welcome & introductions professor peter kelly, acting regional director of public health

North East Consultation on

Review of the Regulation of Public Health Professionals

Monday 14 February 2011

1.30pm till 5.00pm Waterfront 4,

the Millennium Suite www.sphne.org.uk

Welcome & Introductions

Professor Peter Kelly, Acting Regional Director of

Public Health

BUILDING CAPACITY TO IMPROVE HEALTH BUILDING CAPACITY TO IMPROVE HEALTH North East ContextNorth East Context

Alyson Learmonth, Head of School of Public Health North East

School of Public Health North East

To strategically lead the development of capacity to improve health and wellbeing, and reduce inequalities in health, for the population of the North East of England, in line with the Regional Strategy

Better Health, Fairer Health.

Teaching Public Health Network

Bringing together education providers with

the public sector workforce and

workforce planners to embed public health in curricula, develop and enhance public health teaching capacity and capability related to

identified need and co-ordinate the sharing of existing good practice with regard to public health teaching and

learning

Public Health Workforce Capacity

Building

To co-ordinate and lead the development of capacity to improve

health and wellbeing and reduce inequalities in

health for the population of the North East in line

with Better Health, Fairer Health

Public Health Specialty Training

Committee

To oversee the training of specialists

who aim to be registered with the

GMC or the UKPHR. This encompasses those on the formal training scheme and

those using a portfolio route

North East Leadership in

Health and Well-Being Task Group

Public Health Fellowship Programme

Combined to form Building Public Health Futures in October 2010

Dental Public Health Specialty

Training

To oversee the training of dental

public health specialists

Specialty Training Committees for Public Health and Dental

Public Health

• Recruitment• Work-based and academic supervision• Quality management• Trainer development and support• Assessment• Trainees in difficulties• Career advice and support• Meeting GMC quality assurance requirements

PH Fellowship programme• Public health skills developed among

Consultants in other specialties• Pilot work involving 3 students in diabetology,

rehabilitation, and primary care• Demand for more but technical difficulties• Funding withdrawn• Needs identified among established Consultants

as well as trainees

Building public health futures

• PH Careers: research exploring experiences of post graduate PH MSc on career aspirations and development

• Link workforce development needs to programmes of study led by the 5 universities

• Develop a Framework for Health Promoting Universities linked to healthy workplace setting

• Link existing CPD provision and where required develop modules to support public health educators

• University CPD contract commissioning to include Making Every Contact a Health Promoting Contact

Sharing practice based examples of building capacity

• Leadership• Develop a workforce plan to manage disease

registers• Quality based initiatives e.g. CQUIN Scheme

incentives for provider led workforce planning• Development of role outlines across a sector

Sharing practice based examples of building capacity

• Database for monitoring and mapping systems • Distance learning programmes • Community based approaches • Workplace based approaches• Co-ordinated delivery across priority areas such

as alcohol, obesity and, smoking

Leadership to Improve Health and

Wellbeing

Major challenges

• Fragmentation of planning for sections of the public health workforce

• Standards and competencies: practitioners? defined specialists?

• Voluntary or Statutory? • Maintaining a multi-disciplinary public health • Financial flows and financial pressures• Leadership: across the whole system leadership

to improve health and wellbeing

Multidisciplinary Public HealthOverview of Current Policy Proposals

Rowena ClaytonConsultant in Public Health

Department of Health West Midlands

Proposals Bearing on PH Workforce

• Need to respond consistently to various documents, in particular:

– Healthy Lives, Health People http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm

– Review of Regulation of PH Professionals http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_122089

– Developing the Healthcare Workforce http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf

Public Health Funding & Commissioning

Key

Route for funding

Route for accountability

Local communities

Department of Health including Public Health

England

NHS Commissioning Board

Local Authorities GP Consortia

Providers

Multi-disciplinary PH: some dates

1970s… 'Specialists in Community Medicine' 1980s… ‘Consultants in Public Health Medicine’2000s… ‘Consultants in Public Health’

• Recognition of MDPH & non-medical PH professionals. 1999 Our Healthier Nation

• Opening up of DPH posts. 2002 Shifting the Balance of Power in the NHS

• Establishment of UKPHR 2003 Tripartite Agreement

• Q. How to recognise and to regulate all PH professionals as equally as possible

Seite 16Thema Datum Bereich

Commitment

Com

pete

nce

Stru

ctur

e

Enga

gem

ent

Compliance

Governance

Best Practice

Commitment

Com

pete

nce

Stru

ctur

e

Enga

gem

ent

Compliance

Governance

Best Practice

Effective education & training

Understand risks Understand & believe ‘why’

“know what is expected” Confidence to challenge

Effective systems for reporting Policy & Process & Audit Clear functional structure, roles &

responsibilities Standards and specifications Consultative machinery

Objective setting Problem solving Access to tools

Strong, visible mgt commitment

Personal acceptance of responsibility

Meet legal requirements

Doing the right things Doing those things right

Understand it Shape it Learn & continuously

improve

Governance - e.on

Remind ourselves: my story

• Background: bench scientist then HSE• Joined NHS 1987. Health Promotion Officer

then HP Dept Manager• In HA/PCT PH Dept 1993-2002 as SMgr

– Needs assessments & APH Report– Chronic Disease Mgt Progs– HAZ, H&SC Strategies etc– Emergency planning strategy– ….

– i.e. Nearly all but CCDC role• Consultant and regulated by 2007

Healthy Lives, Healthy People:

• Seizing Opportunities for Better Health• A Radical New Approach• Health & Wellbeing Through Life• A New PH System:

– Role of GPs in public health– Public Health evidence– Regulation of public health professionals (Scally Review)– Making It Happen: Cross cutting issues; Top 5

implementation issues.

Review of Regulation of Healthcare Professionals

• As part of HLHP, DH published this review (p73) – ‘As the Government believes that statutory

regulation should be a last resort, its preferred approach is to ensure effective and independently-assured voluntary regulation for any unregulated public health specialists’.

– ‘For other PH practitioners, the DH will discuss with relevant groups the arrangements for setting and sustaining high standards of practice’

• ‘We would welcome views on Dr Gabriel Scally’s report. If we were to pursue voluntary registration, which organisation would be best suited to provide a system of voluntary regulation for public health specialists?’ –

Scally Review: Overview

• Introduction & Background:– Case for change, approach to regulation

• Regulatory Policy: – Purpose & principles of healthcare professional regulation

• Risk Assessment: – Data on poor practice, public safety

• Case Studies of Professional Regulation: – pathologists, pharmacists, physician assistants, surgical

care practitioners

• Options Appraisal • Regulation of Public Health Practitioners

Scally Review: Regulatory Policy

• Regulation (WGp on Extending Prof Regulation)

– Safety, effectiveness, high Q care– Proportionate to risk– Confidence of public & registrants– Improvements in quality of care– Apply equally across sectors and employment– Protected titles where public common interest

• Various issues include;– Complexity, distributed/dual registration, costs/fees

etc.

Scally Review: Why Regulate

• Main issue to manage risk:– Set & promote standards for admission &

remaining on registers;– Keep register of those who meet the standards

and check that registrants continue to meet them;– Administer procedures for dealing with cases

where right to remain on register called into question (fitness to practice); and

– Ensure high standards of education for the health professionals they regulate.

Scally Review: Regulators & Risk

• Standards (in the 10 Key Areas)– Faculty of Public Health

• Regulators– GMC (doctors) – statutory (NB also GDC)– UK Public Health Register (non-medics) – voluntary.

• Risks– GMC cases - 119 PH docs since 2006: clinical care

(45%), patient relationships (20%), probity (23%), other incl working with colleagues

– UKPHR – currently consulting on ‘Enhanced Risk Assessment’

UK Voluntary PH Register

• Established 2003 for PH specialists with no other regulatory body.

• At Nov 10 - 466 Gen & 25 Def registered.• Standards for admission & remaining. • Opened up routes to registration:

– Retrospective Portfolio (Generalist)– Prospective Portfolio (Defined Specialists)– NHS PH Training Scheme (Specialist Trainees)

• Now opening up registration for PH practitioners

Scally Review: Options

1. Mixture of statutory & voluntary self-regulation

2. Fellowship model

3. Chartered status

4. Conferring on UKPHR the status of statutory regulator

5. The GMC registering public health specialists

6. The Health Professions Council registering public health specialists

Scally Review: Options

Scally Review: Recommendations

1. HPC to regulate PH Specialists, and no change to roles of the GMC, GDC & NMC.

2. Protect title of Consultant in PH for those registered. DPH role to be filled by CPH.

3. Single training pathway for specialist training in PH; FPH role in education & standard setting.

4. HPC regulation entirely self-funded.

5. Case for statutory regulation of defined specialists is not made at present.

Scally Review: Recommendations/

• Case for statutory regulation of defined specialists is not made at present. The absence of required attributes of health professional formation, including established training routes and a compelling case for the protection of the public, means that these groups do not currently meet the criteria for statutory regulation of a profession.

Our Response to ConsultationDiscussion Paper

STRATEGIC ISSUES FOR THE MULTIDISCIPLINARY PUBLIC HEALTH WORKFORCE IN SETTING UP THE NEW PUBLIC HEALTH SYSTEM AND SERVICE IN ENGLAND

– Purpose and legitimacy of paper– Vision for the PH workforce– Potential risks in the new system– Major strategic PH workforce Issues– Recommendations

Our Discussion Paper

• Purpose & Legitimacy– Belief in MDPH– Need for strategy

• PH Workforce strategy (Autumn)

• Vision for PH Workforce– Support principles of PHWP– Change in scale & scope of workforce– Need for competent specialists & practitioners– Build on current system

Our Discussion Paper/cont

• Potential Risks in the New System– Fragmentation – diversity of agencies

• LGov, DH/PHE, NHSCB, GPCC & providers (NHSTs & independents profit/nfp)

– New roles & partnerships– Wider workforce - skilling– Local government understanding– Commissioner recognition (GPC/a)– Concern re: LG HImp & PHE Hprot !!

• ACTUALLY: PHE has Himp responsibiity & DsPH have responsibility for health emergencies


• Major Strategic Issues: Regulation

– Spec Trainees (ie in training scheme):• They need to be regulated

– Generalist & Defined Specialists

– Dual Accreditation• UKPHR role in regulation of PH competencies for

eg, pharmacists, EHOs etc

– Practitioners• Lot of interest, big SHA/Wales investment

• UKPHR open, RSPH also?

• Essential to future of PH & way forward needs resolution

–


• Major Strategic Issues: Regulation/cont

– Generalist specialists: • Risk appt of non-regulated people so…• Support FPH – Stat Instr to protect AAC

– (Adv. Appointments Committee – for consultants)

• Essential for PHS to be in CPD

– Defined specialists • Senior PH people: core + higher competence• Believe should have same recognition:• Review prospective route (? Equivalence)

Developing the Healthcare Workforce

– Proposes:• Healthcare providers lead commissioning• Through Local Skills Networks• With Health Education England oversight

– PH Workforce strategy • To be developed in 2011• PH England will need to work in partnership

with healthcare providers and LAs• Centre for Workforce Intelligence will support

PHE with data re current & future needs• Various Qs arise.

Developing the Healthcare Workforce

Our Discussion Paper/cont• Training & Development

– How to respond to workforce paper• How is PH training commissioned• And hence where will funds lie• What will be roles of PHE & LSN• What powers to ensure LG and healthcare

providers play

– In order to ensure integrity of• Higher Specialist Training schemes• Continued development & support to

specialist & practitioner workforce• Development of new elements of workforce• Accurate forecasting & planning

Our Discussion Paper/cont• Recommendations/Action

– Need further work – propose group to work with DH

– Must promote PH, eg to LG– Ensure MDPH voice heard in strategic

discussions• DH, PHE, and its constituent bodies eg HPA• FPH, BMA PH Med Cons Ctee, UKPHA, etc• Other interested groups, eg CIEH, RSPH etc

– Build discussion, informed sources of information & encourage response

• eg this mtg and the paper

Building Consultation

• Now to 31st March 2011

• PHW e-group for debate about the PH workforce now established:– First: subscribe at:

www.jiscmail.ac.uk/lists/phw.html– Second: can then send emails to group at:

[email protected]

Must respond, as individuals &

organisations.

Don’t let it go by

Royal Society for Public Health

RSPH www.rsph.org.uk

Chartered Status: another option?

Professor Richard Parish




Options Appraisal

“Through amendment of an existing charter, or the application for a new charter, a body could offer chartered status to public health professionals. The chartered title would be protected. The Royal Society for Public Health, already an organisation with a Royal Charter, is a body that could develop this within the broad context of public health.”

Scally Report



Purpose of Regulation

• The primary purpose of regulation is to ensure safety, effectiveness and quality

• Regulation should be proportionate to the risk posed to the public and service users

• Regulatory systems need the confidence of the public and registrants

• Regulation should lead to improvements in quality for the public, users and consumers

• Proportionate regulatory systems need to apply equally well across all sectors and employment situations

• Protected titles should be used where public interest is promoted

Adapted from the Scally Report



A Work in Progress!

• First outing – formative input

• RSPH supports Statutory Regulation, but must have a Plan B

• Consultation period• Build on existing

arrangements



Statutory Regulation

• Political support – deregulation, not regulation!

• Health and Social Care Bill – timing

• Treasury criteria• Other options available



Underpinning Principles

• Support PH practice development

• Public protection• Employer protection/indemnity• Build capacity and capability• Support the PH Career

Framework• Add value, not replicate



Relevant

• Public• Employers and Managers• Practitioners• Other regulators• Academics



Professional Designations

Specialists• Chartered Consultant in

Public Health

Practitioners• Chartered Health

Promotion/Improvement Practitioner

• Certified Health Educator• Credentialed PH

Practitioner

CharteredPractitioner



Adding Value

• Consolidates existing contributions

• Faculty to set standards• Recognises contributions of

UKPHR, CIEH, etc• Could operate at several levels• Public and professional

recognition• Enhances development support



Why the RSPH?

• Royal Charter – link to Privy Council• International accreditation and certification body• Nationally approved qualifications body• 100,000 students a year• 7,000 members• Systems and database management• Communication structures

1



Why the RSPH?

• Competencies in Health Promotion Project• ‘Shaping the Future’ initiative• Links to WHO, WFPHAs, APHA, IUHPE and other

organisations• Multidisciplinary membership• Academic network + NGO Forum• Health Trainers and ‘Understanding Health Improvement’• Independent of, but close to DH, Government and

Parliament

2



Why the RSPH?

• History since 1856• Member of the Tripartite Group• All sectors of employment – private, public and

voluntary• Other professional groups e.g. health

physiologists• Critical PH mass to influence policy and practice

3



Costs

• Volume and numbers• Development + Administration

costs• 500 Specialists @ £160 = £80k

(includes Fellowship benefits)• 1,500 Practitioners @ £85 =

£ 127.5 (includes Membership benefits)

• Total £207.5k



A Joined-up Approach

• PH Careers Framework• FPH Learning Outcomes

Framework• UKPHR Areas and Levels• Principles of the CHRE• HP Competencies Project



Key Points

• Provides protected title• Essential to have employer

recognition• Chartered status next best thing to

statutory regulation• Requires support from the public

health community• Timescale



Questions

• Does this initiative have broad support in principle?

• What else should be taken into account in drawing up the proposals?

• What services/support are needed?• What should be the key entry levels?• Is there a better alternative?

Response to the Review of Public Health Regulation

D P Landes

Deputy Faculty Adviser

What does the Faculty do?

• Standard setting body for Public Health UK– Maintaining professional standards– Quality assurance of the profession

• Provides Advice to employers– Appointments– Good practice in Public Health

• Advocates for public health– Health promotion– Health protection– Health care improvement

Why is Quality Assurance of Practitioners important

• Health protection– Immunisation– Screening– Emergency preparedness

• Health promotion– Increasing health inequalities– Increasing incidence of cancer

Things go wrong & right• Going wrong

– Stanley Royd 1985 deaths of 19 elderly patients

– 1997 227 children Scotland effected by poor administration BCG vaccination

• Going right– Smoking ban– Cervical cancer screening

Type of Regulation• Statutory register

– Medically qualified– Non medically qualified

• Encompass– Consultants– VSM public health

• Protection of titles– Director of Public Health

Voluntary Register• Maintenance of standards

– Training and Education– Entrance qualifications– Robust Open Transparent mechanisms

• Maintain fitness to practice– Mechanism of regulation– Mechanism of removal

• Health Professions Council• Robust communication between Regulators

Wider Workforce• Voluntary self regulation beneficial

• FPH – Review standards– Develop standards

The Wider Workforce Context

ED YOUNG NHS NORTH EAST, PEOPLE (WORKFORCE)

The Wider Workforce Context

Parallel consultation on the new workforce system closes on 310311

Liberating the NHS: Developing the healthcare workforce : Department of Health - Consultations

Looks at the whole workforce Includes a section on the public health workforce Responses to the consultations on public health need to be linked to

the wider workforce agendas

Overview

The White Paper “Equity and Excellence: Liberating the NHS” sets out a vision, strategy and proposals for the NHS where:

Patients are at the heart of everything the NHS does Healthcare outcomes are amongst the best in the world Clinicians are empowered to deliver results

Consultation Liberating the NHS: Developing the healthcare workforce launched on 20th December 2010 and closes on 31st March 2011.

There will be a specific event for the region on 02nd March 2011. It is important that public health is represented

Successful patient care depends on the whole workforce. Staff who are empowered, engaged and well supported provide better patient care.

The NHS Constitution requires all employers to ensure all staff have personal development, access to training, line management support to succeed and support to improve staff health and well being.

The White Paper sets out proposals for a new framework for education and training: driven by patient need, led by healthcare providers and underpinned by strong clinical leadership.

A focus on value for money, and effective linkage to delivery of better healthcare outcomes.

A strong relationship with education providers to ensure that we can improve on the quality and value for money for pre registration and post registration training and continued professional development.

What are we trying to achieve

We want to design a system that has:

Robust workforce planning and security of supply.

A flexible workforce that can respond to the needs of local patients.

Continuous improvement in the quality of education & training of staff.

The right incentives and accountabilities to drive value for money.

A diverse workforce that has equitable access to education, training and opportunities to progress.

Local ‘skills networks’ will take on SHA workforce functions. Quality of education and training will remain under the stewardship of healthcare professions, working in partnerships with universities, colleges and other education providers.

Local Autonomy & Accountability

Healthcare providers are the engine of the new system.

All providers have an obligation to plan and commission thoughtfully for the whole workforce and long-term sustainability.

Clinical leadership will raise standards of education and training at every level.

Appropriate ‘checks and balances’ will provide accountability.

Centre for Workforce Intelligence will raise standards of education and training at every level.

Will decide how they work together.

Will need to create and own a legal entity to:

Manage workforce data. Develop and consult on a local skills and development strategy. Hold and allocate education and training funding. Contract for education and training, secure value for money and quality. Manage all clinical placements including deanery functions. Work in partnership with universities and other education providers. Work with LAs across the health, public health and social care workforce. Contribute to the development of national policy.

Will decide on size and governance of their local ‘skills networks’

Healthcare Providers

A new executive expert organisation bringing together interests of healthcare providers, the professions, patients and staff.

Building on the work of MEE and professional advisory bodies, involving patients and promoting equality.

HEE will have four main functions:

Providing national leadership on planning and developing the workforce. Supporting the development of healthcare provider ‘skills networks’. Promoting high quality education and training responsive to the changing needs

of patients and local communities. Allocating and accounting for NHS education and training resources.

Health Education England

The proposed timetable for change is:

The new system would start on 1 April 2012. SHAs will hold and allocate the Multi-Professional Education and

Training (MPET) budget for 2011/12. Employers will need to work together with local partners to set up their

own skills networks as legal entities to be ready to commission education and training from April 2012.

SHAs, before dissolving, will help develop plans for the new local arrangements.

The new HEE board will be established in shadow form in 2011 and as a special health authority from April 2012.

What next?

If you wish to participate in the workforce consultation on 02nd March 2011 contact [email protected]

Use this information and the information in your pack as part of the group work later

For any further clarification contact [email protected]

North East Consultation on Review of the Regulation of Public Health Professionals Monday 14 February 2011 1.30pm till 5.00pm Waterfront 4, the Millennium Suite

Questions to the Panel

Group Work

Presentations available at

http://www.sphne.org.uk

Consultation on the Healthy lives, healthy people white paper has been extended to 31 March 2011.

http://consultations.dh.gov.uk/healthy-people/healthy-people

welcome & introductions professor peter kelly, acting regional director of public health

Documents

public health network

regional strategybetter

public sector workforce

development of capacity

north east of england

north east consultation

workforce planners

training of specialists