The NHS Long Term Plan – let’s stop the ‘us and them’

January 18, 2019 in ADPH Updates, President's Blog by Lucy Sutton

The NHS Long Term Plan has finally arrived. There is much in the plan that Directors of Public Health would support: 

  • The shift in focus to primary and community services
  • Extra funding for those places with the greatest health inequalities
  • Training of medics on nutrition in all hospitals 
  • Action on air pollution within the NHS fleet 
  • Action on screening and vaccination inequalities 
  • £30M for rough sleeping initiatives 
  • Additional NHS gambling clinics 
  • Important focus on children and young people, cardiovascular disease, musculoskeletal disease, mental health and falls prevention.  
  • Alcohol care teams to be developed in collaboration with local authority commissioners. 

We welcome too the strong focus on smoking; but this, and in fact every commitment above, needs to be done in collaboration with LA commissioners.  

Our members are less welcoming of the doubling of the Diabetes Prevention Programme, and I’m sure could have found a more effective use of the £105m already invested in it. 

The press release on the NHS Plan’s commitments on alcohol and tobacco preceded the full plan by two days. We responded positively to this as they heralded the good intention for the NHS to do more to prevent modifiable factors damaging patient’s health. However, we waved three red flags of concern – the plans were ‘undeliverable’ without a good spending review settlement for public health; bold national policy change is needed to address the social determinants of health; and thirdly, the NHS needs the support and contribution of local authorities and the Director of Public Health to deliver the plans efficiently – we need to operate as a public health system.  

Cuts are the issue – more restructuring is not the solution 

But let me turn to some of the disappointing aspects of this plan. Imagine our surprise when the full NHS plan arrived the day after our welcome with the proposal to: ‘consider the potential for a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be.’ 

Unacceptably, ADPH was neither involved nor informed about the inclusion of a review of our commissioning responsibility – by NHSE, another public sector commissioner. At best this is a well-intentioned but extraordinarily ham-fisted effort to deal with public sector funding cuts – at worst, it is an unwelcome distraction from cross-sector collaboration to manage those cuts to ultimately improve citizen’s health and wellbeing. Cuts are the issue – restructuring is simply not the solution.  

Fighting among ourselves will deliver a worse outcome; how you do things does matter. So in that spirit, and for the NHS’ own good, we’re pushing back and saying there can be no review of the commissioning of public health services without the full involvement of Directors of Public Health. Reviewing what we do can be productive in illuminating areas for improvement – and we would support a review which looked at how public health services could be sustained and improved.  

I have raised our concerns with DHSC and have been reassured that they want to work closely with ADPH and public health stakeholders on this review. 

System challenges 

Austerity has been a major driver of change for over a decade. In part it has driven necessary transformation and efficiencies within public services; but for the most part, it has driven unnecessary demands on those services and arguably is now costing the government more than it is saving – as well as leading to all sorts of distortions within the public sector. Indeed problems which properly funded public health teams could prevent are now being displaced to the NHS, with avoidable extra cost. 

It was within this challenging context that public health moved from the NHS to local government in 2013. The case for the transfer of public health responsibilities remains unchanged – indeed we would argue, it is stronger than ever. Directors of Public Health are providing leadership and expertise to tackle the social determinants of health and deliver strong place-based population health approaches – as well as leading the transformation of those services we’re responsible for commissioning – substance misuse, sexual health, 0-19 year old’s health and wellbeing.  

There is much more to public health than the NHS – the Clean Air Strategy published this week has significant roles for local government and the Serious Violence Strategy advocates a public health approach. We need to challenge this default ‘NHS first’ logic if we are to build a truly preventative system. 

Public health commissioning has delivered improved outcomes 

The completely false presumption in the Long Term Plan is that council commissioning is delivering worse outcomes. This is simply not true. It is not borne out by outcomes data. There are several national reports that show local government has been successful in delivering services under difficult circumstances and has prioritised increasingly scarce resources effectively.  

We’ve brought new energy and rigour to the commissioning of these community services, often transforming who delivers them, where and how, making integration and partnership-working real – and, in the context of rising demand and huge cuts, largely delivering good outcomes. Redesign in many areas has focused on integration – integration with other public services, such as criminal justice, adult services, children and young people services; and integration across the wider health economy. It has also looked to commission the community and voluntary sectors and to increase social value through its contracts.  

‘Be careful what you wish for…’ 

When public health was in the NHS, we know that the funding for prevention was always on a shaky footing – there in good times, the first to go in difficult. This was also true of the funding of many non-acute, preventative community services, including those now commissioned by local government. As Jim McManus has blogged: ‘it was not better in the glory days’. We inherited long-standing challenges – from the underfunding of school nursing and fragmentation in health visiting, including poor links with GPs – to overly medicalised and expensive sexual health services, or drug services focused on clinical treatment and not yet recovery; and Directors of Public Health have worked hard to innovate and introduce new models to deliver improved outcomes for less. Local authorities have also taken some decisions that the NHS could not or would not make.  

In December 2018, our successful ADPH conference focused on ‘disruptive leadership’ – the kind of leadership that understands that improving outcomes often needs challenge and change, that isn’t afraid of challenging ‘the norm’ to enable innovation, and that knows how to be pragmatic and savvy while doing this. This is the kind of leadership that we so desperately need in the public sector – leadership to enable the reforms needed to better serve a population with changing needs and expectations.   

But commissioning can be a thankless task; with a focus on improving population outcomes with efficiency, it’s not often that providers thank commissioners for their efforts. It can lead to experienced professionals being asked to do things differently, or to change a service skill mix or integrate with other providers, or to change the location or mode of the service to make it more accessible for residents and patients. Often, the best innovation comes through commissioners and providers working in creative tension together – and there are very many examples of this leading to fantastic services.  

Joint commissioning of local health and care services in integrated care systems is becoming increasingly important to enable local government and the NHS to shape effective services – and indeed is already happening in many areas. 

It’s time to work as a system. With each part funded appropriately and sustainably. We will focus on articulating that. We all need to join together and end the unhelpful “us and them” discourse. 



by admin

200 Days On – My Reflections as ADPH President

December 6, 2018 in ADPH Updates, President's Blog by admin


(given as the introduction to the December 2018 ADPH annual conference)  

It’s 200 days today since I was inaugurated as President of the ADPH. Usually Presidents get asked what they’ve achieved in their first 100 days – but I’m proposing that, seeing as I’m a part-time President, my time gets doubled. So, time to see how we’re doing on the priorities I set out in May:

  • 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’ 

My first priority was to seek to highlight the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, gender, disability. This normalisation of inequality in our society serves to protect the power of some groups over others, yet it is unjust and profoundly damaging to our health and wellbeing.  

When I spoke at my inauguration in May, the UN’s Special Rapporteur on racism had just published their report, which noted that racism in Britain was becoming ‘normal’ again. This week, analysis showed a record number of children are being excluded for racist bullying (The Guardian, 1 December 2018).  

And in November, we had the report of the UN’s Special Rapporteur on extreme poverty and human rights, which found that ‘for almost one in every two children to be poor in twenty-first century Britain is not just a disgrace, but a social calamity and an economic disaster, all rolled into one’. He noted that it was women and children and those most vulnerable who were being disproportionately impacted by recent tax and welfare reforms. The 49% real-term reduction in government funding from 2010/11 to 2017/18 was cited as a contributory factor, with people no longer having access to the vital services they needed. The UN’s Rapporteur’s view was that the UK government could end poverty if it wanted to. 

Many believe that austerity is now actually costing more to the UK government than it is saving, with the Rapporteur noting: ‘the many billions [taken from] the benefits system since 2010 have been offset by the additional resources required to fund emergency services by families and the community, by local government, by doctors and hospital accident and emergency centres, and even by the ever-shrinking and under-funded police force.’  

While the renewed focus on ‘prevention’ is welcome, the reality is that interventions to prevent poverty, poor outcomes and mental distress are being cut on a massive scale. And the money and focus continue to prioritise crisis management – rising A&E attendance, knife crime, suicide, homelessness.  

Increasingly, our members are shining a light on the negative impact that the changes in our public services are having on citizen’s health; this month the Guardian covered research commissioned by Alice Wiseman, DPH Gateshead, on the negative impact of the roll out of Universal Credit particularly on claimants with disabilities, mental illness and long-term health conditions, as well as homeless people, forces veterans and care leavers. The findings led Alice to make the damning comment that: ‘I consider universal credit, in the context of wider austerity, as a threat to the public’s health.’  

Our members have also been leading efforts to challenge the new cultural norms created in society by commercial interests, which perpetuate the concept that our major public health issues are down to a collective failure of individual willpower. In London, Danny Ruta, Steve Whiteman and Vicky Hobart have been key in the efforts to challenge what’s normal to impose on our children, with the ban on junk food ads across the Transport for London network; or Ruth Tennant’s work with ASH on reducing children’s exposure to smoking in their homes.   

Today, we are in the middle of the international 16 Days campaign to end violence against women and girls. The ability of those in power to maintain their positions through normalisation and victim-blaming is no better demonstrated than by this form of violence and control. We kick-started our ADPH policy work on violence (in all its forms) through a lively conversation at the ADPH Council in October – and hope many of you will be engaged as it evolves.  

And finally, I recently had a fantastically positive challenge to my own preconceptions of what’s normal, when Becky Rich, a Dance Leader and Ambassador for DanceSyndrome ( – a dancer-led, disability-inspired organisation – spoke about her many years managing her heart condition, how she had lost 3 stone through dance and healthy eating, and how she wanted to support others to do the same. I celebrate Becky who inspires us all to challenge the norms that limit us from living our lives fully. 

  Becky Rich #dancer #activist 

My second priority was you, our membership. Today, our ADPH conference was over-subscribed for the first time, with a waiting list – that suggests to me a vibrant organisation, where people want to be a part of a body that learns, challenges and improves, together. I’m particularly thankful for the contributions that our members make through the Board, our strengthened Council and soon-to-be reinvigorated Policy Advisory Groups (PAGs); many have also been active through our peer mentoring, our immersive days (one on DsPH with expanded portfolios is coming up in March; do send ideas for further topics!) and the recent workshop for new DsPH – please join in and be part of our growth.  

I, with members of our brilliant ADPH team, have been visiting many of you across England – Cheshire and Merseyside, Yorkshire and the Humber, the east of England, the north east and the south east of England, and in Wales. I’ve enjoyed getting out to meet you and hear about your challenges and successes – you’re doing amazing work under increasingly difficult circumstances. What’s struck me is how committed you all are to improving the public’s health in our local places – but that we also have our heads raised to working to improve as a sector, respectively and collectively, in our regions and at a country level.  

I’m looking forward to connecting with those of you I haven’t yet met, when I complete this round of first visits early next year.   

I’ve also enjoyed hearing our members’ voices commenting on visions and plans and budget decisions, prevention, population health and public health interventions. For this contributes to what’s needed to deliver on my third and fourth priorities – promoting the unique leadership role of the DPH in local systems; and ensuring we continue to be a well-respected – and ‘edgy’ – voice for public health nationally.  

These priorities require a lot of relationship-building – with Public Health England and Public Health Wales, the LGA, ADASS, ADCS, the Faculty, Royal Society, and of course with the NHS. And the ADPH team and many of you, our members, have worked tirelessly to ensure that we get our voice into the many spaces and places shaping our context and our role as DsPH within this – from PHE’s and other agencies’ initiatives, to the NHS long term plan and the Secretary of State’s prevention vision, to the budget and forthcoming spending review. 

We need to – and are – raising our public voice and profile, developing our ‘edginess’ and trumpeting our successes – through tweeting and writing blogs and pieces for the LGC, HSJ, BMJ and elsewhere, and presenting our local work nationally, in the media, through social media, conferences or hosting visits. And we’ve also continued our presence in public hearings, parliamentary committees and other parliamentary bodies, and the many different summits and conferences.  

At November’s Health and Care Committee on the impact of the budget on health and care, the messages I gave were:  

  • Prevention – or health creation – needs investment in all the things that help make us happy, healthy and able to lead fulfilling lives – our childhoods, our friends and our play and learning, our houses and the places where we eat and live, and our occupation and income. Yet there has been a 40% cut to local government funding and a £700m cut to the Public Health Grant over the last 5 years (2014/15 – 2019/20)  
  • DsPH have been doing the best we can, and managed the cuts to the Grant through innovation and transformation of our teams and services (many provided by the NHS) and through a focus on integrating and strengthening local systems; but this is not sustainable   
  • We are local system leaders and ambitious for our population’s health, with proven positive impact – just think what more we could achieve if we were fully resourced. 

We need to continue to develop and strengthen our key messages and overarching narrative. We need you to help us do this with your examples of local successes – watch out for the requests for this, and please contribute yours.  

So, 200 days on: 

  • Priority 1: With Brexit on the horizon, there are many areas for concern in our society, and we need to keep calling these out and championing human rights and equity 
  • Priority 2: I’m loving the way we’re developing as a vibrant, member-led organisation 
  • Priority 3: We need to be much clearer on our impact and our successes 
  • Priority 4: As an organisation, we continue to be well-respected – but I definitely see our ‘edge’ developing. 

I look forward to working on these priorities over the next 200 days! 

by admin

Tackling alcohol, challenging the norm

September 28, 2018 in ADPH Updates, President's Blog, Publications by admin

I remember arriving in the UK as a Junior Doctor to work in the NHS in the mid-90s. The nurses were my new friends, and I used to join them at 9pm post shift for a crawl down the Derby Mile.

The bigger the group, the more the rounds to be gotten through before the 11pm closing hour bell rang. Then curry and Cobra at the end. Not something I had known before, but seemingly commonplace and well, normal.

I jumped into my new social scene with gusto, before long exceeding any recommended unit count, and rapidly putting on weight. A trip back home allowed for a welcome detox and sensible reflection and resolve.

Drinking too much. So easily done when it’s so normal.

The normalisation of harmful heavy drinking

Around that time, there seemed to be an explosion of new product development, new marketing approaches, new ‘normal’ ways of drinking – I remember the bursting onto the stage of alcopops, the surge of stag and hen dos, the creative, free-flowing Happy Hour promotions …

Licensed premises have exploded in numbers since 2005/6 – in my borough, there was a 41% increase. Schools and even hairdressers joined the corner stores and 24 hour pubs.

Since 1970 the amount of alcohol consumed per person has risen by 50% in the UK. Over that period alcohol has become relatively cheaper and more readily available. Alcohol is aggressively and expertly marketed and drinking has become a normal feature of everyday life.

Alcohol can play a positive social and economic role – and the large majority of people enjoy alcohol without harm. However, excessive alcohol use can have a harmful effect on individuals, their families and our community. The number of alcohol-related admissions to hospitals in England has risen yet again, with middle-aged drinkers most likely to be admitted, according to new Public Health England figures. We know we need to do something.

Navigating new approaches to population health

We know that public health issues such as these are too complex for a business as usual approach. We do need to challenge our own thinking and innovate – while developing, and keeping an eye on, the evidence of what works.

Partnering with Drinkaware could be just such a shift. However major changes in approach need careful consideration – a precautionary approach. The Alcohol Leadership Board should have been a place to talk this through with experienced and knowledgeable people.  The ADPH was therefore disappointed at PHE’s independent decision to collaborate with Drinkaware which has led us to a place where we, as a public health system in the broadest sense, have been, in effect, arguing publicly. And sadly, it is likely that this will lead to further confusion for the public around the actual messages about alcohol harm.

The key point is that alcohol is produced for profit. The more that is sold, the greater the profit. The industry spends billions creating new markets, promoting its product and lobbying for favourable business conditions. It spends some on corporate social responsibility (CSR).

A critical review in the latest (Sept) edition of WHO’s Public Health Panorama: Alcohol industry actions to reduce harmful drinking in Europe: public health or public relations? concluded that CSR activities conducted by the alcohol industry in the WHO European Region ‘are unlikely to contribute to WHO targets but may have a public-relations advantage for the alcohol industry’.

And we can all now quote the evidence review produced by PHE (2016) which demonstrated that education campaigns on their own, and particularly those with industry involvement, will not reduce alcohol harm.

These are some of the reasons why the public health community has a healthy scepticism of all things alcohol industry. As we noted in last week’s BriePH (the regular briefing for Directors of Public Health), ADPH has a clear Ethical Collaboration and Sponsorship Policy which sets out that the ADPH ‘will not work with, or accept donations from, organisations whose activities, policies, aims or objectives contradict or are inconsistent with its own’ – this includes partnerships with organisations involved in tobacco or alcohol manufacture. We regard Drinkaware as being too close to the alcohol industry. ADPH remains a member of the Alcohol Leadership Board. But we believe partnering with Drinkaware as they currently stand is unethical.

Missing the value DsPH can bring

I’m sure many of us can tell our own stories of how ‘normalised’ high risk drinking is in our communities and boroughs.

Directors of Public Health recognise that nationally developed social marketing campaigns such as the ‘One You’ have their part to play – and many have adapted these locally. Linking the One You brand with the Drinkaware campaign – without DsPH having any input – may adversely affect these local efforts. And declaring the campaign is ‘where the people are’ forgets that DsPH work closely with elected members and local residents. To some of us, it’s unhelpful and galling.

There is much work to do to reduce the harm. Minimum Unit Pricing, Health as a 5th Licensing Objective, adequate funding of treatment and recovery services and a levy on alcohol driven business to support the cost to councils and police of keeping safe and clean town centres are all part of that. The ADPH is committed to working with, challenging and supporting partners in the public health system – including PHE – to make sure we unite behind efforts known to have impact.

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.


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.