National policy and local practice: a trainee public health registrar’s view

Abstract

The first six weeks of my training as a public health registrar has been an eyeopening time. The dedication of the workforce, the depth of knowledge and the experience that many registrars bring to the scheme from previous careers, as well as the breadth of opportunities available, has contributed to an exciting - if occasionally intimidating - start to the programme.But with a previous career as a policy analyst behind me, what has really struck me are the ways in which national and local policy play out and my assumptions about this have shifted quite significantly. Indeed, part of my reason for applying to the public health training programme had been a growing disillusionment with the impact of the policy that I was crafting on front-line practice. A typical exchange with a medical director would involve me enquiring as to whether they had read such-and-such a report, and them politely nodding and pointing to a pristine and evidently un-thumbed copy sitting on their shelf.This viewpoint had been reinforced by the rhetoric of politicians of all stripes. Clanging bedpans and recalcitrant councils that refuse to empty the bins have provided me with a caricature of a perpetual tug-of-war between 'local services for local people' and Whitehall command and control. Thankfully, my experience so far is that this relationship doesn't have to be as oppositional as all that.With a background in child health and obesity policy, my first pleasant surprise was an induction meeting with a senior public health manager. He had read a report that I had co-written for the Academy of Medical Royal Colleges called Measuring up: the medical profession's prescription for the nation's obesity crisis.1 Not only that, he had taken the trouble to tabulate its recommendations in a spreadsheet of evidence for comparison with National Institute for Health and Care Excellence (NICE) guidance, academic papers and other grey literature. Here was an example of national policy carefully considered, its implications for practice at a local level methodically teased out.One of the recommendations had concerned what we perceived as a 'postcode lottery' in terms of weight management service provision. My new local authority, Medway, already has good coverage in this area for children and young people through the delivery of its MEND (Mind, Exercise, Nutrition, Do it!) programmes.2 On reading Measuring up, my new colleague could have given himself a pat on the back as a recommendation met, but instead has been benchmarking its local outcomes to those reported by MEND nationally and conducting a health equity audit, both activities helping to ensure that they are addressing local people's needs equitably. …