Better Health For All

President’s end of term report – Part one: Professional public health development

As my term of office comes to an end, I have been reflecting on our major achievements over the last three years. You can read some of these in our latest annual report, which does, I think convey the spirit of work over a much longer period. I hope it presents a view of a Faculty in a respected position, ready to build further to create an organisation of which our members can be confident and proud. So, I won’t reflect on all of the business I have been involved in, but rather give my personal top ten things I’ve most appreciated. All of them reflect extraordinary team effort on the part of our members, our officers, our Board and our partners, and I am extremely grateful to all of you.

1. FPH as a trusted source of public health advice

The Faculty is now respected and restored in the public health lobby and in advice to government in the four nations. We are seen as the trusted, authoritative voice for public health by ministers, chief medical officers, public health agencies, civil servants and partners. We are in the tent. We are in the room, speaking truth to power. When we disagree, we are not disagreeable. Good public health practice has been very helpful to me in shaping the behaviours we need to demonstrate. Patience, courtesy, authority. We should hold to our professional independence, but we must ensure it is not personal prejudice, party politics or preaching we are beholden to. And we must speak well of our colleagues, having our disagreements in private and a united front in public. Our policies are written to a tone of voice policy, our behaviours are conditioned by codes of conduct for staff, members and Board trustees.

Our members should be confident that our voice and our concerns are being heard in the places that matter.

2. Contributions to national policy making

Over the last three years we have made substantial contributions to national policy making – more behind the scenes and under the radar than shouted from the rooftops. Among these, our responses to the NHS long term plan; the Call to Action Scotland; the Brexit ‘Do no harm’ campaign and work on healthy trade; our strategic case for funding for prevention and public health including the role of NHS in prevention. Our special interest groups and committees have contributed to 29 position statements and consultation responses. I am grateful to Sue Lloyd for her fantastic work this year as Board lead for policy.

3. Training offer

I am always impressed by the quality of our new registrar intakes each year. I am also heartened that they are all finding consultant jobs on leaving the scheme. We have undoubtedly improved the training offer through the curriculum review 2015 and will do so again through the review starting this year. I am grateful to Brendan Mason, Samia Latif, Suzanna Mathew and the staff team for their considerable work in raising our standards through the curriculum, the education committee and related bodies. It is our lifeblood. I am particularly delighted by the scheme we have for Specialty Registrars to undertake national project work with us. So far 18 registrars have been involved in project work on funding for public health, Brexit, FPH strategy, ethics and values work and other special interest groups.

4. FPH governance and strategy

Our business in support of workforce, training, standards, membership and governance has been substantial and puts us in a good place as we seek to build a new strategy to 2025. Outstanding elements of this work have been the Workforce strategy; our work with PHE on quality standards for public health teams; our Board membership development group led by Sue Atkinson; our new website; our revitalised attention to Equality and Diversity, thanks to Harry Rutter and Megan Harris; and our new governance committee. Our members supported 171 advisory appointments committees in 2018, a record in my memory. Employers value our advice on the role of public health and making these vital appointments. Our Registrar, Maggie Rae has been the key driver of this work and I am most grateful to her for all she has done in this most unsung, essential but unexciting area of our business. Our finances, thanks to Ellis Friedman and the staff team are better placed than in previous years, with a balanced budget planned for 2019. I am also grateful to Ted Schrecker and Eugene Milne for the awesome job they have done in making the journal the successful, authoritative, international journal it is today.

5. Wales: a beacon for the public’s health, and future generations

I was heartened by my first official visit to Wales in January 2017. I was inspired by the potential of the Wellbeing of Future Generations Act and the central role for Public Health Wales in taking forward the health in all policies approach and the sustainable development agenda. In two further visits I have watched the confidence grow in Welsh colleagues taking up this baton, and believe it is where we all need to be. I am also profoundly grateful to Angela Jones for revitalising the work of the Faculty in Wales.

6. Health come all ye! Scotland

The Committee of the Faculty of Public Health in Scotland, led by Julie Cavanagh, have also grown their influence and made themselves the go to voice for public health in Scotland. I’ve spoken at two Scottish conferences, met with two health ministers, given my support to the development of the Call to Action, and the work of the CFPHS on Scottish Public health reforms. The UK Public Health Network was impressed with Scottish leadership on health as a human right, the theme of the 2018 conference and the launch pad for FPH’s Nanny State report.

7. Public Health walk, Belfast

David Stewart’s Walk in Belfast recounting the stories of the public health of the city he served as DPH was fascinating and inspiring. After our productive meetings with colleagues in Belfast in November 2016, the government collapsed and colleagues in the north still find themselves in difficulty getting policy agreed and services developed. I have been made very welcome in visits to Irish colleagues in Belfast and Dublin and we will build on these relationships for the future.

8. British public health in demand abroad.

Colleagues in other countries value and seek to emulate the British system of public health. Thanks to the dedicated work of our international registrar, Neil Squires, FPH continues to be involved in work with a wide range of international partners in the lexicon of public health acronyms. Among them, the International Association of National Public Health Institutes (IANPHI), the Association of Schools and Programmes of Public Health (US), the Association of Schools of Public Health Africa (ASPHA) and the Association of Schools of Public Health in the European Region (ASPHER). The European work is glued together by the World Health Organisation European office’s Coalition of Partners and through them we held productive meetings at Imperial College and the London School of Hygiene and Tropical Medicine last year. Our country-based special interest groups for Africa, India, Pakistan, Yemen and Sudan have been active. The India SIG have scored a significant result in getting a public health curriculum approved nationally, based on pioneering work by Sushma Aquila in the FPH Odisha community health workers training pilot.

9. Great public health hiding its light under a bushel

I have been privileged to observe just a few of our brilliant colleagues work first hand and heard about very much more in conferences over the last three years. I have been involved in business meetings and conferences in all regions of England, in Scotland, Wales and Northern Ireland and also in the European Public Health conferences and the World Federation of Public Health Associations in Melbourne, 2017.

Great public health goes unsung in the Inter-island public health forum, which I’ve seen in Jersey 2017 and Gibraltar 2018; thanks Susan Turnbull and Vijay Kumar; David Ross and colleagues gave a great series of presentations on the work of the Defence Forces public health service in February 2018 in Lichfield. I’ve visited DSPH in Newcastle, Herefordshire, Knowsley, Sefton, Wakefield, Wolverhampton as well as attending ADPH regional committees across four nations. I was humbled and inspired by the work of the University College London Pathway Homeless health care team ward round, which has led to some collaboration with Alex Bax of the Faculty of Homeless health and inclusion.

10. Stand together, or fall, apart.

Partnership is a vital element of what we do.

FPH has been active as a key partner in forums, such as the United Kingdom Public Health Network. We are respected members of the Academy of the Medical Royal colleges. We have developed partnership agreements with the paediatricians, emergency medicine and dentistry. The Public Mental Health conference with the psychiatrists was outstanding. We have also restored our partnership with the British Medical Association and other health unions representing public health colleagues, through the Public Health Medical Consultative committee. We have been active in enhancing academic public health and its partnership with service public health, through our academic and research committee through the Academy of Medical Sciences, ‘2040’ report, the National endowment for Science Technology and the Arts (NESTA) for the Alliance for Useful Evidence and our Bazalgette lecture 2019.

The future

After a lifetime in service public health making partnerships work, I believe we need to see more progress on partnership at the national level. I am surprised at how little government departments and other national leaders think partnership. In an increasingly complex and inter-related world, it is essential that partnerships work at all levels, across all disciplines, and interests private public, user and community. Our FPH strategy 2025 seeks greater and more effective partnership working. It is crucial that we work together or divided, we fall. I urge everyone in the public health community to come together to explore better ways of working together.

Many thanks for all your support and interest in the work of the Faculty during my time in office. Please continue to give your support to my successor, Maggie Rae.

Yours in health,

John Middleton

Written by Professor John Middleton, outgoing FPH President