Public Health Dialogue: prevention and wellbeing

Careers • Public health has to remain an attractive career for doctors. We need to continue to recruit people into the field for it to be successful. We need both medics and non-medics in public health. We need to clearly articulate that, even though it has moved into local authorities, there is still a medical role to play, otherwise doctors may look elsewhere to specialise • Salaries might cause problems, especially in London. Switching from the NHS into local government is causing some concern over long-term salary expectations, beyond TUPE agreements (The Transfer of Undertakings, Protection of Employment) • The mantra should focus on the importance of localism, doing things locally where possible and nationally if necessary. This should be seen as a chance for the NHS to open up new avenues and work with different people who also have an interest in health and well-being • There are some people who are worried about the skills that might be lost from the NHS when public health moves to local government. There are lots of very able people working in public health, but morale is low and people think they can't do it, that the changes will be too difficult. They don't know what the move to local government will be like, and they don't know what to expect: this is scary • We need to communicate the changes better to people, so that they feel secure. We need to boost their confidence about change to make sure they move with the NHS and local government when things are different • Ultimately some staff will leave, but this could be seen as a good thing – a chance to get rid of some dead wood, resulting in a dedicated team Relationships • Business has an important role to play in using data and modelling to understand how relationships will work and how we can all work better together. Business hasn't been very involved in preventive medicine before, but it is looking forward to working with local government and others on projects to boost the populations' health across the board • There are concerns over perception, especially of drugs companies, from within local government • We need to understand who we should be forming relationships with when public health responsibility changes • Localism won't work for some specialist conditions such as HIV because people don't just have sex with people in their own area. There is a stigma of some conditions. The concern is that this is pervasive in local government where many employees don't come from a medical background • Changes needs to happen both ways. Local authorities need to change their mindsets, just as the NHS must do •The fact that wider changes in the NHS are happening at the same time as public health changes makes things difficult to explain and for staff to understand. It has complicated matters. • Some people are worried about a postcode lottery emerging when public health goes to local government, although it could be said to exist already within the NHS • If we don't make the right decisions on this now, there could be an continuing legacy of public health issues left by the gap between moving from the NHS to local government • We need to make sure that we don't forget the direction we're heading in when services transfer from the NHS to local authorities. Finance • Dealing with disadvantaged people in a time of spending cuts is a challenge. Public health is an art and not a science: we need to focus on what people need and spend what we have wisely • The good thing about local authorities bringing public health under their control is that the budget will effectively be increased because it forms part of everything councils do, from housing to transport • We need to explain the value of health to authorities in that good public health can delay social care admissions and take the strain off other budgets • We also need to work directly with the community to get them to recognise and take responsibility for their own problems Strategy • There will be variations in service in different areas, just as council structure differs across the board. Clinical commissioning groups should overlap with council boundaries nicely, which will make the process easier • The process of change is slow. This means that some people lose interest and get caught up in minor details before we really get going. There are lots of unanswered questions and we need to make sure that senior staff don't lose sight of the direction of travel • There is some concern that the government is "playing the localism card" and in doing so avoiding having to give too much detail about how the changes will work on the ground • Because of this, in some areas people are already working together to produce their own plan of action, to make sure that nothing is missed when the changes finally happen • There is a worry that political differences will make it tricky to introduce initiatives which span county boundaries. It is also a worry for authorities who are considering sharing directors of public health