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The report says public health doctors’ remuneration package should be reviewed to ensure that competitive and attractive salary packages can be offered.
In return, the duties of public health physicians should be formally revised, according to the report.
Fundamental strategic and structural change is needed to move the public health function forward and to develop the role of the public health physician, outlines the report. A new national strategy for public health is required, and a new organisational model, envisaged as a “hub and spoke” type structure, whose staffing should not be wholly dependent upon public health physicians, but should include a more diverse public health workforce.
The report recommends that the HSE should develop “a significantly (and possibly even radically) different organisational model for the delivery of public health services, in line with the proposed new public health workforce development plan”.
The report says the structure and organisation of higher specialty training in public health medicine in Ireland is on a par with higher specialty training programmes in other medical specialties.
However, it says the development of dual training programmes between public health medicine and other relevant medical specialties (such as general practice, infectious diseases, community paediatrics and occupational medicine) would be a positive and welcome development.
This, plus expansion of the range of attachments available for those training in the specialty, would be likely to further enhance the attractiveness of public health and also aid the longer-term career development of consultants. “Our survey of public health physicians indicated a high level of dissatisfaction with current contracts, status, and remuneration, with a clear desire to see these addressed by means of the approval of consultant status for Specialists in Public Health Medicine. The survey also, however, emphasised the commitment to the principles of public health medicine and a belief in the importance of the function and its impact among respondents.”
The higher specialist training scheme should contain a significant element devoted to the leadership role which public health doctors will be increasingly expected to play within the revised model for public health medicine set out in the report, with a view to maximising the contribution of public health doctors across the full spectrum of healthcare services, it recommends.
The achievement of consultant status and enhanced remuneration “should be contingent upon significant progress being made in the revision and enhancement of the role and function of public health physicians in line with these changes”.
In a statement, the Department said a reformed and strengthened specialty should contribute to implementation of Sláintecare, the continued development of Healthy Ireland and maintenance of ongoing focus on strengthening clinical governance, ensuring patient safety and achieving integrated care at national and regional levels.
“Dr Gabriel Scally, in his report on the National Cervical Screening Programme, made clear that the skills of public health doctors must be more appropriately deployed at the core of all public health programmes so that they contribute at leadership level across the health service.
“The recommendations contained within the Crowe Horwath Report have been considered by the Department in the context of both Dr Scally’s recommendation and ongoing work in relation to Sláintecare. A process of engagement around implementation of these recommendations, including the development of a significantly different operational model for the delivery of public health medicine services, will commence with stakeholders early in 2019.”