As part of our 10 years of children's public health in local government interviews, Greg Fell, President of the Association of Directors of Public Health discusses the impact councils have had on child health over the past 10 years but also the challenges they face over the next decade.
Councils have had a significant impact on child health over the past 10 years, says Association of Directors of Public Health President Greg Fell, but they will need to re-double their efforts to meet the challenges of the next decade.
Greg Fell is proud of what has been achieved in children’s health since the move to local government. “I was initially sceptical about leaving the NHS,’ said the Association of Directors of Public Health President. “To be frank, I thought it was a bad idea. But now I would not have it any other way.
“Ultimately, the Director of Public Health role is the same wherever they ‘sit’ – to be the local leaders of health and wellbeing for their population. However, there is no doubt in my mind that working from within local goverment has given us a different degree of influence over those wider determinants of health that will help not just treat ill-health, but prevent it too.
It’s easy to think of children’s public health as just health visiting and school nursing – but by being in local government we have shown it is much more than that. We are having an impact in all sorts of areas – smoking, sexual health, air quality and schools – that we simply would not have had if we had remained in the NHS."
“Take sexual health, services have really innovated. We’ve seen the development of digital pathways to access support and testing and community outreach in a variety of settings, both of which have really benefited young people by increasing access, but still being mindful we do need capacity for face-to-face access.
“We have also partnered with trading standards with some public health teams having provided dedicated funding to crackdown on the illegal sale of cigarettes and vapes. And we have worked with our planning colleagues to restrict takeaways around schools. I’m not sure we would have done these things as effectively from an NHS base.”
But Mr Fell, the Director of Public Health at Sheffield City Council, said that is not to say the work done with health visitors and school nurses has not been transformative either. “They have both become much more integrated with other key services, such as early years help, education, nursery provision and social care.
“And some of the work done on vaccinations, such as catch-up programmes for HPV, has been really impressive. Schools, immunisation teams and school nurses have worked in tandem together in a way that I don’t think would have happened before. There just were not the right connections.
“Of course, we have to acknowledge the funding situation. We simply haven’t been able to fund health visiting and school nursing in the way we would have liked to have. But we can say that about a lot of services. It has had an impact on numbers and that has made it difficult.”
‘Child poverty a worry’
But if the last 10 years has seen progress despite the tight funding situation, Mr Fell believes efforts will have to be re-doubled if the huge challenges for the next decade are to be addressed.
“There are lots of issues that are making public health directors worried,” said Mr Fell. “But probably right at the top is child poverty. It has been getting worse for years and we know it reduces life chances and worsens health outcomes.
“It could have far-reaching consequences. Take teenage pregnancies, the reduction we have seen over the last two decades or so has been one of the stellar success stories in public health.
“But it has probably bottomed out now – and the risk is it could start going up. We know poverty and hope and aspiration are all important factors. We need to take stock on the evidence base on teenage pregnancy reduction and look at what will be the effective interventions in a contemporary context and put our shoulder to the wheel again.”
However, again, being in local government, Mr Fell said, provides public health with a strong platform. “There are plenty of things we can do to help families. Just thinking about health visitors, they are in so many homes and can have such an influence. They can help families with a whole range of things which, in turn, impact health and wellbeing like income maximisation, for example. It is not about them becoming experts, but with a bit of training they will know what support is available and where and how to signpost families.”
Mental health and obesity
Another challenge is mental health, he said. “We’re not going to improve mental health by only investing in CAHMS, that’s like saying the answer to obesity is to invest in weight management services and drug treatment.
“We have the unique 0-19 offer delivered by health visitors and school nurses. This workforce, alongside mental health support teams and early help services, can play a crucial role, with the right resources and support, in setting the right environment and culture in early years and school settings.
“There can be a tendency for schools to become exam factories when they also need to be inclusive, positive and nurturing places too. Whole-school approaches focusing on staff and children and young people’s emotional wellbeing and mental health can help create an environment where pupils develop resilience and coping skills.
“And then there is obesity. There has been a little bit of change. We have seen the increases stabilise a bit, but there’s still a lot to do. People say it comes down to personal responsibility, but that’s just not the case. The food industry has a huge amount of influence with their marketing and advertising. So, we do need the right policy at a national level, but we should not think we cannot have an impact on a local level.
“As mentioned, we have seen with multiple councils introducing takeaway planning policies near schools. We are also seeing councils restrict advertising and sponsorship in local settings. These measures have come about as a result of really close partnership work between public health teams and other parts of councils.
“There is even more we can do though. We have to use our influence and work with the anchor organisation locally - NHS trusts, universities and other public bodies - to have an impact. We have the levers – we need to use them.”
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