Chair of the IMO public health committee Dr Anne Dee provides an update on the ongoing reform of public health
The reform of the public health function of the HSE has almost reached the end of the first phase. This is a three-stage process for the recruitment of consultants in public health medicine. Overall, it has progressed well.
Dr Anne Dee
While the deadline for full recruitment of the 84 agreed posts by the end of December 2023 was not met, most of the posts have now been filled. Some interviews are still ongoing, and only three of the original 84 posts are not yet advertised. However, there are still a number of posts unfilled as individuals have moved within the specialty as their preferred jobs became available, and it is expected that before it is all finalised, there may be a need to re-advertise some roles, where existing panels are exhausted. This time of interviews and flux has not been easy and has not always gone smoothly for everyone whose futures are still not clear. But it is great that doctors who undergo higher specialist training in public health medicine can now be assured that there will be consultant posts available in Ireland, on an equal footing with consultants in other specialties.
With the completion of recruitment comes the next phase of reform. This is where the new structures are being established to focus on the priorities of the HSE and the population. Six regional departments of public health are now working within the regional executive officer structure, with the area directors of public health sitting on the senior management teams of each region. Each department has or will have consultants in each of the domains of public health, health protection, health improvement, health service improvement and health intelligence.
Public health work involves evidence-based and data driven strategies. They aim to protect the population from biological and other hazards which are a threat to health (health protection); improve the health of the whole population while focusing on health inequalities (health improvement); improve and plan health services and access to health services (health service Improvement); and access and collate all available data and evidence to provide the information needed to perform these functions (health intelligence). At a regional level, work is progressing to profile local populations, assessing need and measuring inequalities in health with a view to focusing services where the need is greatest, in accordance with the aims of Sláintecare.
At a national level, there are now national directors in place for each of the four domains of public health as already outlined. They work within the national public health structure under the governance of the national director of public health. There is a strong focus on developing strategy and frameworks to support the work of population profiling, health needs assessments, improving health, and reducing health inequalities.
The national health protection function has met many challenges having been formed while still battling the Covid-19 pandemic. Since that time there have been many surges of infectious diseases, including MPox and many respiratory viruses. The most recent emerging threat is that of a measles outbreak in the face of reduced uptake of childhood vaccinations in recent years internationally, with multiple outbreaks in Europe and the UK, and sporadic cases on the island of Ireland.
Achieving all this progress in the face of rapid change within public health and the HSE is a testament to the resilience of the public health workforce. This year will bring a consolidation of reform, with increasing stability, and a focus on building teams and addressing important population health issues.
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