. The local SHA (which covers the old Avon boundaries and includes much of Gloucestershire, Bath, Somerset and Wiltshire in addition to Bristol) is located curiously, one may think, in Chippenham!
National Healthcare Programmes such as the National Service Frameworks (NSFs) e.g. for cancer, heart disease, diabetes, the elderly, mental health, and children, will be promoted by Regional Directors of Public Health direct to PCTs. The Regional Cancer Intelligence Service has a Bristol office. Details are available on the website www.theswcis.nhs.uk.
All these new health structures are intended to facilitate the development of close working links with other local government authorities and agencies and with NGOs (non-governmental organisations in the voluntary sector) with functions relevant to public health, particularly through a public health input to "community plans".
The Public Health Observatory for the South West is located in Bristol and monitors progress in defined policy areas. It has recently produced a consultation version of what it styles a "Regional Barometer". The website address is www.swpho.org.uk.
The Local NHS Scene
No reference is made here to the acute (hospital) services.
The former Avon Health Authority Area is split into five Primary Care Trusts: Bristol North, Bristol South and West which serve the population of Bristol, together with PCTs for Bath and North East Somerset, North Somerset, and South Gloucestershire.
The local Bristol NHS Public Health Workforce (public health physicians and their multidisciplinary colleagues) is based in the two Primary Care Trusts (North Bristol and South and West Bristol). They deploy their skills both within their PCTs and across all relevant organisations in the greater Bristol area. Their Avon website is www.avon.nhs.uk./phnet. It is a cornucopia of information of every kind, not only about the local health issues and programmes, but also about health related functions of local government and other relevant organisations. It also gives clinicians who may be interested an opportunity to gain insights into the domestic specialty concerns of their public health colleagues.
The new Health Protection Agency, which came into existence this month, incorporates the functions previously served by the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology Research, and the National Focus for Chemical Incidents, in addition to the work of the Communicable Disease Control Consultants and their teams. The Health Protection Agencies Local Unit covers the old Avon Authority Area. The Unit operates around the clock; out of hours contact can be made through the Avon Ambulance Control who contact the consultant on call. Its phone number is 01454 455433 and fax 01454 455448.
Bristol University and the University of the West of England both have close working links with the NHS, which need not be rehearsed here other than to recognise that the Bristol Universitys Department of Social Medicines (formerly Public Health) is now the largest, and arguably the leading, department of its kind in the country, occupying the whole of Canynge Hall with which many readers of this site will be familiar. The website address is www.epi.bris.ac.uk/
Alexander W Macara
May 2003