Introduction

Following the progress made in the early to mid-1990s, the turn of the century saw significant changes for senior public health staff from backgrounds other than medicine. It had become clear that in order to achieve equivalence for applicants from backgrounds other than medicine or dentistry, certain processes needed to be in place for training, regulation and appointments at consultant level. These were given momentum by a new government with ambitions for public health and the workforce needed to deliver it. It is these processes which are outlined in the next three chapters, beginning in this chapter with an overview of the policy context and demand for public health skills as the backdrop for change to senior level appointments.

The incoming Labour's government's health strategy – creating specialists in public health from backgrounds other than medicine

The English White Paper Saving lives: our healthier nation was published in July 1999 (DH, 1999a). The focus was on tackling health inequalities by setting new national targets for cancer, coronary heart disease and stroke, accidents, and mental health. It also made, for the first time, a commitment to create a role of specialist in public health within the National Health Service (NHS): ‘which will be of equivalent status in independent practice to medically qualified consultants in public health medicine and allow them to become Directors of Public Health’ (DH, 1999a, s 11.25).

Other key measures from the White Paper affecting the public health workforce were: the establishment of the Health Development Agency (HDA) to replace the Health Education, to build and disseminate an evidence base for public health and share knowledge and good practice; a renewed emphasis on cross-sectoral and partnership-working; and the establishment of a public health observatory in each health region to identify and monitor local health needs and trends.

The accompanying circular (DH, 1999b), issued on 6 July 1999, instructed health and local authorities ‘to ensure that the multidisciplinary public health workforce has appropriate capacity and capabilities to deliver the health strategies’.