We’ve been busy writing a review of what we’ve done and achieved since 1st April 2013, and from that several things have emerged :
- Our decision to invest in programme management infrastructure working alongside technical public health capacity was the right one. We have delivered over 143 workstreams in public health since April 2013, according to our overview spreadsheet (also known as “the workbook of Aaaargggh”.) This has won us a reputation for getting on with things.
- There are a few areas we need improvement in, like continuing the upward trajectory on chlamydia testing and so on
- The skill set needed to do public health in local government is a hybrid – technical skills + programme management + influencing + system wide working
- You need to have a game plan- a simple statement of where you’re going
And we had a fantastic Association of Directors of Public Health conference earlier this week. I got to spend an entire day with my Cabinet Member, listening, learning and sharing together. A really important thing to do. And her perspective had a good degree of helpful challenge from someone with significant political experience. Which led me to reflect on and refresh my game plan. Sometimes the best conversations we have are not in the formal briefings but in the informal 1-1s we have over a meal, a coffee, or the brilliant café just along from local government house in Smith Square when we’re there for meetings or events.
The ingredients of game plan delivery
In order to get your game plan delivered, you need a series of things. Programme management, leadership and a host of other things. But most of all you need people who believe in what public health can do at all levels, especially when there are sceptics or you come up against people who disagree with you, for whatever valid reasons.
I suspect I take a slightly different perspective on influencing from some colleagues in public health, and this obviously reflects my learning by experience (good and bad) having been a local government officer or worked in national roles with local government for more of my career than I was in the NHS. So, for what it’s worth, here’s my ramble about this. I know lots of people may well disagree with me but the approach below works for me.
Influencing and “speaking out”
It seems to me we use this as a profession far too liberally. The issue of “speaking out” is something which can be done in a range of ways, and sometimes speaking truth unto power is better done in quiet rooms though sometimes it must be done forthrightly in public. In both circumstances it is better done when all the public health family of agencies can see eye to eye. But the point is not that agencies in the public health family “speak out” together. Writing letters to The … (insert name of newspaper or journal) has to rank as one of the most ineffective influencing tactics of all time. It’s done by most tacticians in my experience to underline an existing influencing tactic, and then sparingly. Useful as part of a tactical plan as one mere strand but in and of itself faintly pointless. And frankly, the immature party political “yah boo” noise coming from some of us just makes us look ridiculous. The trouble with schoolboy shout and pout politics is that you are forever seen as an outsider. You may feel good , but you are almost certainly not doing good.
There’s more than one way to influence and speak out, and the public health family could learn some valuable tactics from Stonewall, for example. Stonewall spoke positively and articulated how and why, things should and could be done, and built relationships. It’s easier to build alliances than being seen as a constant critic. It also means when you do criticise that your criticisms will carry more weight.
Game plans national and local
For me the first rule of influencing is a game plan others can buy into. That may mean you need several iterations of game planning before you get where you want to be. It also means relationships with others are key. And as a public health family some of our agencies excel at this. Others need to do more work on that. The differences between RSPH, FPH, ADPH and other agencies – however important the agencies are to us in what they do – can seem bewildering to people outside public health. I look forward to RSPH, FPH, SSM, UKHF and ADPH bulletins because they give me valuable stuff. And if you have to look up what the initial mean I think that only reinforces my point about bewildering array of agencies.
But there is an achingly heartfelt prayer for Christian Unity I love in the Scottish 1928 Prayer Book which prays “Give us the grace to lay seriously to heart the great dangers we are in by our unhappy divisions.” I pray that in the family of public health agencies our differences do not become unhappy divisions. But it is time to lay to heart the need to work and understand together, and indeed our agencies are meeting and working together. In policy terms when we’re all asking government for something different, it makes the job of government to do public health more complicated than it needs to be.
There is one enormous benefit to having such a number of agencies – if we really get together we can constitute an effective policy network at national and local level. Policy Network approaches are things I have written about before and have been enormously successful in some areas of policy. The public health family of agencies could be such a policy network. There are groundrules about how these work well. I’ve been part of one for 13 years which has lobbied on equality issues and recently by working directly with people who we have historically seen as opponents we have actually secured very quietly a change in national policy. And I have the gift of some new friends and colleagues I admire and respect. On our own, we would never have done this. I’ll write more about policy neworks another time but there is a respectable literature on it, especially in the Journal of Public Administration.
Articulate the possible
And this brings me to my second golden rule of influencing from experience: articulate the way forward in a way which makes it clear to do and buy into. Two proverbs I try to bear in mind and I forget the authors – “if you can’t explain something simply, you don’t understand it well enough” and ” to complicate is easy, to make simple difficult.” Our challenge is to do that. One of our Cabinet Members says that I can in the right time and place be ” a cantankerous git” and “I love it” (I prefer to think of it as robust and thorough). He can read a forty page document and spot what’s missing in ten minutes. And he can sniff the absence of a clear, simple, well articulated plan in the air long before it arrives. I always think of him and three others when getting people to put together a plan.
But the single most effective tactic in influencing I have ever used is investing time in building relationships. And if you want to do that with elected members please leave any ideas that your primary tactic is negotiating skills. Because that bombs in my experience. Mutual respect, an acknowledgement of their importance, an acknowledgement of my role, and a lot of effort on my part to get inside their heads and work out what they are trying to do is the key. And that has always paid off. And they make just as much effort in my experience to work you out. Whether their working you out is supportive is not is partly down to how well you engage from the start.
When members “get” the public health agenda, things start to motor. That may come down to some negotiating, but frankly it’s usually the last tool out of the bag. Articulate the outcomes and reasons in ways that resonate with their agenda. If you cant do that, then find a member in another authority who will mentor you. DsPH as chief officers need officer and member mentoring often because we haven’t had the experience of working with members that other more long-standing chief officers have.
It may sometimes come down to you giving advice that a course of action would not be right, and sometimes even having to be robust in that advice, but the importance of DPH and members “getting” each other – a mutual understanding of each other’s agendas, limits and game plans – is the crucial thing. And being able to express public health ambition in the language which meets the ambitions of members is important.
A kick up the noughties
A next rule of influencing is be ready to renew and change your tactics regularly. Dominic Harrison the Director of Public Health for Blackburn with Darwen said at the PHE conference that “we have a definition of health coined in 1948, competencies set in the 1970s and we call ourselves change agents.” That comment made me go “ouch” and hug him at the same time. He has a point, expressed it well and it resonated round the room with many. There are many ways to advocate change, and “speaking out” if it becomes a default just means you get isolated by the system. Our challenge is to be effective at being change agents, and so we need a large repertoire of influencing methods.
The independence of the DPH
The new system makes us an advocate and advisor for public health. That doesn’t mean we are independent of our authorities and in the NHS independence for non medics like me was really, I feel, a myth. I would argue it’s also a distraction. Constitutionally and legally being a Chief Officer in a local authority means a number of things about sharing corporate responsibility for the running of an authority. (That’s written into my appraisal .) That provides me with far more opportunities to influence for public health than any speaking out would ever give. We are not, as DsPH, independent voices from our employers. We need to live with that and work out tactics for influencing which work within that. Independent advocates eventually get streamrollered or ignored.
My ability to speak out now is no more compromised than it ever was in the NHS. As a non-medic (and remember there have been test cases on this) one did not have in either Agenda for Change or local authority contracts anything like the same contractual freedoms and leeway our medical colleagues would have been able to lay claim to about writing independently to the BMJ, for example. Speaking out in some ways is a very good sign either that relationships have broken down or the person speaking out doesn’t have the skills to influence in a different way. Going back to Dominic Harrison’s pint about being change agents, the world has changed and we need to change how we change it.
So I think there are different styles needed for DsPH who, like me, are one of six Chief Officers charged with corporate responsibilities and those DsPH who are not chief officers. And there is a nuance of approach we need to develop for those DsPH who are in local authorities which are uncomprehending, indifferent or where there are issues, however they arose.
Building the influencing skills
We should be supporting each other through providing leadership and influencing skills while the faculty nationally also does its lobbying and speaking out. For me that leads to two things in particular:
a) How we skill up DsPH to do their influencing role effectively and to take a leaf out of their more experienced chief officer colleagues in some respects.
b) being clear on boundaries, tactics and occasions.
The upshot of this is, I guess, that I am saying we need to get much more sophisticated individually, as a profession and as system about this.
There are small groups of Directors, Consultants and others in public health who meet in learning sets around the country. The ones I know about are about how people work as a network to influence and get what they need to deliver public health.
A final word about values. If all this seems devoid of values, then you are missing the point. The whole point of this is that values are at the centre. If you don’t have values, why influence anything? Values are essential.
Public Health values about social justice, equity and so on are or ought to be at the ground of what we do as public health professionals. But just don’t assume that can only be expressed in one type of philosophical or political language. Public Health Influencing is done in context, and different contexts require different styles and languages.
For me, Catholic Social Teaching is a fundamental set of values which at least in part determined why I went into public health in the first place. You can read more at http://www.catholicsocialteaching.org.uk And if you don’t believe that can be applied in a range of contexts including the corporate world I invite you to check out Blueprint for Better Business,http://www.blueprintforbusiness.org/Home which numbers some of Britain’s biggest corporates in its values-based agenda.
This may or may not work for you. Game plans, influencing tactics and personal styles are personal. But we do need as a profession to get more sophisticated.