Public health reform: A lot done, more to do   

Outgoing IMO President Dr Anne Dee provides an update on the roll-out of the public health agreement

It is good to reflect this year on the implementation of the public health agreement. The agreement has been fully honoured and all agreed 84 posts have been advertised at this point.

Plans drawn up on paper don’t always reflect reality when implemented and there is always a need for flexibility, especially as HSE reforms were also being rolled out at the same time. Regional public health departments are now part of the remit of regional executive officers, with regional directors of public health sitting on regional executive teams. Some governance lines have been altered, and work is ongoing at regional and national level to maximise the public health function across the system.

Multidisciplinary teams are being built up, but there is still a substantial shortfall between what is in place and what is needed to deliver a robust public health function, especially on the population health planning functions of health improvement, service improvement, and intelligence. Data availability and data analytic capability is poor, especially at regional level, in many public health departments.

There is a significant need to increase the number of senior medical officers within the system and offer them genuine career progression and development opportunities. It is to be hoped that the IMO’s pay claim for this group will be successful and it is badly needed for recruitment and retention in this cohort.

National public health functions are being embedded and ensuring that national and regional functions work optimally together is still a work in progress. However, it is fair to say that a huge amount has been achieved and the public health function in Ireland is in a far stronger position than it was before the reform process.

This is important when there are substantial global threats emerging on many fronts, with some states being weakened to such a degree that they could potentially compromise the international health protection system. Climate change, civil unrest, and mass migration from conflict and famine, all pose threats to population health.

A well-resourced and responsive public health function benefits the whole health service, the health of the population, and the country’s ability to respond to global threats. So while a huge amount has been achieved, the work is really only beginning and there is a lot more to be done.