I have heard a lot in the past few months about the debate around terms and conditions of Consultants in Public Health who may transfer over to Local Government. (This debate has been quite heated despite the fact that no HR guidance has been forthcoming either from DH or Local Government Employers yet, and won’t be for a little while. ) People are understandably anxious. I would be anxious if I’d been in one organisation for 20 years and were suddenly being transferred. And the change from NHS to Local Government does feel like the leap of faith till you realise hundreds of people each year go between the organisations and back again. I work with people who have had eight different nhs employers in ten years, and one local authority employer for five or more years. There is cause for optimism while we await the frameworks. And there is much we can do to foster the desire and skill for our best talent to flourish in local government. (More on that next blog.)
But the discourse I have so often been on the receiving end usually goes “you’re in local government, aren’t you?” followed rapidly by “Well Local Government doesn’t want to pay Consultants in Public Health the salaries they’re on and I think everyone should be employed by Public Health England.”
The debate seems still to be heated, and when I sit down with people, what usually gets agreed between us is a) there is still some anxiety about local government, public health england is perceived by some – not all – to be safer [for more or less good or bad reasons] c) the delay in getting HR issues resolved is unsettling a lot of folks and d) some of the folks on both sides of the organisational divide have made remarks which make it feel like people coming from the NHS will have to do the equivalent of asking Charon to ferry them across the Styx to Hades, or pass through Dante’s gates into hell, leaving behind all hope as they do; driven by the “necessity, not pleasure” which brings them there (Canto XII of the Inferno.)
This less than charitable or helpful debate is despite the fact that many local authorities are publicly saying they want to welcome public health staff as a valued source of talent and strength to the local authorities existing strengths, and get the best from all.
People are not, and should not expect to feel, as if they are crossing the Styx or entering the Seventh – or any other – cirle, leaving behind their terms and conditions and any idea of career advancement and satisfaction behing them. And in our heart of hearts we must surely know that we need less foretelling of woe and a wee bit more honest engagement in this debate. The sequence of recent letters and commentaries in the medical press has certainly sometimes shed more heat than light.
We all know a few folks in local government – NOT ALL – have made some statements as rash and unfriendly as those coming from a few folks – NOT ALL – in the NHS and other agencies. (I am not throwing mud here, I am saying there must be a better way.) We and I may even have contributed to this, however unwittingly or unintentionally, ourselves.
Trying to find a more eirenic approach which is based on mutual appreciation of strengths is building steam across the Country. I think this will bode well for recognising the tremendous asset public health consultants could be to local government.
I have written elsewhere, and am about to produce more, on how we can bring local goverment and NHS into a constructive agreement. But meantime, here are thoughts on the thorny problem of considering why consultants in public health should be valued. First we need to look at what’s not working in the debate currently.
So, what are the arguments unlikely to work?
None of what I am about to say in any way diminishes how important I feel public health is, or how much of a unique contribution we can make. But our issue is in how we present this and make a credible case for it.
Claims that public health consultants are somehow so different ( by virtue of regulation or accountability or the fact they are public health) to the other professions local government employs, that they are unique, seem to fail very quickly.
From an HR or finance perspective in local government, or any large set of systems, this argument is not really very strong. In common with consultants in public health, the following professions (just a sample) employed by local government are all i) regulated statutorily or otherwise, ii) have specific qualifying routes and iii) have accountability to professional bodies:
- Veterinarians (statutorily regulated)
- Nurses (statutorily regulated)
- Psychologists (statutorily regulated)
- Solicitors (statutorily regulated)
- Barristers (statutorily regulated)
- Chemists (Royal Society of Chemistry regulated)
- Engineers (craft workers)
- Electricians (craft workers)
- Trading standards officers with police and criminal evidence act powers
- Social workers (statutorily regulated)
- Teachers (statutorily regulated)
All of these professions have salary grades and terms and conditions recognised in one or more of the local government frameworks. Most local authorities are moving to single or grouped categories of salaries contracts for all of them (except craft workers) because it provides ease of management and has financial benefits to the organisation. All of these professions have some “special” or “different” or “unique” role. From a local government point of view, the uniqueness of the public health role is actually nothing new. Far from being a point of anxiety, we should treat this as a point of encouragement in negotiations.
Typically also salary grades in local government are made up a) of seniority reflected by budget and staff/service management responsibilities and b) technical or other expertise which is admittedly somewhat secondary, but not always. So arguments about uniqueness are not likely to succeed, especially when they have not succeeded with any of the above professions.
When seen from an HR profession, this is just one more profession local government absorbs into a range of specialist professions making up the workforce to do what the Local Authority needs to do. Public health is not “unique” in HR terms when you are managing so many “unique” professions .
Yet as Directors of Public Health we will depend very much on the talent of good consultats in public health (and public health medicine), and hope to make them our successors. So we need to make a sound and credible case for why local government needs them, and why we should value them at the extent we do.
So what might work?
This will need some careful advice and input from HR, but here is the combined set of arguments I think from discussions with colleagues in and outside local government, which is likely to preserve most of the terms and conditions and value of the Consultant cadre.
- Safety and effectiveness of the service: A public health service, especially given the highly technical nature of it, will not be safe without consultants. Their range and span of responsibility is significantly beyond that of comparable deputy/assistant directors because of the technical and other responsibilities. Because of this they need to be at the peak of the profession scientifically. The post of consultant in the NHS has historically been given to someone who has reached the practice peak of their profession, and their training and expertise reflects this. In order to be safe in the discharge of public health functions, the local authority needs consultants because they have the requisite training and expertise.
- In particular, Government has now stated that the statutory functions of advising NHS commissioning will come with the Director of Public Health, along with statutory health protection functions. Because of the highly specialised nature of these, these positions need consultants a) to be able to practice safely and effectively [and not end up with clinical commissioners suing the Council for duff advice] and b) to be able to influence other clinicians who will expect people of an appropriate status of expertise and professionalism from public health to be making decisions.
- Recognition of Specialism. Local Government frameworks do recognise specialisms to an extent. The specialism of public health consultants is very high, on a par with consultant clinicians. They bear significant weight of responsibility for the advice they give and the expertise they have, and their accountability. It is this which is reflected in their training, salary and conditions; and their registration to protect the public. This needs to be recognised by local government.
- Investment to save. Consultant posts should be seen as an investment to save, they have some key skills which could be applied across the council’s whole portfolio, not just for health improvement but to help the council meet its entire goal set. The skills are: a) Assessing and finding evidence of effectiveness, b) Identifying effective interventions, c) Identifying value for money, d) Service redesign, e) Monitoring and evaluating impact and f) Priority setting
- Corporate impact. Consultants can make the following impact corporately across the local authority as well as i) Understanding the key drivers of health and wellbeing, and the interventions to improve population health, ii) Understanding the principles of how to target programmes, interventions and policies , iii) Understanding and managing the conflicts between population and individual concerns (equity), iv) Finding, assessing and applying equity, v) Understanding and applying structured ways of doing needs analysis, vi) Applying decision analysis and helping with decision and economic analyses of policy, vii) Supporting effective commissioning using i) – vii) above, viii) Identifying likely prospective policy impact when the evidence is silent, ix) Understanding research and evaluation and applying this to council business, x) Supporting the evaluation of commissioning and xi) Supporting the understanding of complex variables (e.g. different influences on childhood mental ill health) and their interaction in policy and decision making.
These sets of competencies could have a wide and strong application across local government. Applying these skills to youth crime, gangs, looked after children, housing problems and so on – not just core public health – could help develop in local government the evidence and other skills it wants. The impact of public health consultants could be enormous, seen in this light. But first they need to be made to feel welcome, as well as realise that some things will change, hopefully for the better.
I talk and blog often about the “deficit” approach to skills – and how unhelpful it is. Coming into an agency assuming you have all the skills is rarely a successful strategy. Good organisational bringing together sees and values honestly the assets of each stakeholder. I hope, with colleagues, I have found one way of doing it which we’re working on currently.
Those authorities who are having this discussion – and there are some – seem to be developing an ever stronger desire to incorporate public health and include the consultants’ terms and conditions favourably.
It does mean that we as DsPH have some work to do, some of which is about transferring skills. More on that in my next post.