PubMed · 14550724
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Tony Avery. 2003-10-04. Tony Avery interview.. https://pubmed.ncbi.nlm.nih.gov/14550724/
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OBJECTIVES: The aim of this study was to identify key issues around public health workforce development in the North of England, considering the gap between need and current capacity and the training requirements to deliver the public health and health improvement agenda. METHODS: Interviews were carried out with over 50 professionals in a variety of stakeholder organizations, seeking their views on priorities for workforce development and perceived opportunities and threats to the development of a good public health workforce. RESULTS: There was general recognition of a gap between current public health resources and what is needed to meet the public health agenda. Priorities included both increasing capacity at the specialist end of public health and raising general public health awareness at all levels of public organizations. Major barriers identified to meeting these needs included organizational difficulties, professional barriers and shortages of appropriate training and resources. Opportunities were seen to be presented by the increased amount of joint working and by national and local raising of awareness of public health issues. CONCLUSIONS: Across the health sector, local authorities, training organizations and voluntary sectors, similar issues and expectations were mentioned at both specialist and practitioner levels. However, it has not been possible in North East England to translate this finding into practical programmes in the absence of nationally identified resources to address the issue.
OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.
This paper presents findings from a study of the context and processes of provider mergers in the NHS in England. Mergers are an example of organisational restructuring, a key lever for change in the UK health care sector and elsewhere, although it is only one strategy for organisational change. The framework for the study is key themes from the organisational change literature: the complexity of the effects of change; the importance of context; and the role of organisational culture. The drivers for health care mergers and the evidence for these are analysed. Using documentary analysis and in-depth qualitative interviews with internal and external stakeholders, the first part of the paper reports on stated and unstated drivers in nine mergers. This provides the context for four in-depth case studies of the process of merger in the second and third years post-merger. Our study shows that the contexts of mergers, including drivers of change, are important. Merger is a process without clear boundaries, and this study shows problems persisting into the third year post-merger. Loss of management control and focus led to delays in service developments. Difficulties in the merger process included perceived differences in organisational culture and perceptions of 'takeover' which limited sharing of 'good practice' across newly merged organisations. Merger policy was based on simplistic assumptions about processes of organisational change that do not take into account the dynamic relationship between the organisation and its context and between the organisation and individuals within it. Understanding the process of merger better should lead to a more cautious approach to the likely gains, provide understanding of the problems that are likely in the period of change, and anticipate and avoid harmful consequences.