The Last Word: Dr Jeanelle de Gruchy

September 29, 2021 in ADPH Updates, Blog by Campbell Findlay

My final blog for the ADPH – and as a jobbing Director of Public Health – starts with my heartfelt thanks and gratitude for the opportunity to serve fellow Directors of Public Health over the past seven years, first as Vice President and then as President.

From the earliest days of the pandemic, the always wise Jim McManus, our Vice President, put the ‘team of teams’ approach at the heart of our policy and influencing work. We were clear that drawing on the wealth of talent available within the public health community and more widely was essential to an effective response. And this remains true as we look to recovery. We have tried to practice what we preach, seeking to utilise and promote the vast abilities of the ADPH Board and Council, whole DPH membership and networks, and the ADPH staff team.

I want to pay a particular tribute to Jim, who is becoming Interim President, and the whole Board for their calm heads and ceaseless drive and dedication. ADPH Chief Executive, Nicola Close, has been a pillar of strength and experience, leading a dedicated and highly performing team. Every day over the last eighteen months, I have been reminded of the passion and expertise of Directors of Public Health. Forget about going the extra mile, they have all gone the extra marathon.  

I am hugely proud of our collective efforts.  

I also wish to record my thanks and appreciation to the Chief Medical Officer, Public Health England, the NHS, the Faculty of Public Health, the Local Government Association, Solace, the Association of Directors of Adult Social Services, the Association of Directors of Children’s Services and many more valued partners.  

At the start of my Presidential term, I set out four priorities which have acted as guiding stars. I would like to offer some brief reflections on the progress I believe we have made together. Inevitability, I mainly focus on the last eighteen months, but my half-term report is available here for those who are interested.  

My first priority was challenging the norm and advocating for equality in all its forms. In my opening blog as President, I wrote about gender, race, sexuality, disability and class; and asked “how good are we at recognising injustice and structural inequality?” The Me Too Movement, Black Lives Matter and the responses to the appalling murders of Sarah Everard and Sabina Nessa have shown millions of people in the UK to not only recognise injustices but be prepared to speak up and demand change. The Paralympics have demonstrated that a different world is possible. Inequality is at the core of all ADPH work and throughout the pandemic we have highlighted how the virus and its consequences have hit the most deprived and ethnically diverse communities hardest. We have played our full part in minimising harms, from promoting targeted testing and vaccination uptake to trying to keep children in school to highlighting and tackling the enduring transmission experienced by so many poor areas.  

The pandemic has shown us once again that inequality kills. As I have said before, we cannot go back to normal. We must do better as a society. A cross-government strategy to reduce inequalities would be a welcome start.  

My second priority was developing a vibrant, member-led organisation. Emergencies often lead to seismic shifts in the way people work together, and this is certainly true of COVID-19. The appetite among members to connect, share, discuss and, crucially, constantly improve and challenge others to do the same, has grown exponentially. ADPH has worked incredibly hard to facilitate this through briefings, guidance, capturing and disseminating resources, social media, hosting webinars and raising the collective voice at every turn. ADPH operates by consensus and any successes we have achieved, in building strong relationships – such as with the CMO, improving practice or securing policy change are a testament to the strength of member views and insights. 

My third priority was promoting our unique local system leadership role. A constant feature of the COVID-19 response has been the plethora and regularity of new pieces of guidance and announcements. They have often rained down on Directors of Public Health and required piecing together like a jigsaw – our leadership role has been one of local sense-making for our communities. A recent report from the King’s Fund has captured the pandemic role comprehensively. There is little doubt that the profile of Directors of Public Health is uniquely high, the challenge is to sustain and build on it. Understandably, many people might now think we are just Directors of COVID-19 but this reductionism would be a mistake. The core purpose of the DPH role – as our ‘What is a DPH’ briefing shows – is as an independent advocate for the whole health of the population and system leadership for its overall improvement and protection.   

My fourth priority was ensuring we continue to be a well-respected organisation – but with an edge. We established a clear principle early on in the pandemic – that we would be as constructive as possible and as challenging as necessary. Throughout the last eighteen months we have forged good working relationships with different parts of the national response, regularly providing our local insights, operational experience and advice in the quest of improving the response – sometimes quietly and patiently, and sometimes more forcibly. I believe our many interventions have helped deliver shifts in the right direction, from the fundamental recognition of the importance of the local response to smoother data flows to extra funding for outbreak management to a more localised approach to contact tracing to an emphasis on vaccine equity.  

Of course, the public inquiry will enable ADPH to offer a full and frank account of the pandemic and the lessons we must learn to both honour those who have lost their lives or experienced serious illness, and to ensure we are better prepared for future epidemics and pandemics.  

I am immensely proud of the progress and achievements of the ADPH on these four priorities. My appointment as Deputy Chief Medical Officer is, in many ways, a reflection of the respect Directors of Public Health have collectively achieved.  

Whilst we all hope the worst of the COVID-19 storm clouds have passed, the challenges for public health are daunting. But I also believe the next few months and years hold great promise because of the commitment to levelling up, the NHS and public health system reforms that recognise the value of place, renewed interest in the wider determinants of health and prevention, the focus on collaboration and integration of services and local leadership, and the prospect of creating a stronger voice for Directors of Public Health. My time in Tameside, Greater Manchester, has shown me first-hand the power and potential of devolution to realise this promise.  

When I moved from my public health team in an NHS Primary Care Trust to a local authority (due to the Health and Social Care Act 2012), the opportunities to address the social determinants of health widened. Research has shown the good that Directors of Public Health and their teams have done by bringing their knowledge and skills into local government, working with different departments to improve health and wellbeing, from a healthy start in life and aging well to regeneration and inclusive growth, active travel and leisure to a public health response to domestic abuse and violence. The levers available to deliver change expanded and in recovering from COVID-19, DsPH need to continue to influence, enable and deliver positive change for our communities.  

The same potential to influence wider agendas, but at a national level, is an ambition for the new Office for Health Improvement and Disparities. Being a Director of Public Health and President of the ADPH has been an incredible experience and privilege. The relationships I have developed with so many amazing, committed people, and knowledge of how things work in a local place and in communities, goes with me as I step into my new journey as DCMO.