Acheson revisited: public health medicine ten years after the Acheson Report.

The issue of communicable disease control and the role of public health medicine is once more of considerable concern, particularly in the light of recent outbreaks and NHS reorganisations. Ten years ago, following similar concerns, the Acheson Report highlighted several issues with striking parallels to the present day. These included uncertainty over the future and role of public health medicine following repeated Health Service reorganisations. The Report recommended the expansion of the specialty in both communicable disease control and public health medicine in general, and a more clearly defined role for public health medicine. Successive health authority mergers and the specialty's inclusion as part of management costs have meant that the Report's findings have yet to be fully implemented. In fact, the establishment of public health medicine consultants (CsPHM) has fallen by a quarter since 1992. A further review of the public health function is required if the specialty is not to fragment, and if able doctors are not to be deterred from entering the specialty. Such a review should include the removal of the specialty from management costs, and the clarification & standardisation of the roles of the Director of Public Health (DPH), CPHM and other members of the multi-disciplinary public health team, as well as identifying possible organisational locations for the public health function.