Partnerships for public health and the case for a joined up approach to Scottish reform
- Dona Milne, Director of Public Health
- 03 May 2019
- Reform programme
Re-aligning the role of the core and specialist public health workforce is a central part of Scotland’s ambitious plans for public health reform. Given the remit to explore potential ways of organising the workforce differently the Specialist Public Health Workforce Commission has now reached its conclusions, with new ways of working and stronger relationships being seen as the most effective way forward. Commission co-lead, Dona Milne, has more.
It really is time for change, and I hope we embrace it and run with it. By we, I mean the core, specialist and wider public health workforce in Scotland. As part of the Public Health Reform work in Scotland I have been co-chairing a commission with the very thoughtful Dr Audrey Sutton and a wide-range of professionals who formed our Expert Advisory Group. It has been an enjoyable and challenging process and I am encouraged by the levels of engagement from the workforce across Scotland. I want to thank everyone who has taken part.
We have considered a number of new structures during our work and assessed their effectiveness in creating the conditions for the workforce to improve the health of the population. Just as public health is about creating the conditions in which people can be healthy, equally we need to create the conditions for our workforce to thrive and to work hard for and with the populations we serve.
There is concern from some in the core public health workforce and the wider system that if we do not embark on structural change then in fact nothing will change and the potential gains will not be realised. This is a genuine risk and has been a consistent theme for discussion throughout this work. We have asked ourselves - how do you deliver enough change in the system to make it work differently while not grinding to a halt as a result and continuing to do what we have always done?
In fact, the conclusions from our work recognise that there is limited evidence for significant structural change, but significant change is still needed. We already have a new set of common goals in the form of the Public Health Priorities for Scotland – they provide direction. In order to deliver them, we need greater leadership, stronger governance, good management (including performance management), workforce development and the adoption of new ways of working that are clearly embedded in partnership work to address the social and economic determinants of health.
We need to make a clear contribution to Community Planning Partnerships (CPP) that sits alongside delivery of our core public health functions: driving forward work on the wider determinants of health through CPPs should be our core business. Delivery should be through locally and nationally integrated public health teams that pull together the skills, expertise and efforts of the core and specialist workforce in local areas and in Public Health Scotland. These teams should be led locally but include staff from Public Health Scotland.
The adoption of new ways of working across the wider system at both a local and national level will be a challenge for some of us, but it is an essential part of increasing our effectiveness. The areas where we need to see change in order to make this happen are related to leadership, accountability, reprioritisation of workload and clear links between local and national public health effort and a deliberate investment in building relationships at a local level with a common voice. We make no excuses for stating that we need to prioritise relationship building with partners alongside building and utilising our technical public health skills: there is little point in being able to generate and understand evidence if we cannot use it with our partners to achieve change.
We need our core and specialist workforce to thrive, so that they can make their full contribution to achieving a Scotland where everybody thrives and no one is left behind.
You can watch a short video of our Commission co-lead, Audrey Sutton’s take on the report.