EHJ June 2003, page 168-170 The newly established National Public Health Service (NPHS) for Wales promises a wide range of public health services at a local, regional and national level. Dr Cerilan Rogers, director of the NPHS, talks to Nick Warburton

Operational from 1 April, the NPHS is a national organisation that provides public health expertise to all the key partners in the emerging public health agenda in Wales. Incorporating the public health departments of the former Welsh health authorities, the work of the Public Health Laboratory Service (PHLS) and the Communicable Disease Surveillance Centre (CDSC) in Wales, along with the all-Wales NHS Child Protection Service, the NPHS offers a whole range of public health services, including public protection, assessment of health needs, advice on evidence-based practice and promotion of health and wellbeing.

Dr Cerilan Rogers, director of the NPHS, is no stranger to the public health stage. Having previously served as director for Breast Test Wales and Cervical Screening Wales, both managed by the Velindre NHS Trust, and worked as an advisor for the Welsh Faculty of Public Health Medicine, she brings a wealth of experience to the position.

EHJ: The NPHS brings together the public health resources of the five former health authorities in Wales. What has been the rationale behind doing this and how will it improve the delivery of public health in Wales?

Dr Cerilan Rogers: The reform of the NHS in Wales included the abolition of the five former health authorities and the establishment of 22 local health boards (LHBs), which are coterminous with unitary local authorities. The challenge facing the Welsh Assembly government in addressing the provision of public health services was how to support the LHBs and other partners at a local level, while minimising duplication and developing expertise at a national level. The creation of the NPHS provides the opportunity to nationally co-ordinate and manage resources while providing each LHB with a public health director and local public health team. All members of the NPHS can deploy their skills and expertise at both national and local levels. The service is, therefore, able to engage at the most appropriate points in the system.

As director of the NPHS, what will your role be and what do you see as being your key challenges?

My main role is to provide leadership to the service and to establish relationships with a wide range of organisations. In the very short term, the continuity of essential health protection services must be maintained and a work programme for the service developed. Over the next year, we need to develop the support we provide to LHBs, local authorities and other organisations. In the longer term, we need to demonstrate that we are making a real difference to the health of the people of Wales and become recognised as leaders in the field of public health practice.

The NPHS will have a service level agreement (SLA) with each of the LHBs, which will now have the statutory responsibility for undertaking most of the NHS's public health duties in its area. Have these agreements been put into place and what will they require the LHBs to do?

The NPHS will have a single SLA with the Welsh Assembly government outlining the functions to be undertaken and the services to be provided by the NPHS for the assembly and other bodies. This SLA will be supplemented by "memoranda of understanding" with LHBs outlining exactly how the NPHS will assist the LHBs in fulfiling their functions. Specific deliverables will be outlined in a work programme. LHBs must provide the local public health team with accommodation and general support.

The LHBs will receive dedicated public health support through a specialist employed in the NPHS who will also be a member of the LHB board. Where will these specialists be drawn from and what function will they have?

The LHB public health directors were drawn from the existing consultants in public health medicine in the previous health authorities. Current and future vacancies will be filled by public health specialists appointed to posts in the NPHS, for whom the role of a LHB public health director will be part of their job description.

The NPHS also has a duty to support local authorities in improving public health. How will the NPHS provide this support?

We are tasked with supporting local authorities in fulfiling their statutory and non-statutory functions in relation to health. This includes health protection and child protection, where specialist NPHS teams will provide services for more than one local authority area. The LHB public health directors have a lead role in the needs assessments for the health, social care and wellbeing strategies in their localities and will also need to engage locally across the wider health agenda. As with LHBs, the local public health director will act as a conduit for local authorities to access the whole of the NPHS as a specialist resource.

The NPHS will also provide a range of services from public protection to advice on evidence-based practice. Could you explain how these will fit into the emerging public health framework and the working relationship between the different partners?

In many instances, the NPHS is one of several partners working closely together. It will be necessary to build close working relationships with all those who contribute to the health agenda.

While the NPHS will be hosted by the Velindre NHS Trust, staff will be working through three NHS regional offices, each with a regional public health director. What will your relationship be with these directors and how will this influence the delivery of public health?

The NPHS is an integral part of the Velindre NHS Trust. We have three regional directors, which mirrors the regional structure in the reformed NHS. The regional directors are managerially and professionally accountable to me and, as members of our senior management team, help to ensure the efficient deployment of resources across Wales. The majority of staff in the NPHS work at LHB and national levels and are based in a variety of locations around Wales. We need, as in any other service, to ensure the equitable delivery of our service across Wales.

Public health and environmental health already has a good practical working relationship on health protection issues, for example, communicable disease and chemical hazards. Will these be affected by the new arrangements in any way?

We expect these relationships to be strengthened by the new arrangements and look forward to working with our partners to ensure this.

In the emerging public health agenda in Wales, it will be vital for the various elements (the LHBs and the local authorities etc) to work closely together. What potential problems do you foresee, if any? How might these be resolved?

A major challenge will be to establish and maintain good communications with a large number of organisations and individuals. This will be assisted through the establishment of close working relationships at various levels with our partners.

What will be the role of local health alliances in influencing the health of communities in Wales?

Local health alliances will continue to provide an important mechanism for progressing this important agenda.

You have already recognised the important contribution from environmental health practitioners (EHPs) in developing local partnerships and national network arrangements. What skills do you think they can bring to the table and what role do you see them playing, for example, as members of the LHBs?

It is for local authorities to determine their own nominations to LHB boards. Clearly, with their professional expertise and experience, EHPs have a major contribution to make in progressing the issues LHBs need to address.

Dr Rogers is professionally accountable to Dr Ruth Hall, the chief medical officer for Wales, and managerially accountable to John Richards, chief executive of the Velindre NHS Trust, which manages the NPHS.