Intended for healthcare professionals

Rapid response to:


The “redisorganisation” of the NHS

BMJ 2001; 323 doi: (Published 01 December 2001) Cite this as: BMJ 2001;323:1262

Rapid Response:

Response to The Redisorganisation of the NHS


Your leader on disorganisation of the NHS failed to make reference to
another group on whom the current structural changes are having a
profound impact - those in public health. The majority of NHS public
health specialists working in England found out their jobs would be
changing from a speech by the Secretary of State in April. They too are
also suffering from low morale along with the professions and mangers as
described by Smith. The major problem they face is making sense of yet
further structural change in the delivery of the public health function –
and the seeming indifference to their professional as well as personal
futures. The problem is not that public health is not relevant, for there
has never been a time at which there is more discussion of social and
health inequalities (although much of this comes from other government
departments, for it is the Chancellor who champions the need to improve
children’s health through addressing child poverty). Rather, the problem
is the lack of discussion and debate within the NHS about how best to
deliver public health programmes which will deliver these changes. The
media focus relentlessly on acute care and hospital. Just as there is no
evidence that the reorganisation will improve performance, there is none
to show that one of the biggest reorganisations of the public health
service will improve the public’s health.

Our difficulty with the current reorganisation is that the majority
of public health specialists- doctors and those from multidisciplinary
background- work at one or other of the tiers currently being reorganised.
Since last April they have not known where they will be working on April1
2002. The response that they will all have a job is just not good enough.
Working in public health within the NHS requires a long-term view.
Successful practice is based on relationships with a wide range of people,
not least the members and officers of local authorities and community
leaders with in the voluntary sector. These relationships build up over
years and these are the links which will help build the closer joint
working necessary to work with local government colleagues. They do not
make the headlines but nurturing them is crucial to delivery on local
strategic partnerships, key to delivering the NHS Plan.

For some in public health this reorganisation is one too many.
Whereas civic society is based around democratically elected members for a
geographical area, PCT boundaries in many parts of the country have
developed from GP practice base. The relationships built up between DPHs
and their civic partners are thus dismissed, and no one PCT will now cover
large cities such as Birmingham or Sheffield. There is the not only the
risk of confusion but failing to value wisdom and expertise in the rush to

There can be solutions. For example, PCTs and public health
specialists can work in networks which reflect local government boundaries
wherever possible. ( ) There are also public health opportunities in the
new roles for PCTs and regional government offices, not just for
specialists but for all working at this level. There is also the
opportunity to develop multidisciplinary practice as debated in this
journal. But if this reorganisation is not to weaken the public health
function there will need to be time, energy , resources and active
demonstration from ministers and other influential players of the
importance of this agenda. This means not only the general political
philosophy of addressing poor health through economic investment, but
through demonstrating care and concern for the professionals who have to
deliver these ambitious aims.

Sian Griffiths, OBE

President, Faculty of Public Health Medicine

Competing interests: No competing interests

11 January 2002
Professor Sian Griffiths
4 St Andrews Place, London, NW1 4LB
Faculty of Public Health Medicine