Debate at our first Public Health Dialogue focused on the evolving role of directors of public health, as well as commissioning, accountability and inequality
Will directors of public health sink or swim in their new roles in local government? That was one of the key questions raised in the healthcare network's first Public Health Dialogue on Wednesday 14 March.
Bringing together professionals from the NHS, local government and the third sector, attendees were keen to debate the upcoming challenges facing directors of public health, in particular exploring the transition to local authorities and how this will shape the future landscape.
Discussion throughout the evening focused on the independence and accountability of directors of public health working in the political domain of a local authority, and the role the third sector could play in lobbying and funding the direction of public health in local areas.
Joining Guardian public services editor David Brindle – who chaired the main discussion – were Jonathan Marron, head of the department of health's Public Health England transition team, chief executive of the Association of Directors of Public Health Nicola Cross, chair of Skills for Care's Professor David Croisdale-Appleby and joint director of public health at Camden Quentin Sandifer.
Speaking about the changes, Cross pointed out that "a lot of issues around this [the transition] are causing fear among directors" and spoke about independence being a worry for them. This view was echoed by the audience with one attendee arguing that email addresses of directors ending in gov.uk brings up the question of their accountability.
One director of public health from the audience argued that, as the transition gets underway, there is already a tension between the independence of public health directors and the local authorities where they are working. "Leaders in local authorities expect the relationship with directors to be a bit of a fight", she said. It was also recognised by the audience and panel that the necessary skills for directors of public health will change, requiring a greater ability to negotiate in order to handle the "rough and tumble" of working in local government.
Marron, head of the Public Health England transition team, acknowledged the challenge of working with local politics, but spoke of how public health as a result can "drive the political agenda" locally and nationally.
One important theme that emerged in the main debate was also the relationship between public health and social care. Croisdale-Appleby made a compelling case for a holistic approach to public health that centres around the individual, a point with which many in the audience agreed. One attendee argued, "public health is about loneliness and hopelessness, planning issues and building stable communities. If you don't deal with these then you're not tackling public health."
Croisdale-Appleby warned, however, of the problems of outcome frameworks in public health – particularly in commissioning. He told attendees that commissioning has to ensure the values of public health are not just in outcome measures, but also in commissioning contracts. "We need to make the economic case persuasive too," he added.
Outcome frameworks was a theme that continued during roundtable discussions in the second part the evening, as the audience split into different groups to debate mental health and wellbeing, alcohol abuse, smoking cessation, obesity and older people.
A social enterprise that promotes mental health wellbeing told one group about the difficulty in commissioning services in public health without softer outcome measures, and commented that investment banks were more interested in their work than the NHS and local authorities.
Another group raised concerns about unclear definitions of public health and the ways in which agencies and health and wellbeing boards will work together to deliver it. It was argued that both the NHS and local government have to shift the way they operate for the transition to work, and there were worries about losing skilled staff from the NHS. However, one attendee commented that younger clinical staff in the NHS are expressing some optimism about the changes.
A general consensus throughout the evening was articulated pertinently by Sandifer: "Everything that local governments do is public health."
However, for Sandifer, who also sits on the BMA public health medicine committee, a primary challenge as a director of public health is "the same one that has always faced directors of public health" – tackling inequality. "I'm not bothered what happens unless it helps me with or distracts me from preventing inequality."
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Read the complete post at http://www.guardian.co.uk/healthcare-network/2012/mar/15/public-health-directors-forum-sink-swim
Mar 15 2012, 11:59 AM
Healthcare Network | guardian.co.uk
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