So everything is ok now that Public Health comes under Local Authorities and Directors of Public Health now work in local government . Or so you might think reading the director of public health in Haringey as she writes in the HSJ.
We don’t talk about it anymore but there was a time but there was a time when local authorities were ambitious for their populations and felt their remit extended beyond the provision of services to a grander vision. Local authorities had a community leadership role and the vision was to bring a range of agencies together to improve the quality of life for local people. There were many measures of success that partnerships could use but the most dramatic had to be to close the gap in life expectancy.
Chief executives of local authorities would open conferences by quoting the shocking figures on life expectancy between those who lived within one part of their Town/District/County and those who lived in another. Often the difference in life expectancy was as much as 10 years. This was a disgrace they would say but something they could aspire to change. The mantra was no single agency working in isolation could tackle could tackle such a complex multilayered problem but working together we could address health inequality whether its root be be homelessness, long-term unemployment, teenage pregnancies, drug abuse, poverty or discrimination.
As a Director of Community services I attended many of these conferences and Directors of Public Health were always in attendance. Often a Director of Public Health was one of the key speakers. It was clear that they viewed local authorities and their chief executives as kindred spirits providing the leadership and commitment that was lacking from their own senior colleagues in the NHS. Directors of Public Health were frustrated by NHS colleagues who couldn’t see beyond hospital waiting lists, foundation Trust status and tackling the drugs budget. If only they were part of the Local Authority were people understood the big picture. And then their wish came true.
Unfortunately in the meantime LA’s curtailed their ambitions, a new government, a series of austerity budgets and a more limited role for local government. Local Authorities were now preoccupied with closing libraries, swimming pools and museums, outsourcing IT, Payroll and HR, no longer leading schools, providing housing or commissioning care services. The Directors of Public Health once again find themselves isolated , marginalised and operating on the periphery.
Transferred at the wrong time they must now hope that Health and Social care commissioners can see that bigger picture.
Blair McPherson writer and commentator on the public sector www.blairmcpherson.co.uk