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Rethinking the Public Health Workforce

The NHS Five Year Forward View highlights with great clarity the need for a ‘radical upgrade in prevention and public health’. Making the radical upgrade a reality will be difficult without considering who might be involved in prevention and how this will be delivered in the future.

The joint work carried out by the Centre for Workforce Intelligence (CfWI) and the Royal Society for Public Health (RSPH), supported by Department of Health (DoH), Health Education England (HEE) and Public Health England (PHE) ‘Understanding the Wider Public Health Workforce’ goes some way to articulating a way forward in how individuals and professions across a range of areas could support this radical upgrade through a widening of their work roles or volunteer activity to help improve and protect the public’s health.

To tackle the major public health issues and make prevention a priority, we must look beyond interventions delivered by the current 40,000 strong core public health workforce (CfWI 2014 ) and seek to engage with the public via wider occupation groups. The agreed definition for the wider workforce is, ‘any individual who is not a specialist or practitioner in public health but has the opportunity or ability to positively impact health and wellbeing through their paid or unpaid work’ (CfWI 2015).
Recognising the potential for this expanded workforce, the CfWI, PHE and RSPH have undertaken work to define and quantify the wider workforce, gain a greater understanding of the work currently taking place around prevention and identify areas for further development.

We have identified that approximately 20 million people in England have the potential to be part of the wider workforce, this covers 57 occupation groups which include a broad range of the public, private and voluntary sectors as well as 5 million people providing unpaid care and support to family or friends due to disability, illness or poor mental health problems.

These groups have been divided into three categories, ‘active’, ‘interested’ and ‘unengaged’ to recognise their level of development and readiness to support the public’s health. Through a number of stakeholder workshops and an analysis of 30 wider workforce cases studies, commonalities were identified across the wider workforce in terms of a) drivers for change b) ingredients for success c) challenges faced and d) development needs. The key drivers for change include strong leadership, the potential for the wider workforce to support other services and the opportunity to take a whole-system approach in a local authority setting.

With the devolution of responsibility to regions and localities this is an important opportunity to do things differently. Many wider workforce professions highlighted partnership working as a key ingredient for success as well as working in and with communities. It was recognised that developing community assets and community capacity to tackle major public health issues will be crucial to sustainability over the long term.

The cases studies showed us that there were many similarities in the challenges faced for the wider workforce in incorporating, improving and protecting the public’s health into their work. These include the need for a cultural shift for many groups, the need to speak the ‘same language’ and the difficulties faced with regard to sustainability in the face of future budget cuts.

The report highlights the ‘early adopters’ in the wider workforce. These are the occupations who are already engaged with the public’s health, are enthusiastic to do more and should be acknowledged for their part in prevention. Examples include Fire & Rescue Services, Health Trainers, Allied Health Professions (12 distinct professions who make up 6% of the NHS workforce), Community Pharmacy, and Housing Associations. These occupations equate to over three quarters of a million people.

While these are not the only groups making a significant contribution to health and wellbeing, these diverse groups are a good place to start in strengthening capacity, capability and carrying out functional mapping.