The opportunity we’ve been waiting for

Duncan Selbie asks public health leaders to be bold and take advantage of the generational opportunity to achieve real benefits for the public’s health

Last Monday saw the NHS Commissioning Board start work and we are now entering the final six months before PHE itself goes live in April.  In recent weeks I have met many people across the country involved in the wide range of work our new agency will undertake.  What I have found has been set out in these weekly messages.

I have deliberately emphasised the leadership role local government will have in the new system.  PHE will be part of the public health system, providing national and local services, advocacy and practical know how, but it is only part of that system.  To fulfil the ambition for the improvements in the public’s health that is driving these reforms, we will need many leaders across public health and stretching into town halls right across the country.

As we have been setting out our ambitions for PHE, there have been critical voices.  That is right and I welcome them.  Inevitably, mistakes will be made but our vision is clear: a visible and enduring improvement in the public’s health alongside outstanding health protection services.  We need to see progress through improvements locally led and delivered in the next two years, which mark a step change in five and are irreversible in ten.

The key change that makes this possible is the new statutory duty on local government to improve and protect the health of their communities, alongside the transfer of resources – money and people – to support this.  Never enough, but nonetheless a significant contribution at a time of continuing pressures on council budgets.  No single part of the system can deliver these improvements alone but we can together.  With the emphasis on local leadership, all parts of the system will refocus resource and attention on health and wellbeing rather than on disease.  Prevention and early intervention will become the lens through which we view the design of our systems, pathways and programmes.

Right now, as the NHS Commissioning Board takes its fledgling steps, and we in PHE are appointing the first of our national leaders, this may feel overwhelmingly hard.  For many, the changes create unprecedented personal anxiety as previously well understood ways of doing things are disrupted.  In particular, for our most precious local leadership – directors of public health – the changes at a personal level are profound.  Not only will you be leading your teams through change, which you will have done many times before, but the changes involve a new employer working in a new culture to a difficult agenda in a perhaps wider and less familiar context.  Our commitment in PHE is to work with local government to ensure these changes can be navigated and understood and the benefits made real for our public’s health.

We can, as the leadership community for public health, walk backwards into the future or we can be so much bolder and more confident.  This is the generational opportunity we have been waiting for to make a step improvement in the public’s health.  Of course we shall look over our shoulder from time to time and certainly there will be real things we miss with a nostalgia born of familiarity. The future will necessarily be different and I wish us all safely and passionately to be part of that

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