STRONG LOCAL LEADERSHIP – QUALITY PUBLIC SERVICES CHAPTER 5

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					STRONG LOCAL LEADERSHIP – QUALITY PUBLIC SERVICES:
CHAPTER 5, SUPPORT FOR COUNCILS

COMMENTS FROM THE HEALTH DEVELOPMENT AGENCY

1. Introduction

The Health Development Agency (HDA) was created to support and enhance
national efforts to improve the health of people living in England and reduce
inequalities in health. The HDA believes that local authorities play a crucial
role in improving the health of local communities, and we aim to promote
close partnerships between local authorities and NHS organisations. We
welcome this white paper, including the proposals in chapter 5. We believe
that they will support better partnership working.

2. Key points and recommendations

The importance of the public health role of local government is now well
understood.

The ‘wider public health workforce’ comprises the large number of leaders,
managers and professionals outside the health sector – and particularly in
local government – whose work has an impact on the determinants of health.

It includes those with a strategic role, such as elected members, chief
executives and departmental heads, and those with operational roles –
frontline professionals such as teachers, environmental health officers, social
services staff, and staff in leisure services.

People in strategic roles need leadership and management skills that allow
them to work across organisational boundaries. They also need an
understanding of the public health function, health determinants, and health-
related evidence.



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People in operational roles need expertise in community development and
working collaboratively, as well as knowledge of health determinants and
sources of health information.

Specially tailored support for elected members - particularly those involved in
health overview and scrutiny - will be essential, if they are to do their job
effectively and in accordance with principles of corporate governance.

The HDA strongly supports the white paper’s proposals on training and
development. We recommend that:

   There should be a coherent national approach to leadership and skills
    development.

   The Department of Health and the DTLR should collaborate on a strategic
    framework for the training and development of the wider public health
    workforce, linking as appropriate with the DfES and the DCMS.

The strategic framework must take account of the wide range of current public
sector leadership initiatives and of the need for sharing of learning among
them.

Such a framework would support joint working by the Modernisation Agency,
the Improvement and Development Agency and the Local Government
Association; workforce planning and planning for education and training by
PCTs and by local authorities as part of community planning; and the strategic
functions of strategic health authorities.

We also support the proposals on peer support and best practice and
recommend that issues raised at a recent series of learning events on
‘planning across the LSP’ sponsored by the Department of Health/DTLR
roundtable be included in peer support and best practice programmes.

3. The public health role of local authorities – policy background

The importance of the public health role of local authorities is now well
understood. The Chief Medical Officer has stated that local authorities should
be the equal partners with the NHS in delivering better health and well being
for their residents, and recommended more support for the public health
leadership role of elected members and for developing the health leadership
skills of a range of managers and professionals within local government. 1

The House of Commons Select Committee on Health noted that local
authorities had a vital role to play in improving the health of their communities
and recommended that the well being power should lead to public health
being placed at the core of local authority initiatives and strategies. 2

The NHS Plan recognises that the NHS cannot tackle health inequalities
alone, that a new partnership between health and local services is required,
and that the NHS must support local strategic partnerships. 3


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National policies and initiatives on social and economic regeneration have
high-level health targets and local strategic partnerships are a mechanism for
bringing local partners together in pursuit of health as well as other common
goals.

In this context of strong policy interest in improving health and tackling health
inequalities, the role of what the Chief Medical Officer calls the ‘wider public
health workforce’ becomes particularly important.

The ‘wider public health workforce’ comprises the large number of leaders,
managers and professionals outside the health sector - and particularly in
local authorities - whose work has an impact on the determinants of health. It
includes those with a strategic role, such as elected members, chief
executives and leaders in departments concerned with, for example,
regeneration, housing, education, environmental services, transport planning,
social services, and community development, as well as professionals with an
operational role, such as teachers, environmental health officers, social
services staff, and staff in leisure services. It also includes Government Office
strategists concerned with local authority functions and how local authorities
‘join up’ with other sectors.

4. Support needs of the local authority public health workforce

The draft national public health workforce development plan pulled together
the findings of a number of audits of public health skills. 4 There is a
consensus that those in strategic roles will need:

   strong leadership and management skills that will allow them to engage
    across organisational boundaries to work towards community development
    and health improvement;

   high level understanding of the public health function and of the potential
    impact of their role, alongside that of others, on population health;

   a basic understanding of health determinants, health-related evidence and
    issues surrounding risk management. (Depending on their role, they may
    play a large part in monitoring and controlling risks in their population.)

The following types of education/training would support them in developing a
public health ‘mindset’:

   training on health determinants;

   training on outcomes of health needs assessment and health impact
    assessment;

   modules/courses on leadership and organisational development, and on
    collaboration and communication skills.



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Those in operational roles will need:

   expert skills in working with individuals and communities, particularly as
    part of the process of community development, with good collaborative
    skills for working across organisational boundaries;

   in some cases, a broader understanding of the public health function;

   knowledge of the determinants of health and of where they can go for
    more information on health;

   to be able to work with others to assess health hazards and risks, as part
    of work with communities.

Training opportunities should include:

   training on health determinants;

   training on outcomes of health needs assessments and health impact
    assessments;

   training to ensure that their role can be directly incorporated into public
    health programmes and health promotion in specific settings;

   workshops on collaboration and communication.

As noted already, elected members are among the leaders of the wider public
health workforce. Elected members involved in health overview and scrutiny
may have more acute versions of the above needs. Their duties will be
onerous: the current consultation on the overview and scrutiny function
defines the aims of health scrutiny on behalf of the local community as:

   ensuring that people’s needs and wishes for health and health-related
    services have been identified;

   scrutinising whether health-impacting services are accessible to all parts of
    the community;

   scrutinising whether the outcomes of interventions are equally good for all
    groups and sections of the population. 5

In addition, they will need to acquire and digest a great deal of material about
health services and public health, and build links with the other parts of the
machinery for involving patients and the public in health-related policy and
planning (patients’ forums and the Commission for Patients and Public
Involvement in Health) and with agencies engaged in local NHS reviews or
development activities, such as the Commission for Health Improvement
(CHI) and the Modernisation Agency. Specially tailored support will be




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essential, if they are to do their job effectively and in accordance with
principles of corporate governance. 6

5. Mechanisms for meeting support needs

We strongly support the suggestions about training and development,
particularly those on joint training across sectors and across central and local
levels, and on the wider use of secondments between sectors and levels. As
illustrated above, many of the skills needed at both strategic and operational
levels in the wider public health workforce are generic in nature – for example,
working across organisational boundaries, collaboration, communication,
organisational development, community development, needs assessment and
impact assessment.

A coherent national approach to leadership and skills development is needed.
The Department of Health and the DTLR should collaborate on a strategic
framework for training and development for the wider public health workforce
and for the overview and scrutiny function, linking as appropriate with
departments such as the DfES and the DCMS.

It is essential that the strategic framework take account of the wide range of
public sector leadership initiatives (such as the Leadership Centre for the
NHS) and of the need for sharing of learning among them. 7 It should also
take account of programmes such as the Cabinet Office’s Interchange
Initiative, which enables people from different organisations to learn from each
other and to share good practice, ideas and experience. 8

Such a framework would support:

   more effective joint working by the Modernisation Agency, the
    Improvement and Development Agency (IDeA) and the Local Government
    Association;

   workforce planning and planning for education and training by PCTs and
    local authorities, and planning by Workforce Development Confederations;

   the strategic functions of strategic health authorities and Government
    Offices;

   auditing of the skills and resources needed to achieve well being goals, as
    part of community planning;

   the analysis of corporate capabilities as part of the performance framework
    for local government.

Having been closely involved with auditing public health skills and the draft
national public health workforce development plan, the HDA would be happy
to support work on a national framework.

More specifically, initiatives such as the following would be of value:


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   Extension or development of existing IDeA programmes to cover the
    training and development needs of the wider public health workforce.

   Joint training across professional boundaries at the LSP level.

We also support the proposals on peer support and best practice. The HDA
believes strongly in the importance of systematic approaches to gathering and
sharing information about local policies, strategies and practice. For example
we will shortly be publishing a report on the public health dimension of
community strategies. 9

The ‘roundtable’ hosted by the Department of Health and the DTLR to bring
together national, regional and local agencies concerned about the
development of LSPs recently sponsored a series of regional learning events
on ‘planning across the LSP’ which drew a mix of local government, NHS and
voluntary sector participants. The evaluation of the events found strong
demand for:

   cross-sectoral networking;

   regional and sub-regional networks, with national support;

   local patch activities, with local facilitation;

   case studies and examples of good practice.

Participants highlighted the following as issues where they needed support:

   Elected members and the scrutiny role: guidance on responsibilities and
    relationships.

   Lack of coterminous boundaries for local government and health: support
    on working at two levels - strategic and local.

   Community involvement/consultation: toolkits and guidance on common
    approaches to consultation.

   Balancing partners’ priorities: support through integrating targets and
    indicators nationally.

   Health Act and other flexibilities: advice and support in using flexibilities
    and pooling budgets.

   Engaging partners: guidance on two-tier local government and partnership
    working.

   Strategic overview/planning: rationalise planning and partnerships and
    share practice on integrated planning.


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The roundtable is planning a study of practice on pooling budgets. We
recommend that this and the other topics listed become part of programmes
on peer support and best practice.

Health Development Agency
28 February 2002

1
  Chief Medical Officer (2001). Report of the Chief Medical Officer’s Project to strengthen the
Public Health Function. Department of Health.
2
  House of Commons Select Committee on Health (2001). Select Committee on Health.
Second Report. The Stationery Office.
3
  Department of Health (2000). The NHS Plan. A Plan for Investment. A Plan for Reform. DH.
4
  Dunkley C and Speller V (2001). The public health workforce development plan. Draft. HDA.
5
  Department of Health (2002). Local Authority Health Overview and Scrutiny. A Consultation
Document. DH.
6
  Audit Commisson (2001). To whom much is given. New ways of working for councillors
following political restructuring. Audit Commission.
7
  Performance and Innovation Unit (2001). Strengthening leadership in the public sector. A
research study by the PIU. Cabinet Office.
8
  http://www.cabinet-office.gov.uk/interchange
9
  Hamer L and Easton N (2002). Community strategies and health improvement. A review of
policy and practice. HDA/Local Government Association. In press.




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