Association of Directors of Children’s Services: How children's services directors are benefiting working alongside public health

Andy Smith was an assistant director of children social care when child public health moved into local government. He admits he was pretty naïve about what public health entailed.

“I probably did not really understand it in great detail beyond the broader public health perspective and that they were in charge of managing immunisations and some other things. It was a pretty pedestrian view of the world really.”

But in the past 10 years he said he and other children’s services leaders have learned so much. “It has been fantastic for myself and my colleagues to work with public health directors and their teams,” said Mr Smith, who is President of the Association of Directors of Children’s Services and the Strategic Director of People at Derby City Council, a role which oversees both children’s services, adult social care and public health.

The invaluable skills of public health

Mr Smith said the way public health uses data and evidence is the area where it has had perhaps the biggest impact on children’s services. “One of the things that I think has been a strength, and certainly I've seen both locally and from a broader perspective, is that public health is really driven by empirical evidence and insight and data, both quantitative and qualitative. As a service, it has a real understanding of what's happening – and not just at a population level, but a community level too.

“Public health colleagues have utilised that skill in doing things like joint strategic needs assessments and helped us understand and gain insight into future issues and demands. That has permeated now into how the wider corporate teamwork.

“We have also been really impressed in the approach to commissioning and monitoring contracts – again in how data is used in really interesting and dynamic ways. I think that has probably helped both children's and adult services raise their game in relation to commissioning.

“In Derby we have seen this with some of the work we have been doing with children with additional needs. Like everywhere, we are seeing a rapidly increasing number of children with education health and care plans and we have been looking at what that means in terms of commissioned services. 

“What we’ve realised by working together is we are not going to meet the challenge by building more special schools or paying for places in the independent sector. Instead, we need to invest in resources in mainstream schools and early years provision to support children to be school-ready. With early years, I think there has been a tendency to see this as a way of providing childcare so parents can work – what we want to do is focus on children and their development.” 

How Covid-19 changed perceptions

But he admits the journey has been a gradual one. “It has taken time. Initially, I think we saw them as a really well-resourced area of provision, particularly when compared to some of the challenges and pressures in councils, and we looked at new and different ways to use the grant that supported the public health agenda in the widest, and possibly loosest, sense.

“But, quite rightly, public health, for its part, has been robust in arguing that there needs to be an evidence base around what the grant is used for – and that it can’t just be used to prop up other budgets.”

Mr Smith said the biggest catalyst for altering perceptions was Covid. “Public health had a really visible leadership role – the service helped us understand what the impact of the pandemic was on communities, how it disproportionately impacted some, how important communication was, and played such a crucial role in coordinating the vaccination programme. 

“Public health’s role was massive – it cannot be underestimated - and I think it raised the profile hugely - within councils, the wider public sector and our communities.”

And with good working relationships now firmly established between children’s services and public health across local government, Mr Smith believes together they can help address health inequalities and the challenges being caused by the ever-growing levels of poverty.

“It is a really tough climate for many families – they are no longer managing to make ends meet. That is placing huge stress on them. Mental health is now the biggest single reason why we do assessments in children’s services– it has taken over from domestic abuse. So, you can see the overlap between what we are dealing with in children’s social care and the wider public health crisis.

“It is only by working in partnership that we will be able to help. But it is not going to be easy. We know money is tight. The public health grant has been cut and there is virtually nothing left once you have paid for the statutory services that need to be provided and met the NHS Agenda for Change costs. 

“It means you have to be creative. There are pots of money available. In Derby, for example, we are part of the family hubs network and have used some of the money to invest in a specialist health visitor role. If we harness the knowledge and skills we have in public health and children’s services, I believe we can make a difference.”