Regional Director Of Public Health Research Articles

Kevin Fenton: pursuing equity and equality in public health

Kevin Fenton is a public health polymath. He's worked successfully in health prevention and health improvement for more than three decades and is currently the Regional Director of Public Health England (PHE) London and the Regional Director of Public Health for NHS London. “I have a passion for learning and throughout my career it is about looking for the next set of opportunities to make a difference to the people who I have been called to serve”, he says.

Climate change … what can we do?

There are so many other problems besetting the NHS just now that talking about sustainability and environmental policies is diversionary. Right? Wrong. As speaker after speaker emphasised at the conference organised by the Climate and Health Council1 which took place on the 29 January 2008 and held at the Royal College of Physicians, ‘Climate change and its impact on health’, what is good health advice for individual patients, eating less fat, cycling, controlling fertility, is also good for the health of the planet. The editor of The Lancet, Richard Horton, said, ‘Climate change is about social and environmental justice and doctors need to be advocates for their patients and their countries and create a social movement across the health sector’. Fiona Godlee, editor of the BMJ, quoted GMC guidelines. One of the two duties of a doctor laid down by them is ‘to protect and promote the health of … the public’. ‘Gone are the days when doctors care only for the health of individual patients. Climate change should be on the agenda of every health meeting’. The NHS as a whole has huge energy consumption and vast spending power and implementing sustainable policies makes not only good environmental but also good economic sense. The Sustainable Development Commission has been set up to take this initiative forward in six areas, transport, procurement, facilities management, employment and skills, community engagement, and new buildings. Are you a good corporate citizen? Take the test at www.corporatecitizen.nhs.uk.2 Both the Royal College of Physicians and the Royal College of Paediatrics and Child Health have undertaken to become carbon neutral with the RCPCH appointing a champion for carbon footprint reduction who is addressing paper use, improved use of technology, recycling, food and travel policy, and electricity and gas usage. Increasingly, large international conferences at exotic, carbon-expensive locations are being spurned in favour of video-conferencing. What else can we, as individual doctors, do? Mike Gill, retired regional director of public health, wrote recently on behalf of the Climate and Health Council in the BMJ ‘We should inform our professional colleagues and the wider community about the health consequences of climate change … we should set an example by reducing our personal carbon footprints and ensuring that the organisations we work for do likewise. Thirdly, we should advocate … Fourthly, health professionals should seek innovative approaches to using our many networks … to recruit as many … as possible’.3 As GPs, what is our role? Perhaps encourage our College to follow the lead of sister colleges in embracing a sustainable agenda? While environmental campaigning can never intrude into precious consultation time, we, as advocates for our patients, have close contact with our local communities and our views have influence. As Glasgow Professor of Public Health, Phil Hanlon, said at the conference, ‘Economic growth associated with rising consumerism and individualism seems to be damaging our sense of wellbeing and the cohesion of our society’. He believes that sustainable policies will improve, not only environmental and physical, but also mental and spiritual, health. Definitely the business of general practice. Dr Mark Thompson, a GP in Powys, offers a good example. His practice has an environmental policy, ‘A blueprint for a green practice’, which sets out 12 steps towards a carbon-light surgery. These address energy use, transport, recycling, encouraging patients attending for travel advice to consider offsetting, and minimising unnecessary journeys to the surgery. He is pleased that the RCGP Road Map for their vision for the future of primary care included a reference to carbon emissions; and he has submitted to the QOF Committee a proposal that QOF points should be awarded for carbon emissions reduction. Practices like the car-free Dalkeith Road Practice in Edinburgh, which rely on bikes and occasional taxis to do their visits, would earn their points. Rural practices are more car-dependent but Borders Time, the Borders wide Continuing Professional Development programme, is about to promote a green practice award open to any practice with an innovative carbon reduction scheme. Such ideas, and many others, will be shared at a conference in June on ‘Carbon reduction and health, a guide to reducing the footprint of the health sector’, organised by the BMJ, the RCPCH, and the Faculty of Public Health. Legislation against smoking eventually happened when doctors, and the public, forced politicians to act. The sooner we achieve robust legislation to curb carbon dioxide the better. We don't have a lot of time.

Reforming the coroner and death certification service

The intention of the Home Office is to introduce a new system that combines an independent check on all deaths and a professional oversight of death patterns, with, for the majority of cases, the minimum of bureaucracy. No public consultation is intended, so that reforms are not delayed. However as the proposals are developed in the coming months, the details, practicalities and costs will be discussed “with relevant professionals (not defined) and those with experience of the existing arrangements”. The imperfections of the present system are outlined. It is hoped the medical profession will have an input, since statements such as “ ‘hospital post mortems’, which are for medical research and public health protection purposes ” need amendment. There should be a change in perception of the audit value of this procedure to BOTH the family and the treating doctor. Unfortunately it is proposed the new system in total should cost no more than at present . “Professionals” (not defined) will be involved in the financial detail. All deaths, after verification and certification of the medical cause of death (if known) would then be referred to the ‘medical examiner’ based in the coroner's office. He/she would be a qualified doctor employed by the new coroner service and independent of the Health Service. The medical examiner could provide supplementary advice on medical matters required by the coroner. “Retention of tissue should only take place where absolutely necessary and the coroner and his or her other staff should take account of the needs of families and friends carefully throughout the process.” “Coroners could take advice from their medical examiner to ascertain and prescribe the minimum level of invasiveness to establish the cause of death.” This issue is far from resolved, as signified by a recent call from the DoH giving a grant to study the value of MRI versus a full post mortem. No thought is given to systemic diseases, which may present in one organ system or another disease process, other than that causing death. Medical examiners will have to keep abreast of current developments in medicine BUT will be outside the NHS, which could cause problems. Medical examiners will be appointed (with an input from Regional Directors of Public Health) and managed from within the coroner service. They would work closely with the registrar of births and deaths. Deaths from unnatural causes or when the medical cause of death is unknown will result in judicial inquests. The medical examiner will have an input into causes of death and relevant investigations. Details of the proposed structure of the system are given, as well as the investigative and other roles of Coroner's officers. The establishment of medico-legal centres, as “examples of good practice” is advocated. The drawbacks of this system are stressed in this paper. There is at present an on-going review of forensic pathology services and it is hoped thought will be given to the increasing trend for sub-specialisation in medicine.

Whitehall gets quality supporter

Prof Liam Donaldson will become the UK government's most senior medical adviser in September, at a time of great change for the National Health Service (NHS). As Chief Medical Officer (CMO) for England, he will be involved in radical restructuring of the NHS through implementation of the NHS white paper, and in translating the goals and targets of the public-health green paper, Our Healthier Nation, into a white paper and action. Currently Regional General Manager and Regional Director of Public Health at the Northern and Yorkshire NHS Executive Regional Office, he has held senior posts in that region for 12 years in which time he has managed great improvements in health care.

Who contributes to the public health function?

This paper describes the current nature and distribution of staff making an active contribution to the public health function in Health Authorities in England, so as to assess the extent to which the public health function is truly multidisciplinary and to begin to consider the National Health Service public health capability. A pre-piloted questionnaire was administered by Regional Directors of Public Health (RDsPH) to their respective District Directors of Public Health (DDsPH) in all Health Authorities in England over the period June 1995-April 1996. The questionnaire asked for details of all staff in Health Authorities contributing to the public health function as defined by the DDsPH. This provided distributions of: Public Health Physicians; Consultants in Dental Public Health (CsDPH); Trainees in Public Health Medicine (PHM); Epidemiologists; Research Officers; Nurses; Medical Advisers; Pharmacists; Directors of Health Promotion; Others (job titles specific to public health) in Health Authorities in England. Staff contributing to the public health function were distributed as follows: Public Health Physicians (32 per cent); Research or Information Officers and Epidemiologists (16 per cent); Trainees in Public Health Medicine (16 per cent); Nurses (8 per cent); Pharmacists (6 per cent); Medical Advisers (5 per cent); Directors of Health Promotion (4 per cent); Consultants in Dental Public Health (3 per cent); Others (job titles specific to public health) (11 per cent). The public health function is multidisciplinary, but the skill mix within Health Authorities is variable. The contribution of all disciplines to Health Authority public health functions needs recognition, not least in the provision of training, accreditation schemes and continuing professional development for all staff so as to secure an effective public health function at local levels to deliver the health agenda.

Clots of trouble

Last week doctors were forced yet again to find out from the lay press the facts involved in the latest health scare. The furore surrounding the announcement by the Department of Health that all brands of oral contraceptives containing desogestrel and gestodene are associated with twice the risk of thromboembolism must raise serious questions about the government's ability to contact doctors in a hurry. Last year, the government announced new measures to ensure urgent dissemination of information to health care professionals in just this kind of situation. In addition to sending letters by first class post to all general practitioners, the Department of Health planned a “fax cascade,” starting with regional directors of public health. In possibly the biggest ever pill scare, the system seems to have been a spectacular failure, with most general practitioners hearing the news on …

Public health advocacy will remain

EDITOR,—Sally Sheard is right to draw attention to the widely held fears that regional directors of public health will be less able to speak as advocates of the population once they have become civil servants employed by the regional offices of the NHS Executive.1 To say, however, that “the last vestiges of public health advocacy in Britain will be abolished when …

Advocacy for public health will continue

EDITOR,—By saying that “the last vestiges of public health advocacy in Britain will be abolished when the eight regional health authorities are replaced” Sally Sheard overstates the case.1 Impartial advocacy for the public health will depend entirely on district public health practitioners. They will rise to the challenge but will lose regionally published support. Leadership—called for in the job descriptions of the new regional directors of public health—is usually exercised openly. In the regional offices of the NHS Executive it seems to be restricted to advising in …

Gagging public health doctors.

On 1 April 1996 the last vestiges of public health advocacy in Britain will be abolished when the eight regional health authorities are replaced by eight analogous NHS Executive regional offices.1 The regional directors of public health and their staff will become civil servants and hence constrained in speaking out on matters of public health. One consequence will be that the directors, the leaders of public health medicine, will not be allowed to become office holders in the Faculty of Public Health Medicine. From its inception, public health has held a unique place in the British medical establishment. Public health doctors must often speak out against governmental and public opinion in the interest of the public health. As our expectations for quality of life and health care have increased, so has the scope for intervention in all aspects of public and private life. Thus advocacy and the right of free speech have long been intrinsic components of the public health movement, and they have been regularly attacked. In 1847, after the appointment of William Henry Duncan …

Medicopolitical Digest CCSC sets up working party on the new NHS

The Central Consultants and Specialists Committee has set up a working party on the government's proposals that from April the NHS should be managed from Leeds supported by eight regional offices (30 October 1993, p 1091). A consultation document was issued in November (13 November 1993, p 1286) and the consultation period ends next week. The CCSC's working party will look at how the functions of the postgraduate dean, medical manpower planning, medical advisory machinery, and other professional matters can best be organised in the new structure. When the General Medical Services Committee discussed the proposals it was concerned that the regional officers would operate as civil service outposts rather than independent authorities and that the independent role of the regional medical officer or regional director of public health would be lost. The size of the new regions would make it difficult to coordinate the provision of medical advice, and the committee pointed out that the location of regional headquarters will be contentious in some regions. The GMSC will ask to be consulted on arrangements for merging district health authorities and family health services authorities and will ask for general practitioners to be full members or observers on the new authorities. The Labour party will consult widely on its comprehensive health policy document, which, according to the party's health spokesman, will be published later this month. Mr David Blunkett told the Central Consultants and Specialists Committee last month that unlike the health service the party had time to consult and listen. The party's programme will spell out its commitment to patients' rights. It will emphasise a new public health agenda and recognise that prevention is better than cure. Mr Blunkett said that his party would not fine people for not reaching specific targets so ensuring that they did not have …

That was the year that was...

January It was a grim start to the New Year with the Gulf crisis dominating the headlines and medical reservists being called up to join the British forces gathering in the desert. Scottish nurse Henry Power won his battle against the draft on a technicality, having declared that he would rather go to jail. In the build up to the outbreak of war with Iraq, the nursing profession went on red alert. Hospitals throughout the country prepared for the many anticipated casualties and the UKCC launched a 24-hour emergency service to give employers instant confirmation of volunteer nurses' qualifications. Nursing Standard made national news bulletins after publishing, in full, 'confidential' Department of Health clinical guidance on dealing with possible war casualties. The department had sent the information only to regional directors of public health.