By Dr John Middleton, Director of Public Health for Sandwell and FPH Vice President
A packed lecture theatre of over 150 health and local authority professionals, gathered to hear Councillor David Sprason, Councillor Ernie White and Dr Peter Marks about their work in Leicestershire County Council, and from Councillor Ann Jaron and Dr John Middleton from Sandwell Council. The session was designed to contrast urban and rural council public health activities, and to discuss the risks and possibilities presented by the new public health in local authorities. Major examples of joint health and council activity for health improvement including drugs and alcohol services, cardiovascular disease reduction and reducing teenage pregnancy were shared. The move by public health into local authorities was viewed as a major opportunity to improve the health of the people we serve.
The public health community needed to shake off any nerves about the move and get involved with the action in local authorities. Public health specialists need to trust their elected members as potentially powerful advocates for health related policies. Councillors needed to see inequality in health as an important policy consideration, an issue of civic pride – alongside traditional concerns like crime and antisocial behaviour.
Public health has developed tools for health impact assessment, for addressing health inequalities, for risk stratification, for modelling and priority setting which are needed in the new context to support council decision making.
The meeting saw health and wellbeing boards, joint health needs analysis and the joint health and wellbeing strategy as major tools for health action between the council and clinical consortia. Councils needed to take a lead role in respect of overall the health strategy, particularly where there they cover more than one clinical consortium.
Although panellists believed independence was important to giving scientific and credible advice – they also felt that accountability was equally important. Public health professionals need to work with elected members and give them the bullets to fire for improving public health.
Public health professionals could also contribute to the local authority agenda – bringing to councils expertise in research, in systematic reviews and knowledge management and also in workforce planning, training and development of specialist and practitioner staff.
The Local Government Group believes it is for local authorities to decide the nature of their local structures. The FPH and the Association of Directors of Public Health think DPHs should be top-table appointees. Participants reached a strong conclusion that DPHs should report to the chief executive of councils. This was necessary to ensure public health input to all council policies – including ‘people’ policies around social care and education but also the ‘place’ policies of environment, housing and transport and economic development
There is much that is positive about the move to local authorities and this very upbeat meeting concluded with Councillor Sprason stating his DPH was absolutely key to his council’s ability to deliver better health for Leicestershire people.
Better Health For All 
Sounds like a good session – I do think that the transition of public health from the NHS to Local Government represents a tremendous opportunity. Not least because public health – particularly work to address health inequalities – is fundamentally a political activity. Sitting inside the NHS public health has lacked a genuine connection and accountability to local concerns and priorities.
Re-reading the comments above though – I do think a little humility might be in order. Its tremendous to hear all the things that public health has to offer local government – however public health professionals should also be clear that they will benefit from local government expertise. How about these as a starter for 10?
Taking responsibility for rationing services in the face of vicious government cuts; Engaging local people in dialogue; Providing leadership on local economic strategies; Bringing a coherent approach to work on Early Years; Managing and motivating large groups of staff; Developing complex high level strategic partnerships; and my favourite – providing one of the most powerful and public means of challenging government on the impact of policies on local people – particularly the most disadvantaged.