VOL: 96, ISSUE: 47, PAGE NO: 41
Woody Caan, MA, DPhil, is public health specialist, research and development, Barking and Havering Health Authority
Helen Sandle, BSc, MPH, is public health specialist, communicable disease, Barking and Havering Health AuthorityMaking a Difference (Department of Health, 1999a) created two new opportunities for nurses: enhanced career prospects equivalent to medical consultant roles and a chance to go beyond current nursing practice in developing and extending the public health aspects of nursing. In addition, the ambitions of Saving Lives: Our Healthier Nation (1999b) created the need for 'a new specialist post in public health'.
Making a Difference (Department of Health, 1999a) created two new opportunities for nurses: enhanced career prospects equivalent to medical consultant roles and a chance to go beyond current nursing practice in developing and extending the public health aspects of nursing. In addition, the ambitions of Saving Lives: Our Healthier Nation (1999b) created the need for 'a new specialist post in public health'.
A definition of a possible 'specialist in public health' was mooted by Lessof et al (1998): 'A professional who has attained a level of expertise in public health equivalent to that of a consultant in public health medicine and with an explicit work focus on public health.' This implies that the person has a first degree, relevant postgraduate training or education, several years work experience and both a level of seniority/autonomy in decision-making and a broad overview of the various disciplines that contribute to public health.
For some time organisations have been saying 'nurses can provide that vital link between public health departments, communities and coordination of public health action at local level' (Moore, 1998).
In Scotland, all public health nurses working for health boards focus on community development (Craig, 1999) and members of the Community Practitioners' and Health Visitors' Association are involved in consultations on an extended public health role for 'school nurse leaders' (DeBell and Jackson, 2000).
In England, a 'public health professional' is required on the executive committee of every primary care trust (NHS Executive, 1999). This has created tremendous career opportunities for senior, autonomous nurses throughout the country who are innovative leaders.
This public health professional could be either a doctor or a nurse. The competencies specified for such an expert nurse include the ability to 'lead the development of public health capacity and skills within the PCT'.
What is public health?
Health authorities have a duty to improve the health of their population. Barking and Havering Health Authority recently reviewed its public health functions (Watts, 1999) as:
- Health surveillance;
- The control of communicable disease;
- Assessing health needs;
- Monitoring health outcomes;
- Evaluating the health impact of local plans and developments.
There is also a new statutory 'duty of partnership' with local government, for example, in evaluating the health impact of social and economic regeneration programmes such as Sure Start. Partnerships with a variety of agencies are focusing on 'improving communicable disease prevention' and 'developing healthy settings and communities'.
The new national agenda concerning poverty, inequality and social exclusion means that Barking and Havering Health Authority is trying new ways of 'reducing the impact of social disadvantage and the environment on health', for example, through fresh collaborations around housing and health development.
Each of the six public health specialists in Barking and Havering Health Authority has a unique technical area of expertise, but they are also expected to have the knowledge, skills and experience to be able to manage strategic change in organisations, work in management teams and provide leadership for public health initiatives (Watts, 1999). For a profile of two of them see Boxes 1 and 2.
Preparation for enhanced roles
A number of public bodies, including the UKCC, the Faculty of Public Health Medicine and the regional offices of the NHS Executive, have been considering what training would be appropriate for nurses who wish to become public health specialists.
The first job of the new national training organisation for health care, Healthwork UK, has been to address standards for 'specialist practice in public health'.
Over the next three years it is likely that a recognised postgraduate qualification and requirement for continuing professional development will emerge. In the meantime, those of us in the first wave of autonomous, senior posts will make mistakes - but the ethos of public health specialists is all about learning in action, at neighbourhood, district and national levels.
We look forward to watching the next wave of specialists, fully trained and supported by their professional bodies, as they boldly go to places that nurses have never been before.