This morning I chaired a meeting in Local Government House for representatives of councils (officers and members) and various parts of the Public Health Service diaspora from representatives of GPs to Directors of Public Health, from Nurses to midwives.
We all agreed that the transfer of public health to local government was a major opportunity. We have all rolled up our sleeves and started to consider how we can deliver the changes but we have a number of major problems which we need to address before even beginning the transformation which most of us agree are vital.
Firstly the Government needs to make its mind up on three issues:
- What powers and responsibilities does it want to transfer to councils? Does it really mean all aspects of public health or just health education as some fear?
- What structures will it demand and what can be worked out locally. We still don’t know if Directors will be employed by the council or Public HealthEngland
- What form with Public HealthEnglandtake? At the moment it seems neither quango, independent body or departmental board.
When these issues are decided we move to a fourth:
- How much money will be transferred to councils with what remit?
These questions are not academic but urgent. Many PCTs are extracting money from public health activity to try and retain it in the more specific clinical activity. Many public health staff are leaving their specialism and because of the indecision about who will employ whom and when newly qualified PH professionals are not being taken on. 68% of last years leavers are unemployed when there is work that needs doing.
Above all, though, there is a need for something on top of all this detailed structural and legislative stuff – genuine enthusiasm!!
I described two meetings I had held recently with GPs inLiverpool. One was vibrant and full of life. GPs present were looking at the opportunities of the Bill and planning how to bring their surgeries into a much wider public sector context. The other was the reverse. An exciting discussion took place but with practice managers and nurses whilst the GPs sat aloof like the Praetorian Guard.
This is often the problem with people who pride themselves on their professionalism. Of course we want GPs and all medical staff to be highly professional in their clinical activity. But their professionalism needs to be wider than their chosen field. The real art of public sector work is joining things up outside that narrow professionalism. I might have bored you with this before but I always think of the Baby Peter case. Here we had 14 lots of professionals including three parts of the medial profession all achieving their outputs and paying their mortgages in and around the Baby Peter family and others like them. But all of them worked within their silos. No one looked in the round at the family and tried to join things together.
We agreed today that we all want to return to the pioneering spirit and actions of Dr John Duncan Liverpool (and the country’s) first medical officer of health. He had no case law; no existing practice; no professional bodies; no guide lines. He, and the Council, just knew that people were dying and they wanted to stop it. He was a great strategist looking at the overall picture but also a great deliverer actually implementing water and sewage programmes and dealing with some ofLiverpool’s notorious housing courtyards.
We agreed to link the work of some of our comms teams at today’s meeting. Today people are dying needlessly. They are eating the wrong food; they are drinking the wrong drink (or perhaps too much of the right drink); they continue to smoke; they don’t take enough exercise; they are ignorant about many basic health issues. We need to point this out to them and help them find new ways to cure themselves of addiction.
Some will say that this is a lot like the thought Police telling people what to do. Perhaps it is but there are so many pressures in people’s lives that tell people to do things badly that someone needs to redress the balance. We also need to recognise that it is the tax payer and not the manufacturer of over salted food that picks up the bill for the ill health that is caused and the families that are broken by too early a death.
So from September onwards we hope to unitedly take a campaign throughout the country to enable us to get on with the job of moving public health into the local government sector so that lives can be saved and the massive disparity between the life expectancy of the poorest and the richest can be reduced.