Public health in transition: views of the specialist workforce.

The constant structural changes to the NHS in England have created instability and lack of job security within the public health workforce in the U.K. Since posts are linked to structures which keep changing, recent years have seen constant changes in titles, responsibilities and expectations. Effective public health practice involves teamwork across sectors and strong relationships with local communities, and this constant change has posed professional challenges. The changes in 2002 offered the Faculty of Public Health the opportunity to work with the Department of Health to consult with specialists, the main objective being to reach agreement on future roles and ways of working. The lessons learnt from this exercise are described here as they remain relevant as the structural changes continue. Key messages are that if the many opportunities of the current policy agenda are to be realized, the public health profession needs to be supported to play its full role in the three domains of practice: health improvement, health protection and developing better health services. This challenge needs professional bodies to be clear on expected competence of their members; employers to be clear on the potential contribution of public health specialists not only in promoting and protecting health in communities but also within the acute sector; organizational arrangements to be in place to sustain the capacity of the workforce whatever the structural changes occurring. This lesson has yet to be learnt.