The decision to undertake a strategic review of PHE was made in April 2014 by the National Executive. The 2014-15 business plan, published in May 2014, originally stated PHE would “carry out a comprehensive strategic review of our functions and purpose to ensure that we deliver our responsibilities in the most efficient and effective way, doing more for less by October 2014”.
The BMA and BDA are concerned that proposed changes are being driven by cost cutting, at the expense of the public’s health. Further cuts to medical and dental staff will undermine the delivery of vital public health services, and the future of public health medicine and dentistry.
Public health doctors have a unique mix of medical and public health training, taking more than 10 years to become fully qualified. With numbers already low, further reductions to the workforce at a time of rising public health challenges - such as increasing levels of obesity - are short-sighted, especially because the long training time will hamper recruitment and lead to a future shortage of public health doctors. Furthermore, PHE have provided little detail on the effect that proposed changes will have on services and staffing levels, though it is clear doctors’ jobs will be affected and numbers will reduce.
There are currently 26.75 whole time equivalent (WTE) Consultant in Dental Public Health posts in England, compared to a budgeted establishment of 40.15 for 2014/15. With a pre-consultation suggestion by PHE of funding for 29 WTE posts, the specialty is looking at an arbitrary 28 per cent reduction in staff resources.
This is in the context of 20 per cent savings required by PHE across the board, and comes at a time when unacceptable and preventable inequalities in health, including oral health, across the country remain to be tackled, with consultants in medical and dental public health at the heart of any action.
Mick Armstrong, Chair of the British Dental Association, said:
“Together with our colleagues at the British Medical Association we are determined to stand up for public health and for public health professionals.
“We have grave concerns that mooted cuts at Public Health England are being driven purely by the clamour for ‘efficiency savings’. A review that is not based on evidence or workforce need represents a clear risk to public health, for little to no gain.
“Consultants in Dental Public Health should be a vital part of the future integration of health and social care. Tooth decay remains the number one source of hospital admissions among our children, and this small group offer expert knowledge that should represent an invaluable resource for any decision makers trying to provide a joined-up response. It would be simple negligence to let government accountants reduce them to a mere budget line, and a target for cuts.
“This entirely arbitrary reduction will leave these consultants stretched to the limit. What we are not seeing is anything resembling a joined-up strategy. PHE should be working with stakeholders like NHS England as dental commissioning develops and the general dental services contract is reformed. Certainly any outcome from this review should be delayed until the new Chief Dental Officer is in place to consider public health as part of a coherent plan to deliver improved oral health.
“Good oral health is a vital part of overall health and wellbeing and we strongly believe this restructure is a move in entirely the wrong direction at an important time.”
Iain Kennedy, chair of the BMA public health medicine committee said:
“The BMA has real concerns that these changes are about cutting costs, at the expense of the public’s health. Public health staffing and services are at risk of being gutted because of government-imposed cuts on public health spending. This runs totally counter to the Government’s claim to support more investment in preventative health, as outlined by the Five Year Forward View.
“At a time when public health challenges such as obesity, tobacco, alcohol and drug related harm are rising, it is irresponsible to cut the number of public health doctors, without a full understanding of the effects on services now and in the future, including the potential risk to infectious disease control, screening and immunisation programmes.
“The plans outlined by PHE have been at best piecemeal, making it difficult to assess the full scale of the impact these changes will have on public health services and staff. This is simply not good enough - the risk of getting this wrong on public health and the quality of preventative healthcare is too great.
“We are urging PHE to listen to the concerns of doctors, dentists and other key stakeholder and ensure these plans are properly thought-through, evidence based and put the public’s health front and centre.”