Lindsey Davies: Q&A - Royal College of Physicians

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Q&A: Lindsey Davies Image©Jonathan Perugia The opportunities are amazing. Providing we can make sure that public health expertise is still available to the health service, including GPs and hospital consultants, then a DPH should be able to influence every aspect of the population’s health. And improving health and wellbeing will be a major part of a local authority’s work. You could make transport improve health, you could have housing improve health – that is really exciting. What are the major opportunities Q and threats of transferring public health from primary care trusts to local authorities For example, the opportunities to integrate public health into core business-like planning decisions, the risk of a lack of infrastructure, loss of expertise and support staff, particularly against a backdrop of efficiency savings and public sector funding cuts. AAll of those. I think you have got a nice list there. The risk that we haven’t talked about is the risk to health professionals. If you move to a local authority the job will be different and people are nervous about losing their NHS terms and conditions. I know that’s not the sort of thing for a royal college to get involved in – and the faculty is not a trade union – but actually, I really do care. People might leave or retire early, because it is not what they want to do or where they want to be. I am concerned that you won’t have the experienced people to do the jobs. If you look back at previous re-organisations, we’ve lost a significant percentage of staff in each one and they are always the most experienced people. Another risk is relationships. Public health doctors don’t manage large numbers of staff and can’t tell people what to do. It’s all about influencing, knowing who’s who, what’s what and knowing what levers to pull in your local authority to get things done. Whether it’s managing an outbreak, improving the environment or changing policy, you have to get on with people and know them. These relationships develop over time – you can’t just magic them into place. Building relationships through this ‘I would ban transfats tomorrow. If there was a germ that was killing as many people in a year then people would be hysterical about it!’ transition period is important and the risk is that you break the existing relationships. It takes years to get that right. How can public health doctors – and Q the profession in general – adapt to meet the challenges ahead APublic health doctors should be building local relationships with people or strengthening existing ones. We also need to acknowledge that local authorities function differently to health services. Some doctors have experience of this, but others won’t. So the ones that do need to help their colleagues to adapt and those who don’t need to work alongside or shadow people in local authorities – get to know them and establish relationships. It is also important that we don’t lose relationships with GPs. Public health doctors and other clinicians (because it is no good if you have one without the other) need to get into the GP consortia to work alongside them and support them. We can bring the expertise of working with large populations that GPs don’t have. GPs know their practices but as individuals rather than as a big group. They are not used to prioritising in the same way that we are. We are used to dealing with big groups and populations, so we can really help GPs in this area. QHow do you see the relationship between public health doctors and hospital specialists in terms of improving public health Are there missed opportunities at present Yes, I think there are lots of missed A opportunities. This is partly because a lot of public health doctors and nonmedical health professionals haven’t been close to the acute hospital sector for a long time. They may be out of touch because they have focused on health improvement, but equally there are many hospital doctors who don’t know what public health doctors do or how we do it. It is always encouraging to me that when you do get a group of public health doctors and clinicians together that they find, to their surprise, they have a lot to talk about. How you construct those opportunities varies according to what is available locally, but you can’t beat, for example, medical 12 Commentary n June 2011 n www.rcplondon.ac.uk
Lindsey Davies: Q&A Comment Write to us... Respond to any of the articles featured or share your views on RCP matters. Email us at: letters.commentary@rcplondon.ac.uk directors and DPHs, talking about how they can help each other. Quite often new insights and pathways of care develop – it is a great opportunity for a public health specialist to work alongside a clinician. What lessons can we learn about Q major reforms from the past such as the 1990 health reforms that introduced GP fund-holding AThat’s huge. I think I’d go back to relationships. In any big change you lose experienced people because they find it one change too many. We have to try and avoid that. But if you disrupt a relationship it could take years to re-build. If you want to take staff, professionals and the public with you in any programme of change you have to paint a compelling vision – and they have to want to do it. The problem at the moment is that nationally the picture is not very clear. People don’t feel that they are behind a clear vision. Hopefully, after this discussion we will have something that we can really sign up to and move forward with enthusiasm. But we are not there yet. QWhere do you think public health should be focusing its efforts over the next decade ABasically, the health needs of the population and we know what they are – huge chronic diseases, infection, new diseases emerging, and disasters around the corner for which we need to be ready. We also know that there are huge inequalities in health and inequalities in access to health services. One of the challenges for public health is to go back to those three domains [protecting people’s health, improving health, and making sure that the right health services are in place] and make progress in these areas in the next couple of decades. I’d like to think that we have got really good surveillance in place across the country to spot nasty things before they happen. I’d like to think that every health service and social care provider has really good emergency plans in place. QSo do you think that we responded well to the recent flu pandemic that we had last year ALast year’s flu pandemic – I think we responded quite well, I was in charge! [smiles] I was the flu tzar at the DH before becoming president of the Faculty of Public Health. For three years I was planning for a pandemic and then suddenly, just when plans were nearly in place, one arrived! We got a great test of whether our plans were right or not – including the flu line, which was my idea – and I think we did do pretty well. We learned some good lessons and that’s looking really strong now. It is so important that we get that [health protection] right, whether it’s for a pandemic or not. We need to keep looking hard at health services and ask if they are meeting the needs of the population or not. We need to be prepared to make big changes. Look at diabetes, for example. Most diabetics are not in hospitals and yet most diabetes consultants are in hospitals – well that’s not right is it A lot of them are in the community, but we would like to see more of those who understand and can treat the disease working where the patients really are. There are lots of things that we can do to improve health services. Mental health is one I haven’t mentioned at all, but that is huge. I’d love to see better mental health services – public mental health services and prevention as well as cure. We also need to look at lifestyles – smoking, obesity and alcohol are the major health challenges. If we can get a focus on those three that would make a real difference. That means eating healthily, more exercise, less smoking and less drinking. QWhat is your view on the current government’s focus on ‘nudging’ people into healthy behaviours AWell, I think they have all got a place. Any serious campaign or action to make a difference to public health needs a holistic approach. You are never going to make an impact on a health issue – tobacco, alcohol, eating – by just sending out a bit of information or by providing nice parks. You need to have a range of things in place. I think smoking is a good example. People need information that helps them understand that smoking harms. They also need support to help them to stop smoking and regulation to adjust their environment to make it more difficult for them to smoke, or for people to be affected by that tobacco smoke. Information, regulation and nudging in the environment all have a role to play. Healthy eating, for example – I would ban transfats tomorrow. If there were a germ or a bacterium in food that was killing as many people as we think are killed by eating transfats in a year then people would be hysterical about it! QIs there cause for optimism in the public health community AI think there is. We have a government which is saying that public health is important – and they are saying it louder than any government has before. They are saying that they really care about public health and that they really want to make a difference. That’s brilliant. They have made more people more aware, not least across the health professions. Our ambition as a public health specialty is to do ourselves out of business! We want everybody doing public health things and then there would not need to be so many of us. But I shouldn’t say that, should I! We see public health as something that everyone can do. n Read more online... Read and comment on our full-length interview with Professor Lindsey Davies online at Commentary Community, including her views on social determinants of health and on epidemiological research. n www.rcplondon.ac.uk n June 2011 n Commentary 13
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