a director's take on public health, public health england and local politics
TRANSCRIPT
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A local Public Health Director’s personal view on:Public Health, PHE and local Politics
Prof Jim McManus,Director of Public Health, Hertfordshire County CouncilAssociation of Directors of Public [email protected]
April 18th 2017PHE Clinical Fellows’ Away Day
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BiographyProfessor Jim McManus OCDS, BD(Hons), CPsychol, CSci, AFBPsS, FFPH, FRSB
Jim McManus has been Director of Public Health for Hertfordshire since July 2012. Before that he was Joint Director of Public Health for Birmingham City Council and the three Birmingham NHS Primary Care Trusts and previously Assistant Director/Consultant in Public Health in East London and Public Health Lead for the North East London Cardiac and Stroke Network. He has previously worked in the NHS, Local Government, the voluntary sector (national and local) and the private sector. His interests include health improvement and the application of social sciences in public health. He was worked at national, local and international level. He has a special interest in organizational psychology and the psychology of leadership. Jim’s first degree was in theology and he is a Chartered Psychologist, a Chartered Scientist and an Associate Fellow of the British Psychological Society. Jim has worked in equalities for some time and is qualified in Human Resources strategy.Jim co-authored Home Office Toolkits on hate crime reduction and worked for three years on effectiveness and impact with over half of the Crime and Disorder Partnerships in England and Wales. He was appointed by the Lord Chancellor as part of the committee which advised the judiciary of England and Wales on equality and diversity. He is Vice Chair of the Health and Social Care Advisory Group to the Catholic Bishops of England and Wales and a Trustee of both the Notre Dame Francophone Refugee Centre and St Joseph’s Hospice, London. He is a Visiting Fellow in Pastoral Theology at Heythrop College, University of London and an Honorary Professor at the University of Hertfordshire. He is currently working with the British Humanist Association on a joint project on Equality and Diversity standards in healthcare chaplaincy. He is Deputy Chair of the National Institute of Health Research Programme Advisory Board for Public Health, and a Board Member for the Association of Directors of Public Health (ADPH) in the UK, leading for them on sexual health, drug and alcohol policy, sector led-improvement and the public health role in health and social care integration. On behalf of ADPH, Public Health England and the Local Government Association he Chairs the National Whole Systems Steering Group on Obesity. He is co-chair of the British Psychological Society’s Cross-Divisional Group on Psychology in Public Health.In 2011 he was awarded the Good Samaritan Medal for Healthcare in 2010 by Pope Benedict XVI, which is the highest honour for health work the Vatican can bestow. In his spare time he likes weightlifting, cycling and reading and trying to sing Handel.
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Groundrules• Feel free to ask any question you like, I will try to
answer as best I can• If I lapse into jargon let me know
• HR and Organizational Psychology is my key interest in life, applied in different situations
Background
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Hertfordshire
• 1.1m People in 37 Settlements• 10 District & Borough Councils• 1 County Council• 2 NHS CCGs• 8 NHS Trusts• 1400+ vol orgs• Urban/Rural mix
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Some of what Herts PH does in numbers from last year• 4,000 people in drug and alcohol treatment• 60,000 contacts with sexual health services• 20,000 women accessing contraception• 35,000 school nursing appointments• 27,000 NHS health checks• 32,000 people went on a health walk• 6,700 hours of public health advice to NHS
commissioners• 95% of eligible children weighed and measured
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Background• Local Govt has been around in some form for over
800 years• Over 2,250 statutory duties• Over 800 services delivered daily• Historically more stable than NHS• Had much more in way of cuts• Govt seem clear on shrinking the state as a
proportion of GDP – austerity won’t end soon
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WhodoesWhat?
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Historical PerspectivePeriod National LocalBefore 1974 MH Medical Officers of
Health
1974-2012 Devolution – four health systems
NHSMultidisciplinary Public Health
2010 - PHE, PHW, Health Scotland
Varied systemVariety of skills but still challenges
• Some historical anomalies and hangovers• Medicalised profession• Still a clunky system
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The Partnership Landscape• 11 Principal Councils, 137+ Parish/Town Councils• 3 CCGs• NHSE• Police and Crime Commissioner, Police, Probation• 1400+ Vol Sector Bodies• 5 NHS Providers• 500+ Schools• Local Economic Partnership
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Environmental Health& Regulatory Services NHS
Police, Fire, Community Safety Third Sector and
Community Bodies
Public Health England
Specialist Public Health Agencies with Major Public Health Roles
NHS Public Health (moving into HCC)
County CouncilDistrict Councils
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The Hertfordshire Local Government Partnership Landscape – 11 Councils
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The Public Health Shared Strategy
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What is the District Offer?• Innovative scheme to empower districts/boroughs to
further develop their public health role• Grant is £2m over 4 years divided equally between
10 Districts and Boroughs of Hertfordshire• HCC provide support
Public Health knowledge and expertise Evaluation Project management
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Towards Shared Principles
• Public Health might have been designed on a unitary model but we will innovate and succeed in multi-tier areas
• The Local Govt Family is a major asset in public health Parishes/Towns – we need to do more Counties and Districts cannot do public health
without each other. • Three tier areas can do public health with style!
Strong science, strong political leadership, Countywide approach, local focus &
engagement
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What has worked well • Over 100 projects delivered by local councils who
know their own ‘patch’ • Small things could be piloted and tried out • Sometimes a little is enough• We came together to procure – and became a
powerful force. • More than the sum of our parts• We’ve taken some learning points from each other
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Challenges • It takes time and resource – this doesn’t happen
overnight• For some of the District’s it took a while to ‘get’
Public Health (we’re not adult care services, we’re not children’s services – who are we?)
• Gaps in evaluation expertise • Gaps in project management expertise• Funding! What happens beyond the current
funding?
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What Public Health problems are the Districts/Borough’s tackling?• Dementia• Physical activity• Mental health• Obesity• Nutrition• Alcohol consumption• Over 100 projects have been developed and are
being monitored • Key projects – 28 are being evaluated with an
over arching evaluation of the District offer as a whole
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The DPH in ContextWhat works well• The transfer into local authorities for most of us• Behaving corporately like we’re part of local
govt• PHE National work
What doesn’t always
• The sexual health system• Some aspects of PHE –
clarity? Contribution?• NHSE behaviour• We’re not a well oiled
system within a system yet
• Health protection system
Patchy• PH Leadership• Health and Wellbeing Boards• Commissioning
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Protectionism or lack of system skill?• The “Independence” of the DPH – in my view DsPH must
be “set into” not “apart from” the system• The “Joint Appointment”• The Ring FenceChallenges• Understanding the constitutional and political nature of
local government as a place shaper• Systems working• Leadership in a distributed system
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The Hertfordshire Integration Story
• Harness political leadership• Build strategy• Build clear portfolio• Integrate culturally into local authority• Several full scrutinies of our work• Corporate player• Scrutiny every year of budgets
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Some reflections
• Getting officers undestanding local govt• Getting members understanding PH• The LA Law boot camp for DsPH• Hermeneutic of suspicion from some quarters
about local authorities• Lack of understanding still in PHE and NHSE
about how LAs work
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The Added Value Story• How is the current system adding value to the
public sector and to the health of the population?• 4 Es duty
– Economy– Effectiveness– Efficiency– Equity
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How not to add valuePet Hates1.Toolkits2.Yet more return on investment tools3.Conferences and seminars 4.The recent guide which spent longer on “how to work in partnership” than content on the issueLoves1.Practical how tos2.National working hand in glove with local
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Intervening in a dysfunctional system
• Elected member leadership• Partnerships developing• Schools showing leadership• Young people showing leadership• Suicide, Adult MH, CAMHS and Drugs and
Alcohol work being done in phases• Health and Wellbeing Strategy
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Elected Member Leadership
• 14 Member Champions• 510 Pledges to the Year of
Mental Health• Newsletter• 12 Mental Health Focused
Events• 53 new partnerships with
grassroot through to large scale Mental Health focused organisations
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A precedent?• An example of systems
thinking?• Systemic approach to
crime and disorder• £326m put into vehicle
crime at 2001 prices• £7m into violence
against women at 2001 prices
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The mainstreaming duty
“Without prejudice to any other obligation imposed on it, it shall be the duty of each authority to which this section applies to exercise its various functions with due regard to the likely effect of the exercise of those functions on, and the need to do all that it reasonably can to prevent, crime and disorder in its area.”
20 secs
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The Big Tasks• System redesign• Leadership• Skills and competencies• Behavioural Sciences• Knitting the system together• Outcomes• Working as a system – what job does PHE do for
US?
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Some Groundrules
1. Spend time with each other, learning how we do things
2. Don’t “come up with a solution” without engaging us – The STP
3. Don’t behave like we are on the deficit side of the knowledge deficit
4. Don’t try to performance manage us
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Finally
Distributed leadership in a complex system is one thing.....
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Thank you
• [email protected] • Public Health Pages• www.hertfordshire.gov.uk/healthinherts • JSNA• http://jsna.hertslis.org/