Local government can lead public health reform

15 March 2012

The return of public health to local government responsibility is a once-in-a-lifetime opportunity to integrate services and innovate, says Essex county council chief executive Joanna Killian.

It would be an understatement to say I'm thrilled that local government is, once again, to be at the heart of driving forward improvements in public health. While the controversy regarding the health and social care bill rumbles on we shouldn't let this distract from the once-in-a-lifetime opportunity we have to put in place an integrated system of public health at a local level.

Of course, this isn't without its challenges. Leading the new system of public health demands that we don't just take up the baton with determination and energy, but we also have to adapt our thinking so that we are clear on what I see as the main challenge for public sector leaders: forging stronger relationships across what will be an even more complex health and social care system in the future.

So what does this mean for public sector leaders? New and more robust networking and collaborative arrangements will have to be formed; there will be a need to develop and promote a wider remit for directors of public health, embedding their role more firmly across housing, planning and children's services; and we will have to ensure that we accelerate integration across prevention and commissioning strategies.

None of this should come as much of a surprise but as leaders I strongly believe that we have to make sure we drive reform in way that delivers tangible results at a local level.

The next few months are a critical time for public sector leaders. In areas like Essex, where two-tier arrangements define the local government landscape, the effort required to deliver innovation at ground-level is considerable. In an obvious sense, as leaders we have to take a strategic approach exploiting the many overlaps across services in order to deliver integrated approaches.

However, we also have to remain clear that our challenge is to spearhead real change so that, at a local level, communities experience the benefits of the new system. We have to "get out there" and bring together the strategic and local dimensions in a practical way.

This shouldn't be as daunting as it sounds. First, unlike in other areas of the health reforms, we have been given a clear remit to build a solid system for public health. Health and wellbeing boards will be the anchor for this.

If I could emphasise one message it would be that whatever you do in the next few months make sure you seize the opportunity and put in every effort to develop your board to galvanize key stakeholders around a clear agenda for local action to improve public health.

Second, we have to remember that despite the challenges and financial constraints we face, local government offers arguably more freedom and opportunities to innovate than at any time in living memory. That said, the leadership skills we need to deploy today are quite different from those in the 1970s when local government last had responsibility for public health.

Today, leadership across the public health agenda relies on mobilising action by a large number of people around clear goals, and by framing clear questions that inform how we commission services. This means we have to collaborate even more to achieve shared outcomes across very wide spans of activity, and relinquish our managerial control over "territory" as well as budgets, in favour of a truly collaborative way of working.

Sometimes this will feel challenging and uncomfortable, but it also offers the chance to be at the forefront of a significant new leadership role for local government that can deliver a "system-shift" – from dealing with the impact of health inequalities to creating innovations that will prevent poor health and improve health and wellbeing in collaboration with local communities.

For all of us who are passionate about better public health: elected members, local authority chiefs, directors of public health, and the health and social care workforce, what could be a better prize?

Joanna Killian is chief executive of Essex county council and a member of the Society of Local Authority Chief Executives (Solace).


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