Leadership in public health: a view from a large English PCT co-terminous with a local authority

Abstract

It is just under 2.5 years since I took up my appointment as the Joint Director of Public Health for Bristol and this has proved to be a professionally rewarding time to be practising public health in the city. It has been intellectually stimulating to work with others to think through the implications of this role, particularly for local authorities some of whom felt—though not in Bristol—that this was an appointment foisted upon them without adequate consideration of its implications or appropriate consultation. But the implications are almost as significant for the NHS, especially as Primary Care Trusts embark upon the World Class Commissioning voyage—a journey that poses questions regarding the distinctive contribution of the contemporary public health function and how it can be best discharged both within the NHS and more widely. The solutions to these emergent issues regarding the role and responsibilities of public health in today’s complex environment of continuous organizational change, evolving inter-organizational arrangements and the coming-of-age of working in multiagency partnerships are not straight-forward, which is precisely why committed and effective leadership in public health remains an important and rewarding professional role. Working with the local authority is a common experience for public health professionals, but when I started working for the City Council, I was surprised how much I had to learn—about local authority values and culture and methods of working—in order to be an effective member of the Strategic Leadership Team. It is a very considerable privilege to have the opportunity to fulfil this role, for this team, working for and with the political administration (the cabinet) of the Authority has the responsibility and opportunity to significantly influence the future shape and nature of the city; to a considerable degree the cabinet supported by the Strategic Leadership Team can determine the sort of place the city is and will be for its residents, including the richness or paucity of the opportunities citizens will have to make choices that are both healthy for them and for the planet. How can this opportunity of bringing a public health perspective to all the work of the council add real value to that work? This is the question that has and continues to challenge me on a daily basis. An important part of the answer is having public health directorate staff work closely on shared priorities with council staff in all of the major directorates of the council, especially as most people in the council, both members and officers, do not know what public health specialists and practitioners do. Our Health Our Care Our Say can be read to imply that the Joint Director of Public Health role is only or primarily about joint working with Directors of Adult Social Care and Children and Young Peoples Services; thus, the responsibility for the Joint Strategic Needs Assessment is given to these two directors and the Director of Public Health. These are indeed very important relationships, but spatial planning, economic, transport and housing policy, and environmental, culture and leisure services are major determinants of population health and health inequalities. I found that it was taken for granted that I would work closely with the Children and Young Peoples Directorate and the Health and Adult Social Care Directorate—though no great clarity about what my role would be or the added value I would bring even in these areas of work—but initially some surprise that I thought