Multidisciplinary Public Health

Understanding the Development of the Modern Workforce

Wright, Jenny, Sim, Fiona, Jenny Wright, Fiona Sim, Katie Ferguson

• Publisher: Policy Press
• Year: 2016
• Print ISBN: 9781447300328
• eBook ISBN: 9781447322719
• Edition: 1
• Topic: Medicine
• Subtopic: Epidemiology

Including the voices of key protagonists in the development of the public health workforce, this book is an important addition to the history of public health in England. It charts events leading to the unique achievement, from 2003, of specialist status, equivalent to public health medical consultants, for those from non-medical backgrounds. Setting these changes in context it discusses implications for practitioners and the wider UK public health workforce. A lively and comprehensive review of policy change, Multidisciplinary public health: Understanding the development of the modern workforce concludes with a reflection on the new public health system under way in England, making useful comparisons with the rest of the UK. This is an invaluable resource for anyone with an interest in public health, including public health academics and relevant postgraduate students.

Appendix 1: Timeline

This chronology has been adapted from the version presented within the Witness Seminar held in 2005 (Evans et al, 2006) on multidisciplinary public health and updated.

Year	Key events that had an impact on the development of a multidisciplinary public health workforce
1948	The National Health Service (NHS) began in the UK on 5 July. Local government retained the management of health centres, maternity and child welfare services, home nursing, health visiting, immunisation, other prevention work, and ambulance services under Medical Officers for Health. The new health service employed some public health doctors as medical administrators.
1968	The Royal Commission on Medical Education 1965–68 (Command 3569) recommended a period of general, followed by higher professional, training for all doctors following their internship year after graduation. It considered that there were sufficient elements in common for doctors between medical administration, social medicine and public health for these to be treated as a single specialty of community medicine. It recommended the setting up of a professional body to bring together academic and service interests in public health and assess professional training.
1970	The final proposal for a new ‘Faculty of Community Medicine’ (a faculty of the Royal College of Physicians) noted that, ‘at a later date, and by agreement with the Royal Colleges, consideration would be given to the eligibility of non-medical colleagues practising, teaching or conducting research in the field of Community Medicine’ (Warren, 1997, p 45) for membership of the Faculty.
1972	Publication of the Working Party on Medical Administrators (Hunter Report), which recommended that specialist postgraduate training for community medicine should include epidemiology, statistics, environmental health, social and behavioural sciences, social administration, and health services management.
	The Faculty of Community Medicine was created by the Royal Colleges of Physicians of Edinburgh and London and the Royal College of Physicians. Membership was restricted to registered medical practitioners.
1974	Implementation of new health and local government structures. The post of Medical Officer of Health was abolished. Public health doctors previously employed by local authorities were moved into the new district, area and regional health authority structures as specialists in community medicine and community physicians.
	Faculty of Community Medicine holds first examination for membership as the recognised specialist qualification.
1978	Declaration of Alma Ata, by the World Health Organization. Led to development of the Public Health Alliance and the Association for Public Health in UK.
1981	‘Health for all by the year 2000’ World Health Organization initiative.
1983	Publication of the NHS Management Inquiry Report (Griffiths Report). Led to ending of consensus-style management and the introduction of general management.
1986	Publication of the Inquiry Report following the outbreak of salmonella at Stanley Royd Hospital.
1988	Publication of Public health in England: the report of the Committee of Inquiry into the Future Development of the Public Health Function (Acheson, 1988), which identified public health as a multidisciplinary endeavour while retaining medical leadership. It also recommended that there should be a Director of Public Health (DPH) within each health district and region.
1989	The Faculty of Community Medicine changed its name to the Faculty of Public Health Medicine.
1990	NHS and Community Care Act, which led to the introduction of an internal market in the health service in England from April 1991.
	Establishment of multidisciplinary Masters in Public Health at Cardiff University.
1991	Creation of a category of ‘Honorary Membership’ at the Faculty of Public Health Medicine open to those in disciplines other than medicine.
1992	Masters in Public Health at the London School of Hygiene and Tropical Medicine opened to graduates from outside medicine.
1994	Survey of public health professionals identified over 1,500 people from backgrounds other than medicine working in public health in the UK.
1995	National seminar held in Birmingham to explore the career structures, training, accreditation and professional roles in multidisciplinary public health, followed by workshops across different English regions and UK nations to facilitate networking and explore education and development needs.
1996	Survey of members of the Faculty of Public Health Medicine, the majority of whom voted against opening examinations and full membership to disciplines other than medicine.
	Second national conference, ‘Multidisciplinary Public Health – Moving Forward’ organised, which led to the establishment of the Multidisciplinary Public Health Forum, with a National Core Group working through regional and national networks.
1997	Third national multidisciplinary public health conference in Birmingham, ‘Multidisciplinary Public Health – What Next?’
	Joint ‘Statement of Intent’ from the Multidisciplinary Public Health Forum and Royal Institute of Public Health to work together on the development of a framework for the education, development and accreditation of multidisciplinary public health professionals.
1998	Multidisciplinary Public Health Forum ‘Position Paper’ on training, education, and accreditation of multidisciplinary public health.
	Chief Medical Officer’s project to strengthen the public health function in England: a report of emerging findings (Calman, 1998) expressed commitment to developing multidisciplinary working.
	Successful vote of the membership of the Faculty of Public Health Medicine to open its Part I examination and diplomate membership to graduates from disciplines other than medicine.
	Faculty of Public Health Medicine joins with Multidisciplinary Public Health Forum and the Royal Institute of Public Health to form the Tripartite Group to work towards multidisciplinary accreditation.
1999	English White Paper Saving lives: our healthier nation (DH, 1999a) made a commitment to create a role of ‘specialist in public health’. The Health Development Agency to replace the Health Education Authority.
	Fourth national multidisciplinary public health conference held in Bristol.
	First formal regional training schemes for non-medical specialists in public health established.
	First sitting of newly opened Part I Faculty examination.
	Feasibility study of the case for national standards for specialist practice in public health (Lessof et al, 1999) published.
2000	Secretary of State for Health’s speech to the London School of Economics (Milburn, 2000) includes a call to ‘take public health out of the ghetto’ and end ‘lazy thinking and occupational protectionism’ in public health.
	Consultant-level specialist in public health posts open to disciplines other than medicine advertised by some Health Authorities.
2001	Publication of Shifting the balance of power (DH, 2001), which led to the creation of 303 Primary Care Trusts (PCTs) and 28 Strategic Health Authorities, each with a public health team with a board-level (DPH) appointment. 100 health authorities replaced.
	Announcement by Lord Hunt at the Faculty of Public Health Medicine Annual Lecture that ‘this generation of directors of public health will be from a variety of backgrounds not only medical. This reform offers an opportunity to make multidisciplinary public health a reality’ (Hunt, 2001).
	The first multidisciplinary public health trainee passed the Faculty Part I membership examination.
	At the Faculty’s Annual General Meeting, the membership voted in favour of opening the membership to persons from a public health background other than medicine and making the Part II examination available to both medic...

Table of contents

• Coverpage
• Titlepage
• Copyright
• Contents
• List of tables and figures
• Acknowledgements
• About the authors
• Foreword by Sir Liam Donaldson
• One: Introduction and methods
• Two: Developing the specialty of public health, 1972–90
• Three: The multidisciplinary public health movement of the 1990s
• Four: Changes for specialists I: Setting up a multidisciplinary public health senior appointments process
• Five: Changes for specialists II: The new regulatory system for specialists
• Six: Changes for specialists III: The establishment of multidisciplinary higher specialist training in public health
• Seven: The focus on practitioners and the wider workforce
• Eight: Where we are now? The new public health system in England from April 2013
• Nine: Experience across the other UK countries
• Ten: Conclusion
• References
• Appendix 1: Timeline
• Appendix 2: Glossary of terms