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Welcome to our world, directors of public health… Or should I say welcome back to it? The intervening years have seen some notable achievements within the public health (PH) sector; and some notable difficulties. Were the fears held that settling into a medically dominated and medically led world would be too suffocating borne out by practice? And how much was lost to local government and the wider public when the function moved to health in  1974?

Those are questions for the academically minded. For the management minded though, despite the current turmoil affecting the very structure of local government as each responds to the cuts in different ways, there are some positive benefits which are easily identifiable. PH staff and their directors will bring new and challenging perspectives into the growing health remit of local authorities; leaders concerned with the social determinants of good health will be gathered together in one place again, and new opportunities for building alliances over data analysis, planning and evidence-based working towards health improvement ends will be opened up.

Similarly, the close proximity of DPH colleagues will help align similar services such as health protection, environmental health and trading standards, as well as data intelligence, planning and performance focused around local populations. All LA and allied staff are likely to benefit from a revived 'health is everyone's business' approach. And alongside children’s services director (DCS) colleagues closer links will be enabled between prevention for adults’ as well as children's services.

The development will not be without concerns: might there be a danger of elements of commissioning being fragmented? And similarly, could there develop a fragmentation of the coordination of emergency planning? Crucially, there is still insufficient detail concerning the role of the DPH and his/her relationship with the two other statutory directors – for health and children’s services – as well as the issues concerning the number of staff the DPH shall have, and how their existing NHS contracts can be made compatible with their local authority employment.

These are issues still under discussion. But there are wider aspects of the current turmoil which also will be bearing down on this critical structural reform. Adult social care is facing upwards of a £1 billion cut this year, and further retrenchment next and the years beyond. Local government in the round is being even more substantially hit. In that context more and more authorities are seeking to reintegrate the roles for DASS and DCS – the so-called `twin-hatters’, while others such as Kensington, Westminster and Hammersmith and Fulham in London are making much greater strides towards integration than that.

To put it bluntly, all local authorities are not the same and DPHs face the prospect of integration into authorities where, especially in the smaller ones the idea of having three statutory directors is becoming increasingly unsustainable. And if single posts are increasingly emerging in many LAs with a single director for both adults and children managing over half the authority’s resources, where do the responsibilities of DPHs sit? And how do they fit in?

Perhaps, in the medium to long term we need to reorientate our focus on building up transferable management skills for all public sector senior managers to enable them all to take a take a broader approach. Many DASS already have additional responsibilities for leisure, libraries, culture, housing, and flexibility and transferable skills are fast becoming the norm at senior level.

So yes… welcome to our world DPH's. Welcome to the discussions to see how the skills of the DPH can enhance the local government team and how the knowledge and the skills of their teams can be built into the fabric of LAs. The joins should not be visible. The time of silo working is past. Delivering the much vaunted but still not clearly visible world of the joined up future is our greatest challenge.



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Written by Glyn Jones   
Friday, 26 August 2011 10:55
Last Updated on Tuesday, 30 August 2011 08:59
 

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