The new IMO President Dr Anne Dee writes that while public health reform has advanced, key staffing and pay issues remain unresolved.
As we gather in Killarney for our 2025 AGM, the issues affecting public health medicine are many. While there has been a significant success in recent years in establishing the grade of consultant in public health medicine, along with winding down the specialist in public health medicine grade, senior medical officers (SMOs) in public health continue to be underpaid for the valuable job they do. This role entails working at the frontline of health protection, controlling the spread of infections on the notifiable infections list and, thereby, protecting the public.
In respect of consultants in public health medicine, in many cases the promised multidisciplinary teams have not been recruited due to the HSE Pay and Numbers Strategy. These teams were originally envisaged in the public health reform agreement and were to support consultants and allow them to work to the fullest extent possible.
Workforce gaps
In relation to SMOs, a number of vacancies which were unfilled on 31 December 2023 were lost due to the HSE Pay and Numbers Strategy. SMO posts have become unattractive due to relative disparity in pay when compared with other medical posts.
Under the public health reform process, the National Director of Public Health has engaged with the group to improve training opportunities. In 2024, the IMO secured an increased continuing medical education allowance for all SMOs, with the amount increasing from €1,500 to €2,750. More work is needed in respect of this group and the IMO public health committee will continue to work on this issue in 2025.
For consultants in public health medicine, the 84 posts agreed between the IMO, HSE and Department of Health have now largely been filled, with a small number of posts still outstanding. The IMO continues to work with the HSE in respect of same to ensure full implementation of the agreement.
Structural reform
The reform agreement allowed for domain-specific working such as we see in other jurisdictions and the establishment of the consultant posts as leaders and experts in these specific domains. With the advent of the new regional structures, the Regional Director of Public and Population Health in each region sits on the senior management teams for the region. Also, the newly appointed regional consultants in public health medicine lead the public health domains of health protection, health service improvement, health improvement and health intelligence at regional level. These regional consultants work in close collaboration with their national colleagues covering the domains under the leadership of the National Director of Public Health. This enables delivery of a population health management approach to services at regional and national level.
This is vital in ensuring that public health medicine voices and concerns are heard at the table where decisions are being made. For many years this was not the case. Equally at national level, public health consultants are now consulted in making decisions where their domain of expertise is required.
An outstanding issue in relation to the appointment of the National and Regional Directors of Public Health is the issue of the non-payment of a Clinical Director allowance for these hugely responsible posts. This needs to be resolved to ensure future recruitment into these posts is attractive to consultants.
We must hope that these new structures lead to better decision-making across the health service and society, and that they are informed by best evidence and clinical data to ensure best outcomes for citizens and patients. Public health consultants are trained to be able to bring a unique blend of clinical and public health expertise. However, in order to fully flourish it is essential that SMO vacancies are made attractive and filled and that full multi-disciplinary teams are available to all consultants in public health medicine.
The IMO AGM takes place on 24-26 April in The Europe Hotel, Killarney, Co Kerry
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