In this article, we have Dr Catherine Heffernan share her experiences on what it's like to be a consultant in public health.
Dr Catherine Heffernan is a registered public health consultant with an academic background. She recently finished work on COVID-19 with the national advice and guidance team in the UK and provided systems leadership on immunisations and vaccinations in London for nine years.
She has a great website, drcath.net, a resource for people interested in studying, researching or working in public health in the UK.
A question I get asked a lot is what is it like being a consultant? What do you do day to day? To be honest, it stumps me. There is no typical day. Each day is different. It’s one of the reasons I love this job. That and the fact that I am working behind the scenes, working with decision makers and influencers in helping people live longer, healthier lives and tackle the disparities in access to healthcare and health.
Simply put, a public health consultant job is an office job. It’s a senior manager post but an office job nonetheless. We work Monday to Friday, usually 9 to 5, although flexible and agile working arrangements are available. Colleagues in health protection at UKHSA will also have on-call arrangements, and during crises, such as the COVID-19 pandemic, we initiate the ‘all hands on deck’ mantra and work longer days and weekends. Like other senior managerial roles, we have responsibility for leading and managing a team, budgets and for the performance of our team and our programmes of work.
Managing performance can be tricky as it’s not just about achieving the team’s objectives or personal development plans. We work within organisations (e.g. local authorities, NHS England/Improvement, UKHSA etc.) and have the organisations’ priorities to achieve and align our work. As our focus is on improving population health, we also have an eye on our statistics. There are reductions to be made to the prevalence of non-communicable diseases and risk factors, such as obesity and smoking and reductions in the prevalence of communicable diseases, such as STIs, TB and influenza. On the other hand, we want to improve the uptake of screening and immunisation programmes, healthcare models, and patient pathways to be more cost-effective and prevent early mortality and/or severe morbidity. Success in achieving these aims cannot be done by a lone public health doctor, nor can it be done by a single public health team.
Improvements to public health require partnership work, influencing the movers and shakers and getting buy-in to make a difference.
You may have come across the term ‘systems leadership’ being used in relation to public health consultants. It can be a bit difficult to pin down exactly what it means, but in my view, it’s my ability to build relationships, advise, influence and execute strategic planning for health gains.
Take a public health topic like obesity. The NHS commission provides some of the services – e.g. health checks, digital apps for weight management, and tier 3 weight management services. Local authorities commission Tier 2 services but also provide and commission services that prevent obesity – e.g. maintaining parks and provision of leisure activities and sports. As a consultant, I would look at what my population statistics are telling me about the level of healthy and unhealthy weight in my population. This would commonly be done as a health needs assessment, and I would also look to the evidence base of what works and doesn’t work in reducing levels of obesity. I would reach out to public health teams elsewhere in the country to find out from them their learning on what to do (and not to do). Armed with my knowledge, I would identify the people I needed to work with to devise a plan on how we would reduce obesity in our population. Some will be within the same organisation as me, and others will be outside. Each partner who comes to the table will be coming with a different perspective and vested interest. Some will need a bit of encouragement to be involved. Here I’m relationship building and influencing. Very often, I don’t hold the budget or the power to make things happen, so I need to convince others to take action. It’s a combination of being credible in your knowledge, your diplomacy and communication skills and your ability to network and maintain working relationships.
This moves me onto the advisory part of the role. It’s important to keep up-to-date on recent developments in public health and related fields. Throughout my career, I’ve had to advise politicians, commissioners (buyers) and policymakers on public health issues. I’m expected to give salient, balanced advice based on evidence. Sometimes this advice can take the form of research or evaluations of services or initiatives. For example, when I worked on the flu vaccine, we in NHS England (London Region) piloted in London the offer of ‘flu vaccine throughout community pharmacies. At the time, the evidence base was limited to the USA and was inconclusive of the value pharmacy brought to flu vaccination. With a workforce shortage of vaccinators in London, I worked with my Head of Commissioning to create a business case to pilot it and, more importantly, evaluate its impact. The results of this evaluation led to the pharmacy offering flu vaccinations in London.
A wise boss once told me that as a consultant, I should try to innovate, implement, experiment and evaluate. And so, if there is a need and a lack of evidence, I do exactly that and create the evidence.
This brings me back to the question of a typical day. There are lots of meetings where I network, influence, advice and execute. I lead a home team, task and finish groups and matrix work on different strategies to improve health and health services and deliver on targets. There’s the monitoring of contracts, auditing of services, and research collaborations with academic partners. I write reports on public health and the performance of programmes and supervise public health registrars and other trainees. And every day, I advocate for better health and better access to care. Duncan Selbie (former Public Health England chief executive) once said at a meeting I attended that you don’t get into public health to be noticed, and your work is often invisible. You do public health because you care about people and making a difference.
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I've worked with hundreds of senior doctors and public health professionals across the UK and internationally over the last 6 years, supporting them with all aspects of their careers and professional lives. Many doctors and public health professionals tell me that they feel like they are floundering in their career, at a crossroads, are stuck in procrastination, are worried about burning out, or fear being able to sustain their role into the future. Others feel excited, and perhaps daunted by their leadership challenges.
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