by admin

Presidential Inauguration Address

May 24, 2018 in President's Blog by admin

I first arrived in the UK in the late 90s – in those days, flights from South Africa still allowed smoking. You could be in a non-smokers seat just where the smokers section started. Trapped in a closed environment of smoke for 14 hours. Annoying, but normal. You wouldn’t dream of that being normal or acceptable now. Same with smoking in pubs and restaurants – once so normal, now totally not normal, harmful to people, not acceptable.

So I came to the UK and there I was as a PH trainee in a PCT in Nottingham in the early 2000s, and I remember going along to a talk on the NHS Pension. By then, I had been working quite a few years in the NHS and had been paying into the scheme diligently. I sat in a room with others, and a perfectly nice man in a suit talked us through how it worked, you know the 1 over 80 times final salary times years of membership. Then he spoke about what happened if you died and how your widow or widower benefited. It then occurred to me to check. ‘Yes – he clarified – only those who were married could get the survivor’s pension.’ It was only for straight folks in state legitimised partnerships who diligently paid into the NHS pension that benefited. Not folks like me. ‘But – he explained – that was normal’, just the way it was – inequality hidden, banal… Now, thanks to a lot of people fighting for what is just and right… I just need to get married (and of course die) and the survivor’s pension is hers!

I’m sure you could think of your own stories – about class, about race or gender, about disability – of when things were supposedly just normal. But they were – or are – damaging to people, to groups of people and unjust, and they create and perpetuate inequalities in our health and wellbeing.

The #MeToo generation has woken us up belatedly to the fact that people have turned a blind eye to practices and behaviours that have entrenched power, have created a norm of sexual exploitation; the exposure (yet again) of the gender pay gap suggests a norm that carries on regardless. The stories from Rochdale, Rotherham, Oxford, where ideas of the norms of race, class, gender and age enabled the sexual exploitation of hundreds of girls.

Indeed some stories suggest a rolling back of positive change – the callous changes to the disability living allowance that had enabled so many people to get on with their lives in society is for me a particularly iniquitous one. Can you imagine it, people with disabilities being actively part of our society, no longer the norm.

Or Brexit Britain, this week the UN Special Rapporteur on racism spoke about the ‘extreme views’ on racism having gained ground in Britain. Racism becoming normal again.

‘The harsh reality is race, ethnicity, religion, gender, disability status and related categories all continue to determine the life chances and wellbeing of people in Britain in ways that are unacceptable and in many cases unlawful’ – Tendayi Achiume, UN special rapporteur on racism

So how good are we at recognising injustice and structural inequality? How much do we really understand what groups of people are experiencing because of who they are or are seen to be – and how is it impacting on their health and wellbeing?

Fundamentally this is about power – and power works to keep the norm, it’s hegemonic power, something that operates very effectively in the UK.

Hegemony: the dominance of one group over another, often supported by legitimating norms and ideas. The term hegemony is often used as shorthand to describe the relatively dominant position of a particular set of ideas and their associated tendency to become commonsensical and intuitive, thereby inhibiting the dissemination or even the articulation of alternative ideas.

How are we complicit in this, it’s just so easy to not recognise when we have power over others, to not see things as problematic, to not see the inequality. Being white, and a professional, I recognise how steeped we are in – indeed conflicted in – what is the ‘norm’.

So my personal focus as President over these 3 years is to help us make things visible, to make them problematic, to name them and for us to be comfortable with talking about them – because by challenging ourselves and upskilling ourselves, I believe we become more effective agents for social justice.

The other areas of focus for my time as President were set out in my manifesto:

Firstly, I’d like to prioritise you, our members:

  • It’s been fantastic to see the number of people standing for positions – it really does suggest a vibrant membership who’re keen to step up individually and be part of the collective – and well done to our new Vice President and Board members, very exciting, I’m really looking forward to working with you.
  • So I’d like to ensure we mobilise all our collective skills and dynamism, through the Council, the PAGs, and in other ways
  • I’d like us to continue to deepen ways to support and energise each other including continuing mentoring support for new DsPH
  • And I’d like to understand what your experience and your issues are, locally and respectively. So I will be coming out on regional visits – and as part of these, I’d like to not only meet you in a large room meeting setting, but see whether, alongside this, I can set up a meal or coffee with some of you, or visit to one of your boroughs at the same time.

Secondly, I pledged to promote the unique leadership role of the DPH in local government – I think our understanding of what exactly this is continues to evolve – and again I’m keen to hear your experience and views about this. What I will do to support this is work at a national level to develop strong relationships with other local government networks and associations – the LGA, ADASS, ADCS, other public health bodies – PHE, the Faculty, Royal Society – and I’m really going to try hard with the NHS…

What I do think we need to do though, is consolidate our approach to sector-led improvement – DPHs as Members need to step up to the challenge of sector-led improvement.. I’d like to see a step-change in this over the next 3 years and today is an important event in helping us to do so.

Lastly, the recent ADPH survey of external stakeholders showed that we are a well-respected voice for public health – and they want to hear more from us. The word ‘edgy’ was used, they’d like us to be more ‘edgy’. Now I did have a little look at the definition of edgy, and found this from Urban Dictionary:

Edgy: something or someone trying too hard to be cool, almost to the point where it’s cringeworthy

Interesting how words have different meaning to different people… However, we need to work out for ourselves what edgy means (and indeed whether we want to use that word, or perhaps another – suggestions welcome…).

The report also recommended being really focused and prioritise only a few issues for strong advocacy. The Board, with Council, will be working on what these areas should be over the next short while. Watch this space!

So those are my areas of focus:

  • Challenging the norm and advocating for equality in all its forms
  • Developing a vibrant, member-led organisation
  • Promoting our unique local system leadership role
  • Ensuring we continue to be well-respected as an organisation – but with an ‘edge’

Lastly, but most importantly, I want to acknowledge and thank Nicola and the team. They are an amazing group of individuals who work really hard to deliver the goods for us – so on behalf of members, a big thank you to the team, and here’s to 3 really great years. And you never know, we may also hear some wedding bells!

Jeanelle deGruchy

Moving on

October 27, 2017 in ADPH Updates, President's Blog by Andrew Furber

It is with mixed emotions that I start this blog with the news that I am moving on from the role of ADPH President. In early 2018 I will join Public Health England as their Centre Director for Yorkshire and the Humber. I am looking forward to this challenge, but am sad to be leaving ADPH a few months before the end of my term of office.

Being ADPH President has been one of the most professionally fulfilling things I have ever done. It has been a privilege to visit most parts of the United Kingdom (I never got to the islands but did meet most of their DsPH). The work being done by ADPH members in all four countries is inspiring. In the last two weeks I’ve been in Scotland hearing about their impressive work on health as a human right, with DsPH in the South West of England who are doing some excellent stuff in challenging circumstances and in Wales seeing some outstanding local practice at the Public Health Wales conference. From my visits to Northern Ireland I’m aware of the amazing progress being made in a very difficult context.

ADPH is much more than one person and the work will continue without me at the helm. We discussed future arrangements at the ADPH Board meeting this week and I’m grateful that, as our constitution indicates, our Vice President will become acting President until the AGM in May 2018. She will be supported by the other board members and a very capable staff team and I am immensely grateful to them all.

A call for nominations for the next President will go out in the New Year. Three years ago it hadn’t crossed my mind to throw my hat into the ring until someone suggested it to me. Please be thinking seriously about whether it could be you or someone you could propose. I am very happy to speak in confidence to individuals who may be interested. You can contact me via the ADPH office or directly.

Also at the Board meeting we discussed the emerging themes from the organisational impact report we have commissioned from Phil Swann of Shared Intelligence. Overall it was hugely encouraging, but also indicated some clear areas for further development (which is what we wanted). Phil will be presenting the next iteration of the report at our Annual Conference on 29 November. Please make it a priority to attend at least this part of the day if you can. Your advice on how ADPH should respond is essential and will inform the next stage in the development of our organisation, and provide an agenda for the next President. You can book your place here.

I am moving on, but ADPH must move on too. With such talent in our ranks I have no doubt that it will.

by admin

ADPH Cycling – Guest blog

August 15, 2017 in ADPH Updates, President's Blog by admin

I can clearly remember getting the dreaded email from Tim Allison saying that he and his team were planning to start their annual public health bike challenge in sunny Southport and they would love to meet up with DsPH on the route to promote the health benefits of cycling.  All very good, except a photoshoot was inevitable and I hadn’t been anywhere near a bike for 15 years!  Thankfully I was able to get a lesson on a hire bike with our cycling development team who didn’t fall about laughing at me wobbling around cones and veering off onto the grass.  I managed 18 miles with the East Riding team that year and loved it.  I bought my own bike and haven’t looked back since.

The following year I rode the whole route coast to coast from Southport to Bridlington.  The next year the Irish contingent in Tim’s team decided it would be a good idea to add in Ireland to make it a coast to coast to coast ride so we duly headed off to Belfast on the ferry and then on to Sligo and Dublin before heading back to England meeting up with public health cyclists from Northern Ireland and the Republic along the way.  And then this year Wales got added into the mix.  And next year Scotland looks like it may be getting a visit.  Who knows it might be mainland Europe next!

Not only is the ride a great adventure and a real challenge, its also a great way to raise awareness of the health benefits of cycling.  This year on our Cities of Culture ride, the first formally linked to ADPH, we met up with more local cycling groups than ever along the route, made links with the Cycling UK team, and were joined by members of public health teams along the way.  Some people joined us for a few miles, others for a day and this year I actually had some female company for the whole route in the shape of Caroline Bloomfield from the Northern Ireland Public Health Agency.  It would be great to have more public health folk join us next year, especially more women – it could be for a few miles, a day or longer.  I’m not the fittest or the fastest cyclist by any means so there is no fear of being left behind!

Dr Janet Atherton, ADPH Honorary Member

Employment and the public’s health: what is the role of the DPH?

June 30, 2017 in ADPH Updates, President's Blog by Andrew Furber

None of us can be in any doubt that having a good job is an important determinant of our health and wellbeing. And losing your job is one of life’s significant events. But when the area’s major local employer closes down the impact on the community can be profound and long lasting.

So what is the role of the local Director of Public Health when it comes to jobs and economic development? Public Health Wales have published guidance on a public health response to Mass Unemployment Events (MUEs). The report not only highlights the impact on health and wellbeing of such devastating situations, but draws on the evidence to describe how the response should include public health action. These actions range from identifying and building resilience in communities vulnerable to MUEs, actions to support health and wellbeing of affected communities and an evaluation of the response to inform future action.

Any public health response cannot be in isolation from the wider response to such tragedies. The report describes the role health and wellbeing plays alongside interventions to access employment opportunities and mitigate financial hardship.

There are now a number of examples of where Directors of Public Health are applying their skills and resources to economic development as a means to improving health and wellbeing. The Greater Manchester Public Health Network is using their devolution powers to prioritise better employment. The Yorkshire and Humber Public Health Network is developing a narrative around inclusive economic growth. You can hear more about both of these and views from myself and John Middleton, the President of the Faculty of Public Health, at the Public Health England conference on 12-13 September. Come along and share your experience.

Manchester

May 26, 2017 in President's Blog by Andrew Furber

As I write this blog the latest terrorist atrocity in the UK is still unfolding in Manchester. Parents are still hoping to find their children. Students are wondering if they will ever see their friends again. We are all appalled by the brutality of the act.

Of course it is not the first such outrage on our soil. London has sadly had to respond to a number of these tragedies, as recently as March in Westminster.

The response in Manchester as it has been elsewhere has been extraordinary. A homeless man pulled nails out of children, people opened up their homes to strangers and taxi drivers have given a free ride to those who needed to get home. The response from public services has been no less remarkable. Staff have worked above and beyond their paid hours and dealt with things they could never have imagined having to do.

John Middleton and I have sent a message of support to the Directors of Public Health and their teams in Greater Manchester. They continue to do extraordinary work. Other DsPH have been in touch to offer their support too. Currently the local response is being managed within the capacity of the Greater Manchester Public Health Network, but I know these expressions of support have been appreciated. Such were the distances that people had travelled to the concert that many of us will have people directly or indirectly affected in our own patches.

Whilst Directors of Public Health play an important role in emergency preparedness and response, we also play our part in developing the community and personal resilience which is so vital at these times. With the UK terror threat moving to critical and a general election looming, these will no doubt be tested over the coming weeks.

All of us will have been affected in some way by these events. You will have your own way of dealing with them, but we neglect our personal resilience at our peril. This bank holiday weekend I’ll be joining the ADPH Cycle Club (yes, there is one) on its Cities of Culture Tour as it passes through Manchester on its way to Hull. You can follow our progress using #cycle4lifeph on Twitter. Whatever you are doing I hope you get chance to recharge your batteries.

What works

April 10, 2017 in President's Blog by Andrew Furber

A fundamental part of public health practice is that we base our decisions on evidence. But getting the evidence we need for the day-to-day challenges we face is less easy. Knowing whether innovative practice is improving outcomes or wasting money can be difficult. The important research questions relevant to population health are not always addressed by funders when the incentives are weighted towards clinical issues. All of this is why we are focusing the ADPH Policy Workshop on 18 May 2017 on What Works. Look out for the agenda when it comes out shortly, but it will include dialogue with national research agencies as well as hearing about local innovation and improvement. Please note the date in your diary and plan to participate. ADPH events always evaluate very well because they are tailored and informed by the needs of our members. Justifying a day out of the office is difficult, but I’m sure this workshop will repay the investment.

If you are able to attend please bring your research questions. What are the issues you are grappling with locally? How can national bodies help? What is the best way to communicate new evidence to DsPH?

But just as importantly how are you improving public health practice using evidence locally? In England some of this will be captured in Sector Led Improvement (SLI). This approach got off to a good start, with the ADPH framework being well regarded and proving its worth. Every region in England has established a programme, but with local government funding moving to business rate retention we need to move SLI up to the next level. The Policy Workshop will be a great way to hear what others are doing and provide the inspiration to develop your own programme further. There are great examples of service improvements from Scotland, Wales and Northern Ireland too which I hope we will hear from.

To illustrate this, we held the first workshop for the advisory group for the Four Nation Comparative Public Health System study. This research question came from colleagues in Wales wanting to understand the learning from the way the public health systems have evolved across our four nations. I am grateful to the Health Foundation for funding this work and to the University of Sheffield for delivering the research, but especially to colleagues from the four nations for engaging with the study. I’m really pleased that we have Specialty Trainees involved in the programme. Emerging findings should be available by the end of 2017.

If all this has whetted your appetite to get involved more directly in a research programme, please note that NIHR are looking for a DPH to join their Primary Care, Community and Preventive Interventions (PCCPI) advisory panel. The closing date is 21 April.

Finally the 18 May Policy Workshop will also include the ADPH AGM. It will (probably) mark the beginning of my final year as President. More importantly you will be asked to appoint board members, approve our budget and agree our business plan for the next three years. The ADPH staff team will all be there and we are hoping our newly appointed Head of Policy and Deputy Chief Executive, Isobel Howe, will be able to attend ahead of her formal starting date of 1 June. I hope that you agree that in these turbulent times it is even more important than ever that we have a strong and representative Association to fight our corner.

To register, click here.

Happy New Year

January 9, 2017 in President's Blog by Andrew Furber

I read on twitter a few weeks ago that those looking forward to the end of 2016 clearly hadn’t thought through what was in store in 2017.

Last Friday, the end of the first week in January, I received a phone call telling me of the sudden and unexpected death of a good colleague. This was the third such heart breaking news I’ve had in the last few weeks. Three colleagues around my age dying prematurely; all leaving children who were too young to be losing a parent.

As Directors of Public Health, reducing premature mortality is our bread and butter. It’s easy to forget the individual stories. To paraphrase Stalin, a thousand deaths become a statistic, one death is a tragedy.

None us predicted the events of 2016 and surely none of us can tell what 2017 will bring. We know we face the uncertainty of Brexit and the continuing effects of controlling public expenditure. Parts of the UK will see further changes to their health and care systems. We will all face the challenge of improving and protecting the public’s health with much less resource than we’d like.

As I travel around the UK meeting ADPH members I have become even more impressed by the work Directors of Public Health do, and the importance of the role within the local system. ADPH will continue to advocate for the importance of the job and articulate at a national level the difference you are making in your locality.

But the job is not an easy one. The job is big enough in its own right with a significant board level/corporate remit, but many are now taking on additional responsibilities. This is great recognition for the role and for those individuals, but it also brings added pressures.

ADPH already has a number of ways to support our members and this offer will develop further in 2017. Please do not hesitate to contact the ADPH office or me directly, if as a member you would like advice or support which you think ADPH may be able to offer. Where we can help we will, and if we can’t we’ll do our best to point you in the right direction. Any such contact would be in the strictest confidence.

I am aware that many DsPH have local support mechanisms, for example through local networks, learning sets or mentoring. From time to time it is worth reflecting on our own resilience. I don’t usually make New Year’s resolutions, but this year I’m taking my lead from the Five Ways to Wellbeing and will try to do something new each month. In January I’m planning to have some friends over for a Burn’s Supper. Possibly somewhat heretical to be hosted by an Englishman, and even more so as for me at least it will be alcohol free as my Dry January will, hopefully, still be in progress.

As I reflect on the lives of my three recently departed colleagues, I am reminded that each lived their lives well. Each one leaves a significant legacy both in their personal and work lives and these will be, quite rightly, celebrated.

Also on twitter I read this conversation:

“2017 will bring flowers.”

“How do you know?”

“Because I’m planting flower seeds.”

There will be many things that will happen in 2017 that are beyond our control, but there are also things that won’t happen unless we make them.

So may I wish you a peaceful and happy 2017 and thank you for all you do for ADPH.

What do you learn in 160 years?

October 24, 2016 in President's Blog by Andrew Furber

The Association of Directors of Public Health (ADPH) and the Royal Society of Public Health (RSPH) had a birthday party this week. 160 years ago saw the formation of the Metropolitan Association of Medical Officers of Health that, after various mergers and demergers, led to the existence of ADPH and RSPH. You can read the details for ADPH here.

The history of changing epidemiology, organisational changes and personalities is fascinating. The first Medical Officers of Health were appointed to control communicable disease. Non-communicable disease is now the major cause of ill health and mortality, but influenza, Zika, Ebola and antimicrobial resistance serve as reminders that we ignore infectious disease at our peril.

But what has the last 160 years taught us about the role of the Director of Public Health (DPH)? Well, here are my 5 Ps:

  • Place – DsPH and our predecessors have always worked within a more or less defined geographical place. Structural reorganisations have often changed the boundaries, but the principle that the DPH has responsibility for all that affects health in a given locality has endured. Today we know it as system leadership.
  • Population – inequalities are nothing new and DsPH have always advocated for the entire population, and especially those who are excluded or disadvantaged.
  • Persistence – public health is a long game; a marathon not a sprint. Whilst we should grab quick wins and be fleet of foot in responding to public health incidents and opportunities, progress in improving the health of the public is probably best measured in decades.
  • Politics – DsPH have always had to sway national and local politicians, and be astute in influencing the politics which occurs within every organisation. This is perhaps the attribute which is most difficult to acquire.
  • Passion – usually this is the reason people aspire to become Directors of Public Health, and without it you won’t last long.

ADPH has captured these attributes in the Director of Public Health role description. These characteristics have endured for 160 years. The nature of the health and wellbeing challenge will no doubt change, but having someone who can lead the response for the people in a place is unlikely to alter.

The bigger picture

June 9, 2016 in President's Blog by Andrew Furber

The job of a DPH can be so full on that it can be hard to create the space to think strategically, compare notes with colleagues and get a sense of the bigger picture. This is one of the opportunities ADPH events provide and one I certainly appreciated at our recent AGM and Policy Workshop.

It’s hard to have a public health policy discussion in these times without reference to finance, and our workshop was no exception. We heard from CIPFA of the forthcoming work with HM Treasury and others (including ADPH) on the development of a ‘prudential code’ for investments in prevention activity. If successful it could transform the way the public sector thinks about prevention (as the current code transformed capital investments). For years we have made the business case that public health interventions offer outstanding value for money. Whilst we’ve had some success I don’t think any of us could say we’ve seen the level of funding commensurate with the potential return on investment. It is time we went further and considered the bigger picture of how public sector finances operate and how we could influence that.

We also took some time to reflect on our quality improvement work. In England this is captured within our Sector Led Improvement programme. In other countries it takes different forms but with the same end – ensuring we continually improve our practice. Hearing how others do it is always an inspiration and we were presented with some fine examples. We also had our first virtual presentation at an ADPH event! Gill Richardson’s short video on the opportunities to improve the health of the public through the Well-being of Future Generations (Wales) Act was excellent. ADPH will be increasingly looking at how we can use technology to hear from members throughout the UK.

As someone who struggles for inspiration when writing my annual report, I always enjoy seeing how others go about it. Our Annual Report competition this year had a step change in the number of entries (thank you if you sent yours in). Congratulations to this year’s winners and all those shortlisted. Receiving a copy of your report even if you don’t want to be in the competition is really helpful for ADPH to understand your local priorities.

The final session of the day looked at housing (in its broadest sense) and health. It was terrific to hear from Neil Hamlet and Jim McManus on how progress was being made in Scotland and Hertfordshire respectively. Housing is fundamental to health in many respects, but it was the issue of multiple disadvantage that was the focus for our discussion. The evidence was summed up well by Julian Corner from Lankelly Chase based on their Hard Edges report. This seems to me to be a real opportunity for DsPH to make a difference as we see the bigger picture and are not limited to a single sector response.

Our AGM, which was my first as President, was heartening. We thanked those who were leaving the Board and Council for their service, and welcomed our new recruits. It is encouraging that there are still people who are prepared to step up to the plate and support our collective work in this way. It was also good to accept Janet Atherton as a new Honorary Member, the highest honour ADPH can bestow. Recommendations on membership expansion and subscriptions – vital issues for us but always difficult to judge correctly – were supported. It was especially welcome to hear from members that they felt this was precisely the time when we needed to work together through ADPH to advocate for the work of DsPH.

Jeanelle deGruchy did a brilliant job of chairing the Policy Workshop and Nicola Close and the ADPH staff team were exemplary in all the (largely unseen) preparation which was required to make the day such a success. Of the evaluation forms submitted 100% of respondents said the day was a good use of their time and that they have learnt something new. The session on housing and disadvantage was considered the most useful part of the day which inspired some of the members to look more closely at the issues related to housing and homelessness as well as how they link with devolution. Also the session on sharing best practice was considered useful by 96% of respondents many of whom decided to look further into the SLI and ways of developing it within networks. Other actions following from the discussions included watching the Cathy Come Home film, reviewing the Suicide Safer Communities Accreditation and checking on the numbers of health visitors and school nurses locally.

One of the downsides however, was the overall low number of DsPH attending which, we admit, was a missed opportunity for networking and discussion. Therefore, I wanted to ask you now to take a moment and mark your calendars for the following events coming up:

19th October – ADPH 160thAnniversary

8th November – ADPH Annual Conference

In summing up the day I was struck by three things. Firstly the overwhelming case for early intervention – multiple disadvantage often has very obvious, and preventable, origins. Secondly how DsPH are ideally placed to champion the place-based approaches required to resolve our most difficult issues, whether multiple disadvantage or public sector finances. And finally, the value of sharing good practice. ADPH often puts out requests for good practice but we don’t get much back. Partly this will be that DsPH are too busy to write it up, but perhaps we sometimes feel it is not good enough. Have no such fear – everyone loves a sharer. Only by hearing of such examples can ADPH really make the case for the impact DsPH are having locally. If you can think of ways in which ADPH can make such sharing easier please let me know.

Get out more!

November 10, 2015 in President's Blog by Andrew Furber

Reflections on the ADPH Annual Conference 2015

As things get busy and finances more difficult, it can be hard to avoid becoming inward looking. But perversely these are the very times when it becomes most important to look outwards. The DPH role can be quite an isolated one if we are not careful. It was therefore encouraging that our Annual Conference on 2nd November was oversubscribed.

Part of the conference’s attraction was no doubt the excellent speakers we had lined up. Dr Anna Dixon, Chief Executive of the Centre for Ageing Better, kicked us off with the challenge and the opportunity of our changing demography. She rightly questioned some of the negative language around older people such as ‘bed blockers’ and ‘demographic time-bomb’. As a ‘what works centre’, the Centre for Ageing Better will be looking for evidence on how people can age more healthily, with more financial security and be more socially connected. Please send any ideas you have for action or where evidence is needed to ceo@agebetter.org.uk.

A panel discussion, chaired by Tim Allison, with key figures from Public Health England, NICE and the King’s Fund led to a lively debate around the tables on making the economic case for public health. Public health comes out incredibly well on any objective economic assessment. Over 70% of the public health interventions assessed by NICE are cost effective, and 15% are cost saving. Return on investment is the icing on the cake, but it isn’t the cake. The point was made throughout the day that whilst the economics of public health are important we shouldn’t oversell it. The compelling moral and policy arguments are just as crucial. Prevention and early intervention are the right things to do. Economic analyses often don’t reflect inequalities, and to rely on them alone could lead to inequitable outcomes.

In his first engagement as the newly appointed chair of the NHS Confederation, Stephen Dorrell proved to be an inspirational speaker to energise us after lunch. He was very clear on the value of public health – the promotion of health and not the treatment of illness should be our national priority. He described the role of public health as putting “a bit of yeast in the mixture” and saw devolution as an opportunity to change the way government works both nationally and locally. Stephen said he failed to see how public sector reform could work without considering health and care, given the scale of this sector.

On the relationship between public health and the NHS, Stephen Dorrell described two main opportunities. Firstly, challenging unacceptable variations on important health issues such as stroke or diabetes. And secondly, challenging the way NHS resources are used so that the NHS becomes more efficient and equitable, for example, in caring for those with multiple, complex needs.

Devolution was the topic of our final panel debate and table discussion. Mary Black from the Public Health Agency in Northern Ireland described the considerable progress that has been made in their devolved arrangements despite the very difficult political context. There are important lessons to learn from Northern Ireland, and Wales and Scotland, as England begins to think about devolution.

Deborah Cadman, Chief Executive of Suffolk County Council, talked of how public health had become a central ‘change agent’ to the way they do business. The Joint Strategic Needs Assessment is a key driver, and demand management a crucial strategy in their effort to reduce costs and improve outcomes. She noted that ‘making good on the public health opportunity’ was one of Simon Steven’s five tests for government.

Steven Pleasant, Chief Executive of Tameside Metropolitan Borough Council, continued this theme. He said that supply side efficiencies would deliver less than half the required savings required by Manchester’s health and social care economy. Better demand management based on prevention and earlier intervention is critical if their devolution deal is to work. Steven also reflected on the scale of the challenge – 80% of people on the work programme have an underlying health problem, and 60% have a mental health issue, none of which is addressed by the programme.

Jim McManus chaired the session and asked the panel to describe the ideal characteristics of a DPH to respond to these challenges. The answers ranged from cloning Suffolk’s DPH (her Chief Executive is clearly and understandably a fan) to moving outside our comfort zone. Steven Pleasant noted that he normally saw DsPH together but not often enough in some of key meetings where some of these big issues are decided. He challenged us all to get out more!

In my reflections on the day I quoted from the opening lines of Charles Dickens’ A Tale of Two Cities, “It was the best of times, it was the worst of times”. In many ways these are extraordinarily difficult circumstances for DsPH across the UK. But my sense from the day and from meeting ADPH members is that we are a resilient bunch. We need to look out for one another so those in the most difficult circumstances do not feel alone. But there is a prize to be had if we can make public health fundamental to the way the public sector works across the UK. To quote Churchill, “Never let a good crisis go to waste”.