The report in The Guardian that the DH has started to shed public health staff is of course an entrant in the Holy Order of Things That Are Not Surprising.

The likely 1,500 redundancies that will ensure are jobs associated with 'programme funding' – budgets to fund particular areas of work which the government has decided to abolish by March 2011. In context, the article suggests that the DH currently employs 4,286 people.

The rhetoric will be that these people are not 'front-line' staff. Well, ... maybe. It's hard to generalise about public health staff. Some are undoubtedly 'stay-in-the-office' types, whose real impact may be marginal at best. But that has not been true of those I've ever talked to or worked with: most have been people who can help you know where to look for population ill-health, and who have at least some expertise of how to achieve change.

The problem is that assessing the added value of this work is not really much done. Which means making the business case for public health is a hard sell.

Public health has long been a 'virtue' spend - the more so over the past decade or rising budgets. (Although it was the first budget to be raided in the post-Crisp deficit clampdown, shamefully - unpublished research showed that the majority of PCTs reported spending none of their 'Choosing Health' budgets on, erm, public health).

The paradox of NHS thrift
Now the wolf of QIPP (or to give it its full title of 'save money or I'll sack you even sooner') is at the NHS door. Keeping people in good health and out of hospital is all the rage. Which means upstream ... which means public health.

No?