Reform of public health medicine: Where are we now?

Chair of the IMO public health committee Dr Anne Dee provides an update on the implementation
of the agreement to reform the specialty

In 2021, the IMO, HSE and the Department of Health finally reached agreement on the terms and conditions of doctors trained in the specialty of public health medicine, with the granting of a consultant contract and attendant terms and conditions.
This was a great outcome, but one that took over 20 years to arrive at.

In tandem with the new consultant posts, all of which have to be newly recruited, there is a programme of reform. The recruiting of consultants is dependent on the successful implementation of reform as part of the agreement. Of course, it is also the case that unless consultants are recruited, reform will not be possible.

The programme of recruitment was agreed to run between July 2021 and December 2023, therefore we have just over nine months left for the full implementation. The agreed number of consultant posts was 84 over three phases: 34 in the first phase from July 2021 to June 2022; 30 in the second phase from July 2022 to June 2023; and 20 in the final phase from June 2023 to December 2023.

As of March 2023, all 34 from the first phase have been successfully recruited and the posts have been filled. Recruitment for the second phase has met with some delays, and with only 20 of the expected 30 having been advertised so far, and only 10 of these at interview stage. It is expected that the delay will be made up before June 2023, but timelines are very tight at this point in the year.

In tandem with consultant recruitment, reform of the way all of public health is delivered as a function has been taking place. A National Director now leads the function, and Directors of Health Protection, Health Improvement, Health Service Improvement, and Health Intelligence have been, or are being recruited. Regional departments of public health have been realigned to correspond with the planned regional health areas A-to-F. This has meant combining some of the previous eight regional departments. An out-of-hours on-call system is being developed to include a multidisciplinary team working at weekends and is being finalised. New structures and staff are being implemented in surveillance, nursing, and research, and business managers have been put in place to help departments deliver their functions. The lives of senior medical officers working in public health medicine have been altered considerably, with different reporting relationships and new work processes. So in terms of progress, a lot of work has been done, a lot remains to be done and an enormous amount of change has happened in a short time. Managing and implementing change is difficult, and often results in limited success. People find change difficult, and it must be acknowledged that all of what has been described above affects people’s lives, jobs, and work. People have been expected to apply for jobs at a late stage in their careers, when they would have hoped to be established in their roles.

New recruits are coming into situations that are in the process of change and it has not always felt stable or even clear how things are meant to work. Driving through a large change programme in a relatively short timeframe cannot be done without some human cost. It is important that we acknowledge this cost. People have been having all the normal range of human reactions to change situations: Fear; anxiety; discomfort; uncertainty; role confusion; and unhappiness. However, there has also been an unbelievable amount of positivity, courage, and willingness to embrace change, which is of course heartening. It is my sincere hope that, by the time we see full implementation of the recruitment phase, and begin to see structures and processes settle down by the end of this year, nobody will feel that they have been left behind.

Beyond that, it is the IMO public health committee’s vision that reform of public health will be a time of new and exciting opportunities for those working in it, and a time when the health of the Irish population will benefit considerably by the investment being made in public health