Rhetoric and reality?
I never imagined that my first official duty as ADPH President would be a call to the Director General at the Department of Health about the £200m cut to the local authority public health grant in England. I am aware of the severe cuts to budgets in Northern Ireland, financial pressures in Scotland and Wales as well as drastically reduced budgets elsewhere within the wider public health system in England. It seems the rhetoric of investing in prevention is not always matched by economic realities.
The Department of Health consultation is now out [Click here] and it goes without saying that we need a strong response from councils and as many of our partners as possible. In particular we need to provide evidence on how this will impact on health outcomes, on NHS services and on costs to the health and social care economy. Whilst the consultation is limited to England, colleagues across the UK will have produced evidence we can use. In turn I’m sure DsPH in England will return the favour and share the learning from managing these cuts.
I have been struck by the unanimous view from all the leaders I have spoken to that these cuts are at best unfortunate and at worst disastrous. Duncan Selbie specifically asked me to convey his disappointment at the cut and his admiration for DsPH dealing with an extremely difficult situation.
As you would expect, myself and the ADPH team have been lobbying both behind the scenes and in public. I know that many DsPH have been rallying the troops within their own localities and this is invaluable. The £200m was announced in parliament and can’t be retracted, but we want to ensure that budgets which support prevention are not cut again.
As DsPH we are, perhaps unfortunately, skilled at salvaging some good things out of difficult situations. Several of you have told me that this cut has escalated conversations with NHS partners about their role in prevention. The NHS England Five Year Forward View sets out ambitions to save money, improve health and increase quality. There are actions the NHS could take on issues like tobacco and alcohol that would tick all these boxes. Again I’m sure DsPH across the UK will have great examples to share.
Ahead of this autumn’s Comprehensive Spending Review, and equivalent processes across the UK, we need to gather and present the evidence that our work improves health and saves the system money.
We also need a strong narrative. I’ve been struck that whilst many people use the word prevention the meaning can vary wildly. Our narrative needs to capture our role in delivering effective population based prevention work in its widest sense. The ADPH Council has its final development session on 15-16 July and will do some further work on this.
On a personal note, despite having to deal with difficult circumstances, I’ve enjoyed my first month as President. I have found that ADPH is very well regarded by the powers that be and as a result I’ve been listened to. I’ve appreciated the messages of support from DsPH and I look forward to meeting more of you over the coming months. I have spoken at several national meetings and in every case making the point about investing in prevention and the pivotal role of the DPH. I have also set the ball rolling on some further guidance from the LGA on the role on local government on some important health issues. Finally I have started the conversation with our trainees about getting them exposed to and involved with ADPH. The aim is to inspire them to aspire to be our successors. As a by-product of this I’ve arranged for one of our trainees to do some work for England’s CMO in WHO in Geneva. I have to confess to being more than a tad jealous.
Please let me know if you think there is anything else I could usefully be doing. My time is limited, but unless you tell me I will never know. I want to make sure my ambition to represent you effectively is a reality and not just rhetoric.