Better Health For All

By Dr Mary Black,  Director of Public Health for the London Borough of Havering

I am a new Director of Public Health reporting directly to a Council Chief Executive. I have a seat on the senior management team and picked my local authority largely because of that. The public health team has been warmly welcomed; we even had a special ceremony arranged by the mayor to welcome public health home to the local authority (admittedly my idea but enthusiastically received).

A senior management retreat was held to cement my partnership with the Chief Executive and other Directors. At no stage have I felt ignored or less than appreciated.

It is confusing at times in this weird and wonderful new world. I am impressed with the competence of the foot soldiers on all sides that have now implemented these latest NHS reforms, in other countries restructuring on this scale would likely have simply failed. Occasionally I rather wish they had been less competent and let the restructuring all grind to a halt.

On a good day it feels as if the cobwebs have been blown away, public health is in its right place, and finally we get the chance to strut our stuff in the real world. On a bad day it feels as though we are all marooned on the rapidly separating ice floes of our respective organisations, and unfortunately we are heading south.

It is a huge shame that all Directors of Public Health (DsPh) are not at the top management table in our local authorities. Those of us who are will need to demonstrate pretty fast that we deserve those seats and in some places we may well struggle to keep them. We have another 18 months, perhaps less, to prove our value.

For this we will need useful and well skilled public health specialists who can help lead and manage local authorities through a time of unprecedented cuts, take on the challenge of shared health and social care, and be pragmatic crusaders for the use of evidence. We need future leaders who can get off their soapboxes and roll their sleeves up.

The recent decision of Lancashire not to appoint a Directors of Public Health to the top table has sent the Faculty airwaves chattering. It is worrying that our hard won public health specialty tickets may not be valid in future. But my question is this – has the Faculty foreseen and adjusted to the new world and is it now churning out the kind of public health leaders we will need in future?

I recently signed off on a full restructure and now the scanty team I inherited can expand to full strength. I have had no problem arguing that my two new consultant recruitments will be on NHS terms and conditions. I am wondering, though, if I can find the people that I need to take on these jobs.

I take it as given that consultant applicants will be highly literate and numerate, have excellent technical knowledge, be able to knock out a needs assessment, and know their way around health inequalities. Will I be able to find someone who can work out the machinations in the acute sector, position evidence in the right place at the right time in the commissioning process to actually make a difference, and explain a public health concern in the kind of jargon-free language that an average councilor can actually understand?

Will I find a partner in crime to help me write an annual report that people actually read and use and that makes a difference? Can I find someone who can peddle influence in messy situations, horse trade with tiny budgets, get GPs to change their ways and understand how to write and performance manage a contract?

Will I find a diplomat who can infiltrate the council with public health thinking without alienating colleagues in other Directorates – colleagues who would love to be able to plan 20 years ahead while implementing creative pilot projects, but who are actually watching their core budgets being slashed to ribbons and are worried about the safety of some of very vulnerable people in their care? Can I find someone who can rewrite the rulebook with the same passion and nouse that led to the NHS being set up in the first place?

Reverting to my analogy in paragraph four: I am sitting on my ice floe, paddling like hell as I know what will happen if I do drift further south. I have formed an alliance with the hungry polar bear from another post April 1st organization (pick from the long list) that has just swum alongside. The bear did look a bit scary, but my expertly tossed piece of salmon has converted him into a firm ally on the assurance/crisis/partnership board coordinating … (pick from the long list of technical areas). Life is exciting if somewhat complicated.

Which brings me back to my recruitment pitch: “Actively seeking numerate, faculty-endorsed public health enthusiasts. Must have a sense of humour, a killer aim for throwing a well targeted fish, and a big enough vision to understand that we really must tackle global warming or we are all going to drown.”

Any takers?