Speech given on behalf of the Chairman of the Committee for Public Health Medicine & Community Health, Dr Peter Tiplady, by Dr Steve Watkins
Thursday 3 July 2003
Conference, unfortunately Peter Tiplady cannot be present with you in Torquay today. His wife had a total hip-replacement just last week, and she was discharged after only five days, she needs quite a bit or support, and I am sure you'll agree that it is his responsibility to be with her.
This has been a year of great change for public health, with the post of director now being opened to non-medically qualified specialists in public health. The appointment of directors of public health to the new Primary Care trusts was a process that exercised the Committee considerably. We were unable to obtain protection for consultants in public health, who had to compete with the non-medics. However, almost 8 of a 10 of the posts are occupied by medically qualified doctors. We have noted that there is considerable regional variation, and the highest proportion or of non-medics is in the north-west. We had been very concerned that in spite of opening up the post to non-medics there are still vacancies, particularly in the east of the country where there may be very limited public health in at Primary Care Trust level. In other words, there are not enough public health people, medically qualified or not to serve the PCTS. Or, to look at it another way, there are too many PCTs.
Consultants in public health are now fully integrated into the consultant body as a whole. After several years of long and sometimes bitter negotiations, public health now has the same terms and conditions as the main consultant body. We worked very hard to achieve this, and on behalf of the Committee I express a debt of gratitude to Charles Saunders who led the negotiating team for much of this time, and to Richard Jarvis who is now Chair of Negotiators. We have been involved along with the rest of the consultant body in the dispute over the new consultant contract. The majority of our members voted in favour of the new contract but as soon as it became clear to us that we were in a majority we decided that our responsibilty was to stand by the rest of the consultants. I am proud that we did that and I am proud of the unity that the consultant body as a whole showed because the strategy the government used was to divide specialty from specialty, region from region, trust from trust, consultant from consultant and it failed.
The Committee has debated whether it should remain a separate craft, and how public health in the broadest sense should be promulgated within the Association. We have concluded that we should remain, at least for the time being, a separate craft committee. We feel it is important that there should be a distinctive voice for those who treat populations rather than individual patients and that has become clear during the course of this week. I am deep disappointed that the ARM did not seem to understand the significance that differential pricing has for the capacity of people in lower income groups to chose health, for this issue will be back before you conference in future years. I was also astounded to hear on the debate on flying and the environment that there are people in this ARM who do not understand the significance of the environment for human health. I do however understand the problems that the Board of Science and the Treasurer have in producing the report that was called for and so we will help them out: we will produce it. I can say that because all the information that is needed to compile it can be found in the Manchester Airport Second Runway Health Impact Assessment and in the submission that PCTs up and down the country have made to the government enquiry into air transport. There is a Public Health body of knowledge and I do wish that sometimes you would ask us to tell you what it is
I have been instructed to read you a statement in which the Committee pays tribute to me for the work that I did on defending a small group of family planning doctors which had their application for specialist recognition turned down by the specialist training authority. However I don’t propose to do this Conference because there is a more important tribute to pay and that is a tribute to the courage of Barbara Hollingworth, Arabinder Kundu and Noreen Khan who had the courage to risk their own money on trusting my judgement rather than that of the lawyers and who have in consequence performed a great service for the profession. I am having dinner with them tomorrow, they think that the dinner has been organised to thank me for what I have done for them but I would like Conference to take to them your best wishes and thanks for their courage and determination.
The committee has been very concerned to learn of the dire situation of our colleagues in public health in the Republic of Ireland. After some six or seven years of negotiations and promises from the Department of Health they have been refused consultant status and have no other option than to take industrial action. This unfortunate position means that there is hardly any public health advice available to health service management in the republic, which we believe represents a serious risk to health and health care in Ireland. We fully support their courageous action and have made it quite clear that we are standing with them shoulder to shoulder.
I have noticed a distinct fall off in morale in public health. The transition from solid well resourced public health departments to a much greater number of primary care trusts has been achieved by fragmenting valuable resources Many directors of public health are single handed and it was hardly any support staff. The fact that so many are enthusiastic about the contribution they can make to primary care is quite extraordinary, but I can see that some of the excitement and radical approach of public health has gone. In some districts the public profile of public health is almost totally absent. Attendance at our annual conference was poor with one region not been represented at all. In the coming year we will be a taking steps to get our members and those more closely involved with the work of the BMA, and in this context the review of governance of the association is most welcome. Our only criticism of the consultation document is that we feel that public health and other small crafts are not well enough represented in the new structure.
I hope that the ARM goes well and send my best wishes to the chairman.