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The public health knowledge and intelligence workforce

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The public health knowledge and intelligence workforce March Table of contents Executive summary 3 1. Introduction Background to the project Methodology
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The public health knowledge and intelligence workforce March 2015 Table of contents Executive summary 3 1. Introduction Background to the project Methodology Report content Policy context What is public health knowledge and intelligence? Who delivers public health knowledge and intelligence? Policy drivers affecting this workforce Implications Numbers in the current workforce Historical numbers and estimates Estimate of current numbers Models of workforce organisation Implications Career pathways, education and training Overview of current education, training and accreditation routes Formal registration routes Typical career pathways Implications Current issues and priorities Current achievements within the system Current areas for development Implications Thinking about the future Areas of future development identified in interviews Areas of future development identified in workshops Implications Conclusions and suggested actions Short term actions Long term actions Annex future scenarios The influence of improved access to data and technology in the future CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 1 The question of accredited pathways for the profession in the future Changes to local authority teams and impact on services Greater connectivity between public health knowledge and intelligence teams The role of public health knowledge and intelligence Acknowledgments References CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 2 Executive summary Background The Centre for Workforce Intelligence (CfWI) was commissioned by Public Health England (PHE), Health Education England (HEE) and the Department of Health (DH) to provide a clearer understanding of the public health knowledge and intelligence workforce within PHE and local authorities. To achieve this, the project aimed to: provide a better understanding of the skills, competencies and training pathways of the existing workforce; consider the factors driving the demand and supply of public health knowledge and intelligence staff; identify key areas where workforce planning will be required to facilitate a sustainable and skilled workforce over the coming five to 10 years; and identify what staff planning and development techniques could be used to maximise the benefits to PHE and local authorities arising from their knowledge and intelligence workforce. The CfWI has assumed this workforce as those who fulfil the knowledge and intelligence function in support of three main domains of public health: health protection; health improvement; and healthcare public health. These are staff employed primarily in data analysis, informatics, and presentation of public health information; and who are responsible for collation, management, analysis, interpretation and dissemination of data and information from a wide range of primary and secondary health, social, economic and demographic data sources. Our definition aligns with the Faculty of Public Health (FPH) definition of public health intelligence as the: surveillance, monitoring and assessment of health and the determinants of health, plus the development of the public health evidence base and knowledge (FPH, 2014b). The report outlines: The policy context surrounding the public health knowledge and intelligence workforce The current workforce, in terms of education and training, skills, competencies, staff numbers, delivery of services and career progression The current issues and priorities affecting this workforce How skills and career pathways may need to change in future, based on consultation with a range of people working in public health What possible actions could better support the public health knowledge and intelligence workforce within PHE and local authorities The policy context Although there is increasing consensus around the activities of the public health knowledge and intelligence workforce (including those who work in PHE and local authorities), there are still a number of different definitions which cover what this workforce does. However, there is increased recognition of the role this workforce plays in providing and developing a strong evidence base in public health matters. CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 3 Given the increased focus on this workforce, a clearer understanding of what it represents is important for not only ensuring effective delivery of public health services, but also understanding the size of the workforce, where staff are located and what their current and future professional needs are. Numbers in the current workforce The CfWI estimates that there are between 1,070 and 1,370 people working in PHE and local authorities. This assumes approximately 430 staff working in PHE (according to HR data), and approximately between 640 and 940 staff working in local authorities. There are also public health knowledge and intelligence staff working in the NHS and academia, but numbers are too small to count cost-effectively. The figures provided are consistent with the CfWI s earlier 2014 estimate in Mapping the Core Public Health Workforce of between 1,000 and 1,300 staff (CfWI, 2014), but provide a more robust basis for the estimate. Career pathways and professional development Although a number of career routes exist, in terms of professional accreditation and training, there is no single specific route nationally for the public health knowledge and intelligence function. The future for professional development may lie less in formal qualifications (credible routes exist and could be developed further, such as that of CILIP 1 or, at a higher level, specialty training or the UKPHR 2 s practitioner route), but rather in training courses or schemes that develop professionals throughout their careers. Another key message relates to the clarity of career trajectory for knowledge and intelligence professionals up to consultant and specialist level and the lack of clarity beyond that point. Promoting career progression and workforce mobility between different organisations could help to mitigate against the possible risk of career stagnation, and will enable professionals to gain experience elsewhere where desired. This could be addressed through a mixture of informal means (such as increased promotion of courses and job opportunities) and more formal means (such as secondments or through current projects to develop a public health skills passport). Considerations for the future Overall, there are a number of positive observations to make with regards to public health knowledge and intelligence staff: the favourable positioning of public health knowledge and intelligence teams, holds potential for local teams, in particular, to support local authorities in improving public health and to influence decision-making more directly the increased profile of public health knowledge and intelligence work, as a result of the Five Year Forward View (CQC et al, 2014) the appreciation of services offered by public health knowledge and intelligence teams, by local authority staff and others. 1 The Chartered Institute of Library and Information Professionals 2 UK Public Health Register CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 4 These are encouraging starting points for future development, and should not be forgotten when considering possible actions to address this workforce in the future. There are three areas clearly identified in the CfWI s work for the public health knowledge and intelligence profession as a whole to address: 1. Uncertainty surrounding public health knowledge and intelligence specifically within local authorities, as teams are reorganised and previously ring-fenced public health funding is potentially removed. There is also some uncertainty around existing numbers of posts. 2. Career progression and workforce mobility including opportunities to develop, and transfer between PHE, local authorities and the NHS as part of career progression. 3. National support for local public health knowledge and intelligence teams to provide greater support to local authority public health knowledge and intelligence staff and, therefore, help increase the impact of this workforce. Suggested actions A number of activities are already in hand to address these issues, including: Existing work to create a national minimum dataset in public health (NMDS-PH), and on ensuring multidisciplinary public health teams within local authorities Development of a skills passport in public health to facilitate workforce mobility Continued PHE support for local authorities, where appropriate, in resolving identified data access issues. The CfWI suggests that the following further actions be considered by PHE, local authorities and other organisations: A review of PHE s role in providing greater practical support to local public health knowledge and intelligence teams, following the National Audit Office (NAO) s recommendations in its 2014 report (NAO, 2014) on PHE. This could improve the impact of PHE, local authority and other teams in public health knowledge and intelligence. The development of a national professional network and an identifiable Head of Profession for staff working in public health knowledge and intelligence functions within both PHE and local authorities, to provide greater visibility and to foster a stronger sense of community across this diverse workforce. These could build on existing structures such as the Local Authority Research and Intelligence Association (LARIA) and PHE s existing knowledge and intelligence teams (KITs) structure. Promotion of greater workforce mobility between PHE, local authorities and the NHS through job exchanges, secondments and other similar means. This will enable professionals to gain experience and mitigate against the possible risk of career stagnation. An audit or survey of both PHE and local authority teams to confirm numbers working in this function, in order to fully establish a numerical benchmark for this profession pending full implementation of the NMDS-PH. An audit/survey would require investment from organisations across the public health system. Finally, the CfWI suggests that another review of this workforce take place within the next five years, upon full implementation of the NMDS-PH and further embedding of the new public health system. This would enable monitoring of numbers, as well as assessment of any actions carried out subsequent to this report. It is, CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 5 however, for PHE in consultation with local authorities and others to decide how best to respond to the issues identified in this report. We would like to thank all contributors to the project for their support, while also noting that our conclusions and suggestions may not necessarily reflect those of the individuals and organisations consulted. For a full list of people and organisations involved, please refer to the Acknowledgements at the back of this report. The CfWI public health team can be contacted with any queries at CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 6 1. Introduction 1.1 Background to the project Public health as a broad discipline is about helping people to stay healthy, and protecting them from threats to their health. The Faculty of Public Health (FPH) 3 defines it as: the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society (FPH 2014a; Acheson, 1998). In addition, the Health and Social Care Act 2012 defines the legal duties of the Secretary of State for Health in health protection as steps that are:... appropriate for the purpose of protecting the public in England from disease or other dangers to health (Health and Social Care Act 2012, clause 11). This project focuses on one of the critical functions of public health: public health knowledge and intelligence. The aims of this project were to: Provide a better understanding of the skills, competencies and training pathways of the existing workforce; Consider the factors driving the demand and supply of public health knowledge and intelligence staff; Identify key areas where workforce planning will be required to facilitate a sustainable and skilled workforce over the coming five to 10 years; Identify what staff planning and development techniques could be used to maximise the benefits to PHE and local authorities arising from their knowledge and intelligence workforce. A major motivation for this project was the changes to the public health landscape in 2013 as a result of the Health and Social Care Act 2012, following the Government s 2010 White Paper Healthy Lives, Healthy People (Health and Social Care Act, 2012; DH, 2010a). Whereas public health had previously been the responsibility of primary care trusts (PCTs) and strategic health authorities (SHAs) in the NHS, responsibility now lies primarily with, Public Health England (PHE), an executive agency of the Department of Health (DH) and with local authorities. As of 2015, most staff in public health are either local authority employees, or civil servants. In the case of public health knowledge and intelligence, staff have moved from PCTs, SHAs, regional Public Health Observatories (PHOs) and the Health Protection Agency (HPA) primarily to national and regional teams in PHE and local authority teams, with small numbers remaining in the NHS (usually in commissioning support units (CSUs), clinical commissioning groups (CCGs) and individual trusts). This separation between different organisations is reflected in current funding arrangements for public health, as explained by the (NAO) (NAO, 2014). In the 2014/15 year, the DH allocated a total of 5.9 billion, of which: 3.6 billion went to PHE, with 2.8 billion ring-fenced as a grant to local authorities; 3 The Faculty of Public Health (FPH) is nominally part of the Royal College of Physicians. In practice, the FPH is an independent organisation, acting as the primary representative body of consultants, specialists and trainees working in public health. CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 7 2.3 billion went to NHS England, with 1.9 billion ring-fenced for specific public health activities (such as screening and immunisations) (NAO, 2014) For the purposes of this project, this report has assumed that public health knowledge and intelligence services will be funded either by direct allocation of funding to PHE from the DH (for PHE teams) or by PHE s ring-fenced grant to local authorities (for local authority teams). For this reason, this project has primarily focused on teams within PHE and local authorities, with other staff from other organisations out of scope except where directly relevant to the work of these teams. We nonetheless acknowledge the role that other staff play in public health knowledge and intelligence, notably those in NHS organisations and those working in academic public health. 1.2 Methodology For this study, we used a combination of desk research, semi-structured interviews with knowledge and intelligence staff and others, four workshops with PHE and local authority staff, and a data gathering exercise of local authority directors of public health using a survey tool to ascertain staffing numbers and models of delivery within local authorities. As well as current issues, project participants helped identify the potential challenges, opportunities and likely future developments which could influence planning of this workforce. 1.3 Report content Given the project s objectives, this report contains the following sections: the policy context surrounding the public health knowledge and intelligence function the current workforce, which describes the numbers of staff working in PHE and local authorities skills and career pathways, including education and training, skills, competencies, numbers, delivery of services and career progression current issues and priorities affecting this workforce how skills and career pathways may need to change in future, based on consultation with project participants possible actions to better support the public health knowledge and intelligence workforce. CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 8 2. Policy context The purpose of this section is to explain how public health knowledge and intelligence is commonly understood by professionals working in public health. It also sets out the key policy drivers that have affected this workforce in recent years and the main historical factors that have driven demand and supply for this workforce. 2.1 What is public health knowledge and intelligence? A useful starting point is the FPH definition of the public health intelligence function as involving the: surveillance, monitoring and assessment of health and the determinants of health, plus the development of the public health evidence base and knowledge (FPH, 2014b). The FPH definition of the public health intelligence function, focuses primarily on local delivery, involving five key activities: assessing the health and health needs of the local population; interpreting intelligence about health outcomes; carrying out health equity audits and health impact assessments (in order to help develop appropriate recommendations for action, policy decisions and service commissioning); ensuring access to health intelligence; improving the quality of health data. Nationally, the Government s 2013 document Healthy Lives, Healthy People: A Public Health Workforce Strategy (thereafter Public Health Workforce Strategy ) states that: The public health knowledge and intelligence function underpins the delivery of public health practice... This function concerns the management of knowledge needed to inform action, including: analysis of data and statistics; learning from practical experience and sharing best practice; and implementing new knowledge gleaned through research. Staff working in knowledge and intelligence roles have a wide range of skills, spanning analysis, statistics and epidemiology, alongside knowledge management, library and information services, as well as interpretation and evaluation (DH, LGA & PHE, 2013). The Public Health Skills and Knowledge Framework defines public health intelligence as involving the collection, generation, synthesis, appraisal, analysis, interpretation and communication of intelligence that assesses, measures and describes the health and wellbeing, risks, needs and health outcomes of defined populations (Skills for Health, 2008a). Finally, HEE s December 2014 strategy Knowledge for healthcare: A Development Framework identifies staff working in healthcare library and knowledge services as delivering the following activities: Information consultancy Information skills training Document delivery Current awareness and alerts Digital and print collection management CENTRE FOR WORKFORCE INTELLIGENCE CfWI 2015 Page 9 Advice on knowledge management. Public health knowledge and intelligence, nationally and locally, covers a wide range of areas and skills in both developing and maintaining an evidence base for public health, and should be understood as providing the theoretical means to underpin practical actions in health protection, health improvement and health services commissioning. The diversity of the public health knowledge and intelligence function and workforce reflects the multidisciplinary nature of public health as a whole. The function will often require a wide knowledge base to include all domains of public health, from communicable diseases through to health policymaking. Analysis of data and statistics requires a thorough and up-to-date knowledge of relevant information sources, proficiency in modelling, forecasting, tools and software in those areas, as well as communicating appropriate and evidence-based recommendations to a range of key partners. Staff working in this field in local authorities must also contribute to healthcare public health, t
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