Moving public health is not supposed to make things easier;
it is supposed to make them better.
Dr John Middleton (left), Vice-President of the UK Faculty of Public Health and director of public health for Sandwell, gave evidence to the Communities and Local Government Committee on the role of Local Authorities in health issues on 21 November 2012. This is the first of two blogs of an edited version of his evidence.
Our view about the significance of the transfer of the role back to local councils is that we would certainly want to see health as an issue of civic pride for councillors. It should be unacceptable if life expectancy is not as good as it is in other parts of the country. The issue is to get councils to appreciate health as a matter of civic pride and necessity and what they should expect for their citizens.
“There are large chunks of the system that are in flux and are still being devised and determined, and there are considerable risks in that. As to what councils need to do, we describe three domains of public health: health protection, which is about keeping us safe from infectious disease, communicable disease and major emergencies; health improvement, which is all the policies of the council and how we promote health and keep people healthy; and the domain of healthcare-related public health, where the analysis of what goes on in your local acute hospital is every bit as important as those other two elements.
If councils are to be strategic leaders of the health strategy, they will have to be able to understand and challenge what goes on in the hospital on their behalf. Similarly, they will have to be able to support clinical commissioning groups by providing public health advice so that what goes on in primary care can be as effective as we would advise.
“The position of many public health staff is still not determined. There is a programme through which migration to local authority public health and the NHS Commissioning Board is laid out, but there are still many people who have not yet been aligned. There is still a due diligence process to be gone through in councils. There are posts, for instance, in policy analysis, community development and certain other areas where councillors will say, “We already do that, thank you.”
There is considerable risk and uncertainty for public health staff. Potentially, there will be 50 vacant directors of public health posts by April next year according to the ADPH survey. We are seeing a loss of public health staff through the recent mutually agreed resignation scheme. In my own district of Sandwell we have lost one third of our public health workforce in the last two months.
It is a period of serious risk and uncertainty. I think that we will come through it positively. The cadre of trainees in specialist positions is an excellent and outstanding bunch of people and they will graduate through the ranks, but there will be a very uncomfortable period when a large number of vacancies for directors of public health in particular is the reality. A real risk is that people who do not have leadership in public health do not value it and do not see what it is going to do for them.
Health is political, and arguably the reform that moves public health practitioners into the local authority should harness and make a positive out of that. I am not naïve enough to think there will not be difficulties about it. Nevertheless, the best practitioners and managers will harness the political interest to the best benefit for the public’s health.
There are concerns in relation to the different cultures. Evidence base is not necessarily a political concept. Nevertheless, we all need to learn from it and increase the quality of decision making. Moving public health is not supposed to make things easier; it is supposed to make them better.