‘An exciting time for public health’

Niamh Cahill speaks to Dr Áine McNamara, Area Director of Public Health (Area F–West North West), about a defining period for public health medicine in Ireland.

The face of public health in Ireland is changing. After prolonged lobbying for reform by doctors within the specialty, a major transformation is finally underway. 

The multi-year transition process heralding a new model of public health medicine kick-started in 2021, with the announcement of consultant status for the specialty. This development followed an historic agreement between the IMO and Department of Health. 

It is perhaps no coincidence that the reform has come in the wake of the Covid-19 pandemic, which highlighted an ill-equipped and poorly resourced public health infrastructure in urgent need of investment. 

An important part of the multi-year change process occurred recently with the introduction of six new HSE public health areas. 

The areas are aligned with the HSE’s six regional health areas, which are due to be fully operational in 2024. 

Dr Áine McNamara, Area Director of Public Health (Area F–West North West), is one of six newly appointed directors of public health. 

In a recent interview with the Medical Independent (MI), she conveyed her delight at plans for public health medicine and spoke about how much it means to public health doctors following the pandemic. 

“It’s an exciting time for public health. It’s been a long, long time coming. It’s hard to believe in many ways we are finally here,” she told MI. 

“We all got worn down as time went on; that’s why it’s nice there’s finally been a recognition that public health is important. The consultant contract has been welcome but also the prioritisation of public health within the health service structure – that we’re there, we’re valued, we have a voice and we are listened to, that’s been very important for us.” 

Her remarks echo the sentiments of many doctors who believe the reform marks the most significant development within the specialty in Ireland since its inception. 

Background 

Dr McNamara qualified from NUI Galway in 1997 before completing a Master’s in public health medicine in University College Dublin in 2002 and higher specialist training in public health medicine in 2008. 

She worked for many years as a specialist in public health medicine in the HSE midlands area before joining the department of public health, HSE west, in 2015. 

Dr McNamara completed specialist training on a par with consultant colleagues, but until recently she was denied the same contractual and working benefits. 

Throughout her career to date, she has had a strong interest in health protection and child health, pursuing many roles in these domains. 

As director of Area F, her role covers counties Galway, Sligo, Leitrim, Roscommon, Mayo, and Donegal. 

Since May, when Dr McNamara officially took up the position, she has been getting to grips with the region, which has been amalgamated under the changes. 

Tasks have included meetings with staff, setting up teams, establishing new ways of working, and coordinating reform plans within the counties. 

Her priority is leading “the strategic reform across the areas and making sure we have a strong public health function across the areas”, she said. 

“My job will be to deliver a consultant-led service that will protect the population from health threats, promote health, improve health services and tackle inequalities.” 

Public health will have four main pillars, including health protection (where much of the recruitment and developments to date have been focused), health intelligence, health improvement, and health service improvement. 

According to Dr McNamara, the pillars are important for many reasons. 

“There’s a lot that public health do that people don’t often know we’re involved in. That’s the idea of the reform programme; that we’ll be able to provide strong leadership across all the domains of public health practice,” she told MI. 

“There has been a strong focus on health protection recently but going forward we would like to strengthen the other domains of public health and improve them. It’s all about trying to improve the health and overall health and wellbeing of the population, looking at other preventions and intervention activities and reducing health inequalities.” 

It is planned that consultants will lead multidisciplinary teams across the four public health pillars, she said. 

Currently, national health protection roles are coming on stream, including cancer screening and child health posts. But more are planned in 2022 in the remaining three areas. 

The position of director of health protection will be filled shortly, while an overall director of public health is due to be appointed. 

There are many challenges associated with the reform programme, Dr McNamara said. However, she added there is great excitement about the opportunities to create a holistic service. 

Multidisciplinary staffing 

Dr McNamara underlined that the strengthening of staffing within public health departments – not only consultants but nursing, surveillance and epidemiology – is significant. 

This has meant greater focus on population-based needs assessments, profiling of health needs for health service planning, and health improvement work. 

“We have always been able to do this, but it has been limited and the plan now is that we can plan ahead to properly support services,” explained Dr McNamara. 

She is hopeful public health will become more prevention-focused in the future. 

“That’s what public health is all about – prevention. Between vaccines, screening programmes and monitoring disease, looking at risk factors to help prevent disease. 

“We’re finally on the roadmap and people know what public health does now. It’s up to us to lead out on that and that’s what the public health directors will be doing; strategic leadership and clinical leadership, pushing and driving it forward. That’s the hope and vision.” 

The improvements will include a focus on wellbeing of staff, many of whom are burnt out following the immense strain brought about by the pandemic. 

“I’m very conscious of the pandemic and the resilience of staff. We have been through an emergency that lasted over two years. Across the health service people are burnt out, so we are focusing on our staff health and wellbeing. There are programmes we will run in our own area to improve this,” said Dr McNamara. 

“It’s been hard… I think it’s important we stand back and acknowledge the work and contribution of staff. People went above and beyond. There was nothing you asked someone to do that they didn’t do.” 

A much needed move away from ‘pen and paper’ systems of recording data is planned. 

One of the criticisms levelled during the Covid-19 response was the absence of a computerised case and incident management system for public health doctors. 

According to Dr McNamara, a team is now “planning and scoping” out such a system. 

“Hopefully funding will be available for this. Because it is difficult when you get overwhelmed to be able to produce data in a timely manner.” 

As the new model is established, usual tasks continue, she noted. 

These tasks include, but are not limited to, Covid-19 monitoring; addressing the immediate health needs of Ukrainian refugees; and the development of clinical guidance on the emergence of monkeypox. 

The enormous amount of work has left little time for planning for the next pandemic – work the World Health Organisation has advised every country to undertake. 

Despite the challenges ahead, Dr McNamara remains optimistic. Much has been learned from Covid-19. IT and laboratory services have been strengthened, which will assist in any future pandemic, she noted. 

“There are challenges and opportunities and we’re up for it. We’re engaging and we’ll work through it. It’s a good time to be in public health at the moment.”