Introduction

The focus of this book has been on changes to the public health workforce in England. Because a number of the developments during the period covered by this book also applied to the public health workforce in the other three UK countries, it is useful to consider how each of them applied the changes and at what pace.

England, with a population on census night 2011 of 53 million, is by far the largest of the four UK countries. At the time of the census, Scotland had a population of 5.3 million, Wales 3.1 million and Northern Ireland 1.8 million.

Since the 1990s and the establishment of devolved administrations for Scotland, Northern Ireland and Wales, the health systems in the four countries have become increasingly divergent. Devolved powers for Scotland, Northern Ireland and Wales include responsibility for the organisation of health and social care. England is now the only one of the four countries, for example, to retain a full purchaser–provider split in health care. This has had an inevitable impact on the configuration of, and what has been required from, the public health workforce.

Wales

The Welsh Assembly Government is responsible for the funding and oversight of the National Health Service (NHS) in Wales and other health- and social care-related bodies. As a devolved administration, Wales receives a block grant from the UK central government, which is then distributed between the different Welsh departments. Wales has three NHS regions and seven local health boards for commissioning and planning of health care through health trusts and primary care.

The public health workforce in Wales has operated on an all-Wales basis since 2003, with the formation of the National Public Health Service for Wales. Since 2010, as Public Health Wales, an NHS Trust, it delivers specialist public health services to the Welsh Assembly Government, as well as support to the local health boards through Directors of Public Health (DsPH) and their teams.