As part of our 10 years of children's public health in local government interviews, Sarah Muckle, Director of Wellbeing, Public Health and Communities at Essex County Council discusses why the move of public health into councils has allowed closer working with other key services such as children’s social care, schools and planning.
The move into councils has allowed public health to work closely with other key services such as children’s social care, schools and planning even if it did, initially, come as a culture shock to some, says Essex County Council Director of Wellbeing, Public Health and Communities Sarah Muckle.
Sarah Muckle was steeped in the NHS when she made the move across to local government as a public health consultant in West Yorkshire. She had worked as a nurse and health visitor, before moving into an NHS public health role.
“I had only ever known the NHS when we moved into local government. A lot of us were like that and it was certainly a culture shock transferring across. The big difference was working so closely with local political leaders.
“In the NHS, as a clinician or a professional with recognised expertise in your area you had a lot of autonomy. Often, if you could make a case for doing something because the evidence shows it works you could normally do it, if the money was available.
“But in local government your role is to use your expertise to ensure elected members have the right information to make an informed decision about priorities and actions. Making a good case based on the evidence may not be enough to convince the councillors and for them other considerations come into play. How will it play with the public? Is it the right time? Are there other things that need to be taken into account?
“You have to respect that – it’s about local accountability. But I have to admit it took many of us some time to adapt to a new culture and new ways of working. As a result, we probably did not make the best of starts.
But saying all that, if I had a choice now, I would choose to work in local government - and that’s because if you want to make an impact on children’s health this is the place to be.”
‘We’ve seen plenty of innovation’
However, Ms Muckle, who is the National Policy Lead for Children and Young People for the Association of Directors of Public Health, said there is still variability in how different public health teams are working.
“We are seeing some working in a really integrated, cross-cutting way with other council services, while others continue to focus on the statutory services they need to provide, such as health visiting and school nursing.
“Both approaches can have a positive impact on child health, but working across the council with children’s social care, education, planning and others to address the wider determinants gives us more opportunities to improve health in the broadest possible way.
“It is hard to say why public health in local councils has worked well in some places and less so in others, but success relies on leadership teams embracing the opportunities public health can bring and public health feeling enabled to influence core council priorities with a health-in-all policies approach.”
This, she said, has let to plenty of innovation. “We’re seeing council public health teams addressing the affordable food agenda by helping establish social supermarkets and the chance to work more closely with schools has been a real opportunity – that has been a big advantage of being in local government in my view.
“We’ve seen public health teams support schools to address wellbeing and health by taking a whole-school approach. For example, some areas have worked with schools to implement autoenrollment for free school meals to improve uptake and take away some of the stigma.
“Mental health is another key challenge for children and young people with growing numbers struggling with anxiety and in some cases that is affecting their ability to go to school. Public health has been able to work with schools to look at putting services into schools and supporting school staff to help pupils with their mental wellbeing.”
Why planning is biggest surprise
But Ms Muckle, who has worked in Bradford and Kirklees before becoming Director of Wellbeing, Public Health and Communities in Essex last year, said perhaps the biggest surprise has been how planning teams have embraced the public health agenda. “Planning is one of the greatest successes – and in some respects that was unexpected because many of us thought they may be the most resistant.
“But they have embraced the health-in-all-policies approach. We’ve seen public health and planning teams become interested in areas like active travel and making sure new housing developers maximise the opportunity to improve health, such as including parks, play areas and green spaces in developments, alongside policies to restrict the opening of new hot food takeaways near schools.
“But I think one area we could certainly do more on is adolescence – there is always a lot of focus on younger children, which is very important, but as young people become more independent and begin to make their own choices, they need support and guidance to make sure those choices do not negative impact their life in the future.
“We have also faced challenges in recruiting enough health visitors and school nurses. Much of that has been outside of our control in public health. Historically there have been cuts to the funding of 0-19 services as well as reductions in numbers of qualified staff and recruitment has been difficult. One reason might be that nurses want to stay on NHS contracts and terms and conditions where they can and that is not always possible when there are several different providers of 0-19 services, such as social enterprises and council-run services.
“We have looked at alternative skill-mix models – using a range of different roles in the teams to support families with different aspects of development and health, ensuring health visitors and school nurses can focus their expertise where they are most needed. We recognise the need to be innovative, including looking at closer working and integration with children’s centres and family hubs.
“But I am optimistic. There may be plenty more to do to make the most of the potential being in local government offers – but we have already achieved a lot and there is no reason why we cannot continue to build on our successes.”
Please note this is an independent article. The content and views reflected within are those of the named contributor and not necessarily those of the LGA.
