Multiple reports on how to fix Health... no action

THERE is no problem that a Minister for Health won’t try to fix with a report.

However, that prescription rarely cures the illness and further ‘scripts’ are often required. That’s been the case repeatedly when it comes to Ireland’s unfit-for-purpose public health structure.

In 2013 then-Health minister James Reilly set up a working group review of medical training and career structures throughout the medical professions.

Chaired by DCU Professor Brian MacCraith, it looked at every speciality, including public health doctors. After examining the public health situation, the first MacCraith report, published in 2014, called for a repeat prescription – another report.

Specific concerns about the sector included problems with recruitment, retention of staff and the lack of attractiveness public health offered as a career.

Ever since then the MacCraith working group has been producing implementation progress reports for the Department of Health – of which there have now been seven.

But throughout the reigns of Leo Varadkar and Simon Harris nothing has really changed except there have been other reports.

For example, in September 2018 Gabriel Scally’s report into the CervicalCheck scandal pointed to how a better public health input to screening programmes might have avoided the scandal.

‘Public health programmes, like screening, vaccination, tobacco control or infectious disease surveillance, require a skilled and valued public health workforce. There was, unfortunately, limited public health medicine input into

CervicalCheck and I firmly believe that was to its detriment,’ Dr Scally’s report concluded.

‘The time has surely come where public health physicians are accorded the same recognition as clinical colleagues and their skills deployed at the core of all public health programmes.’

Months earlier, in April 2018, another Department of Health report on the ‘role, training and career structure of public health physicians in Ireland’ had drawn a similar conclusion.

In particular this report – by consultants Crowe Horwath – called for the urgent elevation of public health doctors to consultant status and a new national strategy for public health.

The new approach was needed, the report said, to ensure public health units could take on ‘national leadership in major health protection crises and incidents’.

The Crowe Horwath report addressed the threats posed by failures to modernise the system.

‘The Irish health system will be increasingly unable to recruit and retain high-calibre public health doctors, at a time when it will need to increase significantly the number of new entrants into the speciality over the next five to 10 years in order simply to replace the large numbers who will be retiring,’ it read.

‘Under present circumstances, the status and remuneration available to senior public health doctors in Ireland will make it difficult for Irish employers to compete within a very demanding global medical labour market.’

Must ensure ‘public health can lead in crises’