BMA concerned over 'gaps' in public health reforms

There are worrying 'gaps' in the government's plans to reform the public health system in England, the BMA has warned.

BMA warned specialists are needed to deal with emergencies such as a future pandemic and vaccinations
BMA warned specialists are needed to deal with emergencies such as a future pandemic and vaccinations

Cuts to public health staff may leave the NHS lacking specialists to deal with emergencies such as a future pandemic, it said.

On Thursday, the government published its response to a consultation on its public health White Paper issued in December last year.

The government responded to numerous concerns raised in the consultation. These included worries over fragmentation of care as public health is transferred to local authorities and doubts over the impact this would have on maintaining expertise in the NHS.

But there was little mention of the potentially negative effect of the proposed health premium, set to reward public health outcomes, on health inequalities.

The health premium concept - separate from the quality premium that will reward successful commissioning groups - came under fire from co-authors of the Marmot Review into public health who met the House of Commons health select committee in London last month.

Instead, the DoH admitted work was ongoing to improve these areas of the reforms. A series of updates will be published in the autumn to ‘complete the operational design of the public health system’, it said.

The BMA said the government’s focus on public health was laudable.

But Dr Keith Reid, co-chairman of the BMA’s public health medicine committee, said it was ‘disappointing’ that concerns remained about how health time-bombs such as obesity, alcohol misuse and STIs should best be tackled.

‘The government acknowledges that further development of the plans is needed and we urge them to involve the profession, including further discussions with the BMA, to address the outstanding concerns.’

Dr Reid added that the financial climate and NHS restructuring meant posts in public health were being cut.

‘Public health specialists are responsible for emergency planning such as developing systems during a pandemic flu crisis, developing projects to fight unhealthy living such as obesity and alcohol misuse and commissioning health services,’ he said.

‘I am concerned that no matter how ambitious and bold the vision in the White Paper may be, there will be very few specialists left to take forward these plans and tackle these vital health issues.

He said: ‘We do not want a situation where local authorities are handed the keys to public health, only to find that the engine has gone.’

The BMA wants a commitment from the government to maintain the current level of public health specialist posts.

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