Agenda item

This paper sets out the business case for Brent and Hounslow’s proposal to share a DPH as well as the proposed structure for public health and how staff will be integrated into the current officer structure once it transfers to Brent Council from NHS Brent takes place.

Phil Newby (Director of Strategy, Partnerships and Improvement) presented the item and began by emphasising the importance of making public health services more effective and to complement the needs of the borough’s population.  The two main aims of the proposals were to create a fully integrated structure for commissioning public health services and to focus on illness prevention.  Commissioning would take place jointly between the council and the Clinical Commissioning Groups (CCG) and public health services would be mainstreamed to enable improvements in health and make it a core council activity.  Turning to the role of the Director of Public Health (DPH), the intention was to have a shared DPH with Hounslow whose role would be strategic and dynamic in helping to promote fresh ideas on public health matters and help drive policy.  The council was already sharing some services with other authorities, such as trading standards.  In addition, other local authorities such as the London boroughs (LBs) of Harrow and Barnet were already sharing a DPH.  Phil Newby explained that initial discussions with neighbouring London boroughs had involved the possibility of appointing a West London wide DPH, however councils had since followed the route of pairing up where they had identified compatibility.  In the case of LBs Brent and Hounslow, both shared a vision to place public health back into council services and this was the main reason why they were to work together and the shared intelligence of both authorities would benefit them.

Members then discussed the proposals in detail.  Councillor Harrison sought clarification with regard to the budget available for public health services and whether there was potential for conflict between local authorities and CCGs as to how it would be spent and convincing health professionals to be working within the council.  She enquired whether there was an element of risk in pioneering a new way of public health which had not been tried and tested elsewhere.  Councillor Harrison also felt that it was important that a DPH be able to concentrate solely on the needs of Brent residents.  Councillor Sneddon enquired about the main differences between the LBs Brent and Hounslow partnership as compared to LBs Harrow and Barnet.  He asked whether there was a risk that that the Government would raise issues about  the LBs Brent and Hounslow partnership as guidance from the Department of Health and Local Government Association suggested that councils should already have a shared management team in place or share a boundary with each other.  Councillor Sneddon expressed concern that a lack of direct management responsibility and non ownership of any budget could reduce the influence of the DPH, whilst in turn the postholder’s views could be unduly influenced by other budget holders.

Councillor Gladbaum enquired whether the appointment of a DPH would also entail additional staff being recruited and was the council’s Public Health Intelligence Team already in place.  She stated that a shared DPH would mean they would spend less of their time on each borough and suggested that during the first year of the arrangement, there could be separate DPHs for each borough.  Councillor Al-Ebadi sought confirmation of the views of LB Hounslow on the proposals and comparisons of costings between appointing one DPH for both boroughs and one for each borough.  He felt that as the DPH was an advisory role, it would not present any problems appointing one for both LBs Brent and Harrow. 

Councillor Hunter commented that she agreed with proposals to bring public health services into the council, however she was yet to be convinced that working with LB Hounslow was necessarily the best solution, although she welcomed opportunities to share Best Practice with other local authorities.  She suggested that as public health was going through a transitional period, a full time DPH should be appointed for Brent on an interim basis and this would also allow for consideration on whether sharing a DPH with LB Hounslow was desirable.  Councillor Hunter added helping guide strategy was a full time role, whilst it was also important that the DPH was a member of the Corporate Management Team.

The Chair indicated her support in locating public health workers across council service areas and the integration of public health within the council but enquired whether there was sufficient expertise within the organisation to supervise such staff.  She emphasised the importance of the role of the DPH and remained unconvinced that it should be shared with another borough.  In addition, she queried whether the DPH’s ability to influence would be compromised by not having control over a budget.  The Chair also commented that the economic situation and welfare reforms would place even greater demand on public health.

The Chair then invited Simon Bowen (Acting Director of Public Health, NHS Brent) to outline his views to the committee.  Simon Bowen began by supporting proposals to bring public health under local authority control and the vision to mainstream these services and he felt the changes offered good opportunities to improve public health.  However, he expressed concerns about proposals with regard to the DPH and felt that the role may lack credibility with no budget to control or staff to manage and not being a member of the Corporate Management Team.  In order to strengthen the role, he felt that the DPH should have these powers and responsibilities.  Simon Bowen also commented that Brent had gone from one of the worst to amongst the best of public health providers in London, whilst in his view Hounslow was at the same level that Brent was five years ago and so he questioned the value of LB Brent partnering LB Hounslow.

In reply to the issues raised, Phil Newby confirmed that nationally local authorities would receive £2.2bn to provide public health services, although this was less than 50 per cent of the total public health budget.  Discussions would take place between the council and CCGs to determine how the budget would be spent.  Phil Newby explained that as well as a DPH, there would also be a DPH representative each for both LBs Brent and Hounslow, whilst in addition public health consultants working in each borough who would be able to provide advice to councillors and the CCG.  Most staff carrying out public health functions, however, would be transferred from the NHS and a Public Health Intelligence Team was already in place.  As the DPH would be representing two boroughs, this would help carry more weight in influencing the Government and other bodies.  In addition, LBs Brent and Hounslow shared similar characteristics and had similar visions for public health and wished to provide much more integration with CCGs than others.  LBs Harrow and Barnet, however, were taking a more traditional approach to public health and did not intend to embed public health services within the council. The DPH would provide leadership and expertise, however officers and councillors would also gain more knowledge of public health as it become embedded within the council.  Phil Newby advised that the Government was interested in seeing a number of different models for public health being set up and the innovative approach taken by LBs Brent and Hounslow would not be objected to. 

Phil Newby advised that as the role of the DPH was strategic, it was felt appropriate to share the role with LB Hounslow who were fully in support of the proposals.  The DPH was not being recruited in a traditional managerial sense, but would play a role in influencing and shaping public health and sharing a DPH also released more funding to deliver public health services.  Phil Newby cited a number of examples of postholders in the council who were not responsible for a budget and not on the Corporate Management Team, but who nevertheless have considerable influence and helped shape policy.

Councillor R Moher (Deputy Leader of the Council/Lead Member for Finance and Corporate Resources) added that an integrated model for public health services was being pursued by LBs Brent and Hounslow who shared similar ideas.  The DPH’s strategic role may allow to pilot new ways of providing public health services and she advised that local authorities were statutorily obliged to appoint a DPH.  Dedicated teams would be created to manage demand for public health services and the DPH would play a vital role in providing expertise and sharing information with them.

Members then agreed to the Chair’s suggestion that whilst the proposed mainstreaming of public health services was supported, concerns about sharing a DPH with another borough remained and so the Executive be recommended to not agree to share this post with LB Hounslow.

RESOLVED:-

(i)        that proposals to mainstream public health services, as outlined in the report for the proposed structure of the Brent Public Health Service, be supported; and

(ii)       that because of the importance of public health, the committee is concerned about the proposal to share a Director of Public Health with another borough and recommends that the Executive does not agree to share the post with Hounslow Council.