North East Consultation onReview of the Regulation of Public Health ProfessionalsMonday 14 February 2011 1.30pm till 5.00pm Waterfront 4, the Millennium Suite www.sphne.org.uk
Welcome & Introductions Professor Peter Kelly, Acting Regional Director of Public Health
BUILDING CAPACITY TO IMPROVE HEALTH North East Context Alyson Learmonth, Head of School of Public Health North East
School of Public Health North East To strategically lead the development of capacity to improve health and wellbeing, and reduce inequalities in health, for the population of the North East of England, in line with the Regional Strategy Better Health, Fairer Health. Teaching Public Health Network Bringing together education providers with the public sector workforce and workforce planners to embed public health in curricula, develop and enhance public health teaching capacity and capability related to identified need and co-ordinate the sharing of existing good practice with regard to public health teaching and learning Public Health Workforce Capacity Building To co-ordinate and lead the development of capacity to improve health and wellbeing and reduce inequalities in health for the population of the North East in line with Better Health, Fairer Health Public Health Specialty Training Committee To oversee the training of specialists who aim to be registered with the GMC or the UKPHR. This encompasses those on the formal training scheme and those using a portfolio route North East Leadership in Health and Well-Being Task Group Public Health Fellowship Programme Dental Public Health Specialty Training To oversee the training of dental public health specialists Combined to form Building Public Health Futures in October 2010
Specialty Training Committees for Public Health and Dental Public Health Recruitment Work-based and academic supervision Quality management Trainer development and support Assessment Trainees in difficulties Career advice and support Meeting GMC quality assurance requirements
PH Fellowship programme • Public health skills developed among Consultants in other specialties • Pilot work involving 3 students in diabetology, rehabilitation, and primary care • Demand for more but technical difficulties • Funding withdrawn • Needs identified among established Consultants as well as trainees
Building public health futures PH Careers: research exploring experiences of post graduate PH MSc on career aspirations and development Link workforce development needs to programmes of study led by the 5 universities Develop a Framework for Health Promoting Universities linked to healthy workplace setting Link existing CPD provision and where required develop modules to support public health educators University CPD contract commissioning to include Making Every Contact a Health Promoting Contact
Sharing practice based examples of building capacity • Leadership • Develop a workforce plan to manage disease registers • Quality based initiatives e.g. CQUIN Scheme incentives for provider led workforce planning • Development of role outlines across a sector
Sharing practice based examples of building capacity • Database for monitoring and mapping systems • Distance learning programmes • Community based approaches • Workplace based approaches • Co-ordinated delivery across priority areas such as alcohol, obesity and, smoking
Major challenges • Fragmentation of planning for sections of the public health workforce • Standards and competencies: practitioners? defined specialists? • Voluntary or Statutory? • Maintaining a multi-disciplinary public health • Financial flows and financial pressures • Leadership: across the whole system leadership to improve health and wellbeing
Multidisciplinary Public HealthOverview of Current Policy Proposals Rowena Clayton Consultant in Public Health Department of Health West Midlands
Proposals Bearing on PH Workforce • Need to respond consistently to various documents, in particular: • Healthy Lives, Health People http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm • Review of Regulation of PH Professionals http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122089 • Developing the Healthcare Workforce http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf
Key Route for funding Route for accountability Public Health Funding & Commissioning Local communities GP Consortia Local Authorities Providers Department of Health including Public Health England NHS Commissioning Board
Multi-disciplinary PH: some dates 1970s… 'Specialists in Community Medicine' 1980s… ‘Consultants in Public Health Medicine’ 2000s… ‘Consultants in Public Health’ • Recognition of MDPH & non-medical PH professionals. 1999 Our Healthier Nation • Opening up of DPH posts. 2002 Shifting the Balance of Power in the NHS • Establishment of UKPHR 2003 Tripartite Agreement • Q. How to recognise and to regulate all PH professionals as equally as possible
Governance- e.on • Understand it • Shape it • Learn & continuously improve • Doing the right things • Doing those things right • Meet legal requirements • Effective education & training • Understand risks Understand & believe ‘why’ • “know what is expected” • Confidence to challenge • Objective setting • Problem solving • Access to tools • Effective systems for reporting • Policy & Process & Audit • Clear functional structure, roles & responsibilities • Standards and specifications • Consultative machinery • Strong, visible mgt commitment • Personal acceptance of responsibility Thema Datum Bereich Seite 16
Remind ourselves: my story • Background: bench scientist then HSE • Joined NHS 1987. Health Promotion Officer then HP Dept Manager • In HA/PCT PH Dept 1993-2002 as SMgr • Needs assessments & APH Report • Chronic Disease Mgt Progs • HAZ, H&SC Strategies etc • Emergency planning strategy • …. • i.e. Nearly all but CCDC role • Consultant and regulated by 2007
Healthy Lives, Healthy People: • Seizing Opportunities for Better Health • A Radical New Approach • Health & Wellbeing Through Life • A New PH System: • Role of GPs in public health • Public Health evidence • Regulation of public health professionals (Scally Review) • Making It Happen: Cross cutting issues; Top 5 implementation issues.
Review of Regulation of Healthcare Professionals • As part of HLHP, DH published this review (p73) • ‘As the Government believes that statutory regulation should be a last resort, its preferred approach is to ensure effective and independently-assured voluntary regulation for any unregulated public health specialists’. • ‘For other PH practitioners, the DH will discuss with relevant groups the arrangements for setting and sustaining high standards of practice’ • ‘We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary regulation for public health specialists?’
Scally Review: Overview • Introduction & Background: • Case for change, approach to regulation • Regulatory Policy: • Purpose & principles of healthcare professional regulation • Risk Assessment: • Data on poor practice, public safety • Case Studies of Professional Regulation: • pathologists, pharmacists, physician assistants, surgical care practitioners • Options Appraisal • Regulation of Public Health Practitioners
Scally Review: Regulatory Policy • Regulation (WGp on Extending Prof Regulation) • Safety, effectiveness, high Q care • Proportionate to risk • Confidence of public & registrants • Improvements in quality of care • Apply equally across sectors and employment • Protected titles where public common interest • Various issues include; • Complexity, distributed/dual registration, costs/fees etc.
Scally Review: Why Regulate • Main issue to manage risk: • Set & promote standards for admission & remaining on registers; • Keep register of those who meet the standards and check that registrants continue to meet them; • Administer procedures for dealing with cases where right to remain on register called into question (fitness to practice); and • Ensure high standards of education for the health professionals they regulate.
Scally Review: Regulators & Risk • Standards (in the 10 Key Areas) • Faculty of Public Health • Regulators • GMC (doctors) – statutory (NB also GDC) • UK Public Health Register (non-medics) – voluntary. • Risks • GMC cases - 119 PH docs since 2006: clinical care (45%), patient relationships (20%), probity (23%), other incl working with colleagues • UKPHR – currently consulting on ‘Enhanced Risk Assessment’
UK Voluntary PH Register • Established 2003 for PH specialists with no other regulatory body. • At Nov 10 - 466 Gen & 25 Def registered. • Standards for admission & remaining. • Opened up routes to registration: • Retrospective Portfolio (Generalist) • Prospective Portfolio (Defined Specialists) • NHS PH Training Scheme (Specialist Trainees) • Now opening up registration for PH practitioners
Scally Review: Options • Mixture of statutory & voluntary self-regulation • Fellowship model • Chartered status • Conferring on UKPHR the status of statutory regulator • The GMC registering public health specialists • The Health Professions Council registering public health specialists
Scally Review: Recommendations • HPC to regulate PH Specialists, and no change to roles of the GMC, GDC & NMC. • Protect title of Consultant in PH for those registered. DPH role to be filled by CPH. • Single training pathway for specialist training in PH; FPH role in education & standard setting. • HPC regulation entirely self-funded. • Case for statutory regulation of defined specialists is not made at present.
Scally Review: Recommendations/ • Case for statutory regulation of defined specialists is not made at present. The absence of required attributes of health professional formation, including established training routes and a compelling case for the protection of the public, means that these groups do not currently meet the criteria for statutory regulation of a profession.
Our Response to ConsultationDiscussion Paper STRATEGIC ISSUES FOR THE MULTIDISCIPLINARY PUBLIC HEALTH WORKFORCE IN SETTING UP THE NEW PUBLIC HEALTH SYSTEM AND SERVICE IN ENGLAND • Purpose and legitimacy of paper • Vision for the PH workforce • Potential risks in the new system • Major strategic PH workforce Issues • Recommendations
Our Discussion Paper • Purpose & Legitimacy • Belief in MDPH • Need for strategy • PH Workforce strategy (Autumn) • Vision for PH Workforce • Support principles of PHWP • Change in scale & scope of workforce • Need for competent specialists & practitioners • Build on current system
Our Discussion Paper/cont • Potential Risks in the New System • Fragmentation – diversity of agencies • LGov, DH/PHE, NHSCB, GPCC & providers (NHSTs & independents profit/nfp) • New roles & partnerships • Wider workforce - skilling • Local government understanding • Commissioner recognition (GPC/a) • Concern re: LG HImp & PHE Hprot !! • ACTUALLY: PHE has Himp responsibiity & DsPH have responsibility for health emergencies
Our Discussion Paper/cont • Major Strategic Issues: Regulation • Spec Trainees (ie in training scheme): • They need to be regulated • Generalist & Defined Specialists • Dual Accreditation • UKPHR role in regulation of PH competencies for eg, pharmacists, EHOs etc • Practitioners • Lot of interest, big SHA/Wales investment • UKPHR open, RSPH also? • Essential to future of PH & way forward needs resolution
Our Discussion Paper/cont • Major Strategic Issues: Regulation/cont • Generalist specialists: • Risk appt of non-regulated people so… • Support FPH – Stat Instr to protect AAC • (Adv. Appointments Committee – for consultants) • Essential for PHS to be in CPD • Defined specialists • Senior PH people: core + higher competence • Believe should have same recognition: • Review prospective route (? Equivalence)
Developing the Healthcare Workforce • Proposes: • Healthcare providers lead commissioning • Through Local Skills Networks • With Health Education England oversight • PH Workforce strategy • To be developed in 2011 • PH England will need to work in partnership with healthcare providers and LAs • Centre for Workforce Intelligence will support PHE with data re current & future needs • Various Qs arise.
Our Discussion Paper/cont • Training & Development • How to respond to workforce paper • How is PH training commissioned • And hence where will funds lie • What will be roles of PHE & LSN • What powers to ensure LG and healthcare providers play • In order to ensure integrity of • Higher Specialist Training schemes • Continued development & support to specialist & practitioner workforce • Development of new elements of workforce • Accurate forecasting & planning
Our Discussion Paper/cont • Recommendations/Action • Need further work – propose group to work with DH • Must promote PH, eg to LG • Ensure MDPH voice heard in strategic discussions • DH, PHE, and its constituent bodies eg HPA • FPH, BMA PH Med Cons Ctee, UKPHA, etc • Other interested groups, eg CIEH, RSPH etc • Build discussion, informed sources of information & encourage response • eg this mtg and the paper
Building Consultation • Now to 31st March 2011 • PHW e-group for debate about the PH workforce now established: • First: subscribe at: www.jiscmail.ac.uk/lists/phw.html • Second: can then send emails to group at: email@example.com
Must respond, as individuals & organisations. Don’t let it go by
Chartered Status: another option? Professor Richard Parish Royal Society for Public Health Royal Society for Public Health RSPH www.rsph.org.uk
Options Appraisal “Through amendment of an existing charter, or the application for a new charter, a body could offer chartered status to public health professionals. The chartered title would be protected. The Royal Society for Public Health, already an organisation with a Royal Charter, is a body that could develop this within the broad context of public health.” Scally Report Royal Society for Public Health RSPH www.rsph.org.uk
Purpose of Regulation • The primary purpose of regulation is to ensure safety, effectiveness and quality • Regulation should be proportionate to the risk posed to the public and service users • Regulatory systems need the confidence of the public and registrants • Regulation should lead to improvements in quality for the public, users and consumers • Proportionate regulatory systems need to apply equally well across all sectors and employment situations • Protected titles should be used where public interest is promoted Adapted from the Scally Report Royal Society for Public Health RSPH www.rsph.org.uk
A Work in Progress! • First outing – formative input • RSPH supports Statutory Regulation, but must have a Plan B • Consultation period • Build on existing arrangements Royal Society for Public Health RSPH www.rsph.org.uk
Statutory Regulation • Political support – deregulation, not regulation! • Health and Social Care Bill – timing • Treasury criteria • Other options available Royal Society for Public Health RSPH www.rsph.org.uk
Underpinning Principles • Support PH practice development • Public protection • Employer protection/indemnity • Build capacity and capability • Support the PH Career Framework • Add value, not replicate Royal Society for Public Health RSPH www.rsph.org.uk
Relevant • Public • Employers and Managers • Practitioners • Other regulators • Academics Royal Society for Public Health RSPH www.rsph.org.uk
Professional Designations Specialists • Chartered Consultant in Public Health Practitioners • Chartered Health Promotion/Improvement Practitioner • Certified Health Educator • Credentialed PH Practitioner Chartered Practitioner Royal Society for Public Health RSPH www.rsph.org.uk
Adding Value • Consolidates existing contributions • Faculty to set standards • Recognises contributions of UKPHR, CIEH, etc • Could operate at several levels • Public and professional recognition • Enhances development support Royal Society for Public Health RSPH www.rsph.org.uk
Why the RSPH? • Royal Charter – link to Privy Council • International accreditation and certification body • Nationally approved qualifications body • 100,000 students a year • 7,000 members • Systems and database management • Communication structures Royal Society for Public Health RSPH www.rsph.org.uk 1