Readings for a new #publichealth councillor

Over the past few weeks, as the local government year starts to ramp up, a number of newly elected councillors have asked me for some basic reading on Public Health.  This is my suggested list for them.  Perhaps you could suggest some?

 

Dear Councillor,

Here is as  promised at the induction seminar the self-reading guide to getting your head round public health. There are many more topics than those below, and I merely set out some of the more important. Perhaps the best thing is to come and talk and if you want material on specific issues like drugs, or children and young people, I will supply you with a list.

Public Health principles: the very basics

Public Health is about working with populations, out of a framework of analysis, evidence and an intention to promote and protect their health. This involves working with a range of determinants of health from education levels to health behaviours and the various threats and hazards to our health which arise from the environment (naturally occurring diseases) and from the products and progress of contemporary society (air pollution for example). Poverty and inequity lurk behind most poor health like an eminence grise et horrible.  In my own mind, neither individual nor societal explanations for the burden of disease and ill-health and poor flourishing our society carries are sufficient. Both must be held in dynamic tension to elucidate what the issue is and what we can do.  Equally, Public Health is not, to me, purely a science. It is an application of various sciences and art.   Epidemiology and Leadership, Evidence and Influencing come together or lie ineffective. They are a blend, if you will.

We now have three out of 6 short e-learning video presentations on what public health is on Herts Health Evidence https://www.hertshealthevidence.org/ and more will be added soon.  You should be able to access these free by requesting an account at the site.

The Open University has a variety of free online courses here http://www.open.edu/openlearn/body-mind/health/public-health

If you wanted a book, then my best bet to start would be Virginia Berridge’s Public Health: A Very Short Introduction Oxford University Press, 2016. Let me know if you have difficulty finding this, I can track it down easily in London next time I’m there. There are many more choices after that from classics like Donaldson and Donaldson’s essential public health through to Geraint Lewis’ Mastering Public Health which is to my mind far more useful than Donaldson and Donaldson.

English Policy on Public Health and NHS (because Wales, Scotland and Northern Ireland all have very different systems.)

This is invaluable https://www.kingsfund.org.uk/projects/nhs-65/alternative-guide-new-nhs-england

The easy read on the last seven years of policy history (about which I could talk without cease and without notes) is this from the Kings Fund https://www.kingsfund.org.uk/projects/verdict/has-government-delivered-new-era-public-health and this set of videos https://www.kingsfund.org.uk/audio-video/public-health-spending-roi . A further read is here https://www.kingsfund.org.uk/publications/improving-publics-health

I think you can trust the King’s Fund an independent health think tank. It’s well respected

Responsibilities of Local Authorities

In terms of the key Public Health Responsibilities in local government, the choices are endless so I would go for the list below

  1. The basic guidance (there is an awful lot more) http://www.fph.org.uk/uploads/DPH_Guidance_Final_v6.pdf
  2. The Local Government Association www.local.gov.uk publications are always extremely valuable and I suggest these two as starters https://www.local.gov.uk/lga-annual-public-health-report-four-years
  3. https://www.local.gov.uk/public-health-transformation-three-years

But there are many more from the LGA, and the LGA website has an invaluable series of publications for local authorities on public health.  I am of course biased but the Association of Directors of Public Health blog has a series of very short pieces. http://www.adph.org.uk/category/pblog/ and it’s worth checking our updates here http://www.adph.org.uk/

Mental Health

The Local Government Mental Health Challenge website is a very useful starting place to some of the issues http://www.mentalhealthchallenge.org.uk/  I find this guide on system wide (population or public health approaches to mental health) commissioning principles useful http://www.jcpmh.info/wp-content/uploads/jcpmh-publicmentalhealth-guide.pdf  and Finally, the Mental Health Foundation’s report is very good https://www.mentalhealth.org.uk/publications/better-mental-health-all-public-health-approach-mental-health-improvement

Health Inequalities

The Marmot Report is probably the best starting place https://www.local.gov.uk/marmot-review-report-fair-society-healthy-lives but there is also a social sciences answer to it too, which makes specific policy proposals, some of which we have adopted in Herts https://www.britac.ac.uk/sites/default/files/If%20you%20could%20do%20one%20thing%20-%20full%20report.pdf

The NHS Sustainability and Transformation Plans

I would look no further than the reports from The King’s Fund https://www.kingsfund.org.uk/topics/sustainability-transformation-plans

I suggest pick these and come and have a coffee and ask any question you like, or we can even do a seminar for your group or whoever.

Happy reading.  I should finish on one note. If you are confused, then you join the rest of us. If it all makes perfect sense, then you really have missed at least one important thing.

Jim

 

 

Advertisements

Skills for leading the system: Law training for leaders in #PublicHealth

I apologise in advance that some of you will find this (uncharacteristically short) post irrelevant. Some of you will find it boring.  I warrant, though, that just a few of you will find this salient and important.

On 13th October 2017, another one day masterclass for senior Public Health leaders on how to navigate the legal concepts they need to be effective in local government will run in London.  The course is free, it explicitly intends to give public health people working in local authorities the key background to the law and practice issues affecting them, and it already filling up.

Skills for managing the system

Sounds off-putting, doesn’t it?  But this course is in its fourth year and everyone I know who has been on it has found sooner or later they needed what it gave them: enough knowledge to navigate a complex issue.

People will spend a day with several senior and very experienced lawyers, getting detailed guidance, able to ask questions, and going away with a resource pack which one delegate from a previous year described as “incredibly handy: I never knew this stuff. I now know I need to know this stuff.”

The course will be delivered pro bono again this year by several amazing lawyers ; including this year Judith Barnes a senior partner at Bevan Brittan and people like Luis Andrade from Herts County Council and the Society of Local Government Lawyers.  It is a joint venture with ADPH.

There are still a few places left on this, contact magdalena.vandersteen@adph.org.uk to book.

It’s my fault, this idea

This course was my idea. I’m not going to apologise for inflicting it on people.  And after several requests from people to tell them why I came up with this idea, I’m sharing with you my reasons. And they’re pretty simple.

Why on earth did you come up with this?

First, local authorities run on the law.  I speak from experience of over fifteen years in local authorities. They are created by Parliament, they have many legally binding processes and a constitution, and legal issues from procuring services to making decisions are all bread and butter for senior people in local government. And these are things the public health training scheme never prepared you for.

Second, if you want to do something in local government, you need to know the legal powers and duties you have, and how to navigate them.  For example, I use a particular power in the Local Government Act 1972 to fund District Councils to do public health work which saves me a significant amount of process and cost.  Planning, Licensing,  dealing with Anti-Social Behaviour, dealing with air pollution: they all require an understanding of the legal principles.

Third, you have to know what makes a system works if you are going to use that to the benefit of the public’s health, whether by making the system work more effectively or bypassing it.

Fourth, public health leaders need to be equipped with the same knowledge as their peers to be effective in working with them.

What use has it been?

I’ve just finished a round of telephone conversations with a small sample of people who have been through the course. The common benefits people identified from being on this programme are those below:

  • Knowledge – knowing enough to know when they need expert legal help
  • Agility – being able to identify potential solutions
  • Being on a level playing field with other senior managers who know this stuff
  • Confidence that they can promote the public health work and defend the budget and team
  • Ability to recognise a potential problem and deal with it early

So, if you are going on the next masterclass, enjoy. If you haven’t, get in quick.

 

 

 

 

 

 

 

Why I’m not pessimistic about councils’ response to vaping in the workplace

This past week has seen a continuation of different aspects of the debate about e cigarettes.  Neal Roff’s helpful and thoughtful blog for people new to using e cigarettes http://stormchildsblog.blogspot.co.uk/ was published.  And the equally helpful UKCTAS report on a depressingly “bad science” World Health Organization position statement was published http://ukctas.net/news/commentary-on-WHO-report-on-ENDS&ENNDS.html

But I want to turn to the report published over the last few days by  freedom to vape¸ http://www.tfa.net/freedom-to-vape/  a campaign of the Freedom Association http://www.tfa.net/about-us/

This report details the results of responses from local authorities to Freedom of Information Requests about vaping and smoking policies, sent earlier this summer.

“Councils ignoring PHE advice”

The report headline on their twitter feed says “87% of councils ignore Public Health England advice” on vaping being treated differently  You can read their comment posts and the report here http://www.freedomtovape.net/new_report_from_freedom_to_vape_87_per_cent_of_uk_councils_are_ignoring_advice_from_public_health_england?recruiter_id=107

Separately, another blog called vapers in power has published a blog linking to the “write to them” website encouraging people to write to local councillors about their policies https://vapersinpower.wordpress.com/2016/11/06/changing-how-your-council-sees-vaping/

Meanwhile, Simon Clark of FOREST has also written about this campaign on his blog http://taking-liberties.squarespace.com/ giving a different take.

Finally,  a report claiming – implausibly in my view and that of several lawyers I have spoken to – that councils are using “illegal” vaping bans was featured in The Mirror on 5th November http://www.mirror.co.uk/news/uk-news/illegal-vaping-bans-mean-third-9204911

Helping or hindering?

Transparency is always good, and indeed it’s helpful for citizens to write to their elected representatives giving their views on issues like this. I also note that the transparency of councils in Freedom of Information requests is far greater than the transparency of some agencies commenting on this, and the story is being used by some to bash councils and public health. I think that will prove counter-productive and some councils at least will decide not to tread on what feels like an increasingly fractious and flammable path, even if they can see good at the end of it.

One DPH recently told me anything they say positive is met by some people on social media – who really don’t represent vapers but many folk wouldn’t know that – with tweets about them being evil and how public health and tobacco control want shooting.  And then we wonder why public health folk are keeping their heads down in this debate.

The FTV report, while useful, doesn’t tell the whole story

There are several reasons why I don’t think the latest freedom to vape report tells the whole story. Doubtless some will disagree but let me list my reasons why:

  1.  The PHE report which contains guidance for workplaces https://www.gov.uk/government/news/vaping-in-public-places-advice-for-employers-and-organisations was only produced in July 2016.  The Freedom to Vape policy report was issued this past week. That’s just over three months between PHE guidance and the FOI report. The idea that most or even some councils will have considered, read and changed their policies on workplace vaping in that period is optimistic in the extreme, to put it mildly, given everything else they have on.  The Freedom to Vape report can’t be taken as more than a snapshot of what the position was at the time of the FOI. For many councils this will be in a queue of issues to deal with, and breaking even will be top of the list.
  2. How can I say that?  Because I know personally of a number of local authorities who are currently in discussion, or drafting revisions of policy and using, among other sources, the new PHE guidance and work from CIEH and others as a support. We are currently working on ours. I’ve commented on a few, and indeed many have commented on our draft policy.
  3. FOIs are an industry. Most local authorities employ a team to answer them. And I suspect (indeed having had informal discussions I know) that some councils have had their FOI team look at existing policy on the intranet and answer the FOI from freedom to vape. This won’t have captured that nuance. And it wont have captured those authorities where discussions have taken place but nothing is being written yet. The freedom to vape report, in that sense, misses out some work going on.
  4. You may say the FTV report will only miss a few local authorities doing positive policy development.  But local authorities tend to be pack animals. They watch and learn what others do and follow those they think are best, especially in an uncertain area.  And I know from speaking to people across the country that this is exactly what’s going on here. The few will shape the response of the many, in time. And three months is not enough for that to happen.
  5. It will take time, because there is no statutory duty on local authorities to do this, no policy obligation to do it either and the PHE guidance isn’t binding. Local authorities have discretion here and the key for people who are pro e-cigarettes is to help councils and support them use evidence and guidance sensibly and wisely. Frankly, the state of this debate will make some councils wish to exit the debate because it begins to look like a thankless low priority task when they’re about to fall off a financial cliff.
  6. Given everything else on the corporate agenda of councils (finances, social care, moving to business rate retention, devolution and so on) we need to find ways of making it easy for councils to do this. No amount of opprobrium and campaigning will make councils prioritise this if they think all they’re going to get is noise and hostility – even if it’s only from a few and the intention behind this report was about doing some good for peoples’ health.
  7. Several multinational tobacco manufactures have developed new, potentially risk reduced tobacco products which heat the tobacco but do not burn it. The Committee on Toxicology has been commissioned to evaluate the available evidence and at least some councils will probably  want to await this report before making any definitive statement or revision of policy.  Independent evidence on this latest development is extremely scarce but a study by the Dept of Public Health at the “La Sapienza” University of Rome suggests that it may be more appropriate to treat these products like e-cigarettes than to treat them like smoked tobacco.  What is likely is that councils, given everything else on their agenda, will not want to revise their policies several times within a year.

But there is a wider issue here, surely?  Why focus on just councils?  What about NHS, civil service, other public sector and commercial and NGO/third sector employers?  From what I can see and the discussions I’ve had with local employers, many of them don’t seem to have moved very far since July either. That’s because this shift will take time. The HR world is still in many places working out what it means in terms of employment law and local workplace policies and contractual entitlements.

Don’t just dismiss the FTV report

There will be some who dismiss the FTV report as a hostile publicity stunt, done in haste and poorly thought through. That would be a shame. And that’s a line I am neither going to believe nor support. The report was done by people passionate about the benefits of e cigarettes, I believe done for good intentions, and it does give us a snapshot of where councils are at and where the opportunity lies. The task now is supporting the HR community with getting on with this.

Time to re-orient how we debate with one another

I worry that there is a danger that some councils will see the report through the lens of some quite frankly hostile social media coverage (some from people who don’t like local government anyway) and decide they will wait and see what others do rather than trying to change things and get even more opprobrium.  To that extent, there is a real possibility that some of the social media coverage around this may backfire.

There is a whole discussion about people saying public health and tobacco control are fit for nothing, well I’ll address that another time.

Some factual corrections to the recent debate

There’s also some factual things to correct here:

  • Media reports that PHE advocates vaping rooms are not correct.
  • PHE has avoided prescriptive guidance and has proposed 5 criteria to help form local policies. The fact they have avoided prescriptive guidance means employers have to rely on their own interpretation of the law and their local contracts. The idea that most or even many employers will manage this between July and end of October is a triumph of hope over reality.
  • A conversation with a knowledgeable employment lawyer this morning told me that they and their legal colleagues have met with derision the media claim that local authorities are acting unlawfully on this. As someone who has worked in HR, I personally cannot see the legal claim for this. Employers remain able or not to consider whether or not to allow vaping.
  •  Establishing a right to vape in law will be very difficult, and would undoubtedly need legal precedent

Where next?

The adoption of the PHE principles will take time. We’ve been working locally on our policy for several months. That wasn’t reflected in our FOI response to this. This is not cause for anger or depression.  Nor is it cause for trading insults. We need to take the heat out of this debate.

There are lots of challenges lying ahead in developing and taking an evidence-based approach to welcoming e-cigarettes and similar devices. Setting to each others’ throats or “bigging up” an issue as a legal one when it isn’t – at least not in the way some folk report it – is not a recipe for elucidation.

 

 

Leadership…it’s not all transformational in public health

I don’t know about anyone else but when I was training in Public Health, things like leadership education were largely missing. I was lucky to get onto the national Public Health Leadership programme over a decade ago now, and even luckier to have other training.

And yet leadership is an absolutely central function in public health, and leadership across systems especially. http://www.slideshare.net/jamesgmcmanus/leadership-and-ds-ph-update-oct-2014

You’ll be aware from a pile of postings, articles, slideshares and other stuff that I have an interest in (obsession with?) leadership in public health.  This is at least partly due to reflections on my own failures and a desire to try and get it right. And it’s partly due to my training as a psychologist. In the last few months I have reflected again on my own leadership roles but also have done a number of sessions for new public health leaders.

One thing I have noticed is that Transformational Leadership models seem to be the flavour of the month at present. I have found transformational leadership models, especially when adapted to the public sector (e.g. the work of Beverley Alimo-Metcalfe on local government) very helpful. Try these links for more reading on this:

The last link above on Post Francis enquiry approaches is especially interesting.

But there are some challenges with Transformational Leadership models, before we go running down the road to apply them in preference to anything else:

  • Some commentators feel transformational leadership is better in an organisation. When you work across a whole system, as public health leaders need to try to do, there are additional behaviours, styles and tactics you need, and you need to flex your style much more as a system leader across different organizational cultures than just transformational models would suggest
  • Transformational leadership training is not always good at explicitly integrating the scientific background of public health senior roles with the leadership tool portfolio they need
  • There is a very thin line between transformational leadership and dictatorship or bullying. Engaging people in your system and organisation is hugely important with transformational change and leadership and rightly many researchers are now emphasising this.  Beverley Alimo-Metcalfe, who created among other things the Local Government Transformational Leadership questionnaire, has spent a great deal of time on the importance of this.

Dennis Tourish’s new book The Dark Side of Transformational Leadership (Routledge, 2014, £24.99) is a salutary read on the strengths and weaknesses of Transformational Leadership as a model and theory.  He presents a significant amount of research on transformational leadership and case studies. The book has a good style, discussion questions and reflection questions and if you’re looking for a CPD text then do yourself a favour and give it a go.  Even if you only read the last chapter on new styles of leadership and better ways of thinking about leadership.

But he makes a range of important points that Public Health leaders who are attracted to transformational styles:

  1. Tourish spends some time in his book looking at the (usually catastrophic) consequences of leaders with vision whose decisions have not been challenged or helped to mature by being reflexive or open to others. There is always the potential that leaders in trying to transform do as much harm as good
  2. Unregulated power in a leader (I’m sure many of us have been there, on whichever end) is not a good thing and a key part of leadership in a system is about being held to account as much as holding to account. Leadership seen as service, as enabling a system is better at that
  3. Transformational leadership models in people who think they know better than anyone else can become a justification for arrogance. Public Health has not always been a stranger to that arrogance about its role, importance and abilities.
  4. Transformational leadership which is all about the leader and not about the team or organization or structure can have, like any leadership style, profoundly negative consequences on others.

Transformational leadership has its place. But if you are a public health leader in a system which doesnt want you, or is dysfunctional, or where others think they know your public health job better than you, then I am unsure that transformational leadership is the solution. An adaptive style which enables you to assess situations and use a menu of styles, tools, tactics and mechanisms is more likely to be helpful.  And indeed much recent research on leadership seems to be showing that across mutliple context systems that works. http://www.slideshare.net/jamesgmcmanus/adaptive-strategic-public-health-leadership

Trying to apply this is an interesting process, and I sat down one day with a group of colleagues when we were sharing challenges and perspectives. I have some rules of thumb on leadership which seem to be working at present:

  1. There is no Perfect style or perfect leader:
    • I will never be a perfect leader and there will always be fallout from what I do. But thats not an excuse not to do better. Doing better is the whole point
    • There is no single model of leadership which is right.
      1. The best “model” (or rather frameworkk which enables us to take different bits of different models) I can find at present is that of distributed, adapted leadership which is about leading systems. It takes in a range of elements including the transformational. You can find my presentations on this here   
      2. Leadership is a journey towards being authentically you and truly effective. That journey never ends and we can all always do better
  2. As with all public health, science and art must be held in dynamic tension to be effective and authentic
    • The science of leadership, good solid psychological science, needs to be taken seriously. But the more science I read on leadership, the more I realise it’s just as much art as science.
  3. Sources of reading and learning
    • Do yourself a favour and check out reviews in decent journals like  Harvard Business Review, The Psychologist or Management Today rather than buying blind in a book shop
    • Rarely trust anything you buy in an airport book shop
    • Do Read Harvard Business Review (even if you do find it in an airport bookshop)
  4. Models can be deceptive
    • If a model or course sounds too good to be true (you will become an amazing leader in one day) it usually is.
    • Be sceptical of people who espouse a model of leadership but have never led in your context. (If you haven’t spent a day in local government, how do you truly understand the context? .)
    • Models will change and my learning and style should change as knowledge develops
    • Over-reliance on one model is usually unhelpful because it limits your grow
  5. Think of Frameworks not models
    • A framework tells you what sets of thing you may need to be doing rather than prescribing “this is how you do it”. These rules of thumb are my framework
    • Ethics, Values, Vision and Context are as much a part of any good framework as tools and tactics and inventories
  6. Leadership cannot be context independent and be effective
    • Leaders are set into not apart from the contexts they serve (so the “independence of the DPH” needs to be handled carefully here).
    • Beware the “high” doctrine of leaders as great individuals. The context and the people make the leader as much as the leader.
  7. Leadership is a service to the common good or it is nothing
    • Leadership is a portfolio of influencing skills and tactics to get to the common good (ok this is my bias, but I bet you have one too)
    • That desired good will always be changing, like everything in life
  8. As the recent Kings Fund report suggests, as a leader across systems you need to be comfortable with chaos. Please note that my and your leadership style creates at least some of that chaos anyway!
  9. Dont expect people to be gentle and trusting of your leadership style if you cant spend some time being gentle and trusting of you and them
  10. Four golden functions: Nurturing, Guiding, Healing and Reconciling and Discipline (I dont mean sticks I mean holding a line and standard to keep people to) are important in leadership, and you need to be a receiver as much as a giver of these
  11. Leadership always has a dark side or down side
    • It may be just the fallout from your style. It may be just the dysfunction of being human and imperfect. But leadership ALWAYS has a down side, at least for some of those your leadership touches. If we don’t deal with this openly and work out what to do along the journey then our leadership is unethical.

Anyway, these are the things that help me. It may be different for you. Let’s help each other on our journey.

Influencing and tactics – some thoughts

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 :

  1. 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.
  2. There are a few areas we need improvement in, like continuing the upward trajectory on chlamydia testing and so on
  3. The skill set needed to do public health in local government is a hybrid – technical skills + programme management + influencing + system wide working
  4. 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.

Relationships

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.

Values

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.

Public Health Leadership: the conversation continues

Having been working on leadership styles appropriate to public health in the new English system, I thought it was about time to share the results of some of the conversations I’ve been having, since the last time I posted.

I’ve had conversations with a range of people about leadership and DsPH and domain skills and way back in 2011 there was a colloquium on leadership and local government at which I presented from an organizational psychology perspective and as a DPH in local government, about the leadership styles and roles of the DPH. You can find this here. http://www.sph.nhs.uk/what-we-do/how-we-can-help/local-government/lg-colloquium-1

My perspective

I come at this as a psychoogist, who is CIPD qualified and qualified in strategic learning and development. I have been involved in leadership development in local govt, nhs, third sector and faith settings since about 2000. I started doing leadership development for community safety managers in local government at the time, on secondment to the Home Office.

I’ve also done leadership development in third sector, faith and safeguarding contexts, including work on self-care for leaders.

Most importantly, from my perspective, I found a lot of the models then being discussed not very helpful for a number of reasons. Some models being advanced were too focused on technical competence. Others focused more on “holding the ring” , while others seemed to suggest a largely transactional style focused on statutorily defined functions.

I argued at the time that we need a larger model of different domains for public health leadership, and three years (and many workshops, seminars, learning sets and my own reflection on my leadership style) later, I still think that multiple domains of competence for leaders are where we need to go.  My own colleagues and teams may tell you I am good, bad, rubbish or (as I think myself) a mixed bag on my own leadership. Personally I think as leaders we are always “on the way” and need to reflect and learn as we go.

So I set about doing three pieces of work. The first was developing further the work I presented in 2011. The second was doing some work on what types of leadership “style” might be suited to public health leadership today. The third is working with ADPH and others to develop some specific “content” for public health leaders – like the seminars on understanding how local government law is crucial to working in local government these days. I hope to do more of this content stuff.

Developing future leaders is different from supporting existing ones

Public Health England have been working with a number of other agencies to produce a  programme for future public sector directors (which I think will be excellent), and will focus on building new leaders and directors across childrens’ service, adult social care, nhs, local government and public health together. This could be very powerful at integrating  and producing leaders working across the whole system. But while this is excellent, we still need some work to develop further and support existing public health leaders.

Why existing initiatives may not work for current senior public health leaders in local government

My own view is the leadership models from the NHS and those proposed by a number of agencies don’t work for the following reasons:

  • Existing models and programmes don’t necessarily incorporate the multiple domains of skill and competence the DPH needs to show to be effective
  • Another major area is how to influence across systems, when many DsPH have been trained to be technical not system leaders and some are better at it than others. Similarly the training scheme doesn’t always prepare trainees to come off it ready to do this at the level they need to in local government.
  • A third area is the domain specific knowledge and competencies for local government which need to be added to technical public health domains.
  • A fourth area is partnership and system wide distributed leadership skills, which some have more of than others.

Another point about my own experience is important here, because it has influenced me significantly. When I started in local government in 1990 (so I have been much more and longer a local government officer than an NHS one) as a new Principal Officer (as we were called then) I got sent to London or Manchester once a month for three years for a programme on skills for local government management and leadership. This ranged from technical skills (local government law) to the crucial skill of understanding the members and officers of the local authority [or even department within the local authority] I would find myself in, understanding the culture and knowing which styles of influencing and working work and which styles don’t. This was essentially a senior local government finishing school. It was the best programme I ever did. It’s a programme I wish someone had run for me as a new DPH and it’s a programme I know a lot of existing DsPH would find valuable.

It also helped me understand when to stop wasting my time in a role I would never fit and move on when needed. Not every public health leader or local government leader is right for every local authority. The issue of “person-organisation fit” was something we can easily conclude is more important in local government. But in reality it was important in the NHS, they just dealt with people who didn’t fit in different ways to local government.

Understanding leadership from the inside

The literature on leadership development is littered with reflections from people who have designed programmes have done so from “outside” the system they are looking at in one way or another , which means a particular view of what is needed or a particular solution is chosen without necessarily investigating it thoroughly from the inside out.

One of the common themes in conversation with DsPH is that a number of programmes for us seem to have been designed from “outside” the context DsPH are now in, so miss a number of issues. We need to understand the challenges from “the inside” to design effective development and programmes. Listening to DsPH in local government is going to be crucial to design effective programmes for them. Equally, helping people in local authorities and people in Public Health England learn about the other by immersing them in each other’s agencies is potentially very useful, and is happening in a number of areas with PHE people and local authority people shadowing each other. This kind of exchange can only be good.

But the issue of leadership style still needs to be addressed. There are many common areas where people across the system can do some similar work on leadership styles. But I can’t get away from the feedback I get that specific work around public health leaders in local government is still needed.

Some potential solutions from Occupational Psychology and Leadership research

So, onto the specific pieces of work. Again I stress this is “on the way”. The history of research on leadership had been typified by a range of paradigms, models and concepts which have changed, dialogued and developed over time. The “leaders are great men” theory, common in the early thirties, is one few people would seriously subscribe to now. But a bewildering array of models from trait theory, servant leadership, transformational, transaction and situational leadership to diversity leadership all exist, with varying challenges and problems. And all of them attract researchers and practitioners for different reasons. My own take after years of working on leadership is:

  1. Leadership is a set of influencing tools and mechanisms applied for a given purpose in a given context
  2. The ethical, interpersonal and intrapersonal aspects of leadership are as important as both the task and the situation/context
  3. Many models can be made to work, some are better than others, and the next model will be along in 5 minutes
  4. Be very suspicious of much but not all in airport bookshops, especially if it begins with “leadership secrets of Atila the Hun…” or some such stuff.
  5. Leaders exercise power, there is no getting away from it. That must be done ethically and connects public health leadership directly to the competence of ethical stewardship of self, resources and others.
  6. Leadership divorced from values is dangerous. Leadership without clearly understood and examined values is reckless.
  7. An effective style for the varied role of a DPH is emerging in the world of complex organisations, and I call it “adaptive strategic leadership”, about which a little more below.

Conceptualising Domains of public health and leadership – I have updated my 2011 work on Leadership and DsPH with thinking from conversations and discussions and learning events to reflect where I think some of the issues are, and you can find this here http://www.slideshare.net/jamesgmcmanus/leadership-and-ds-ph-update-oct-2014 If it’s useful, use it. If not, discard. Your comments and views would be very elpful.

I have presented these challenges using the occupational psychology concepts of “person-role fit”, “person-organisation-fit”, and “person-system” fit. My own view is many of us DsPH have been struggling to redefine our competencies and skills to be effective when our role, organization and system has changed and the leadership programme currently available have not always been right for us.

Adaptive Strategic Leadership: Conceptualising Leadership Styles – An immense amount of work has been done in the world of leadership research across complex and distributed (geographically or organizationally) systems. After a great deal of reading and reviewing and listening and reflecting it seems to me that leadership style which is adaptive and strategic (see the powerpoint in the link below) is a style which works for the role of senior public health leader in England today. Again, I’ve used the three categories of “person-role fit”, “person-organisation-fit”, and “person-system” fit above as a first way into this challenge.

Based on this work I’ve put forward some hypotheses about DPH leadership styles where I have, I hope, colligated the evidence correctly, but of course have not had either the time or resources to write up the conversations and learning with peers I have done on this, or do some really thorough primary research on this. But for what it’s worth I offer where I have got to so far.

The self-learning powerpoint of this is here http://www.slideshare.net/jamesgmcmanus/doing-the-mix-leadership-mcmanus-shorter

The detailed slides with bibliography on this is here http://www.slideshare.net/jamesgmcmanus/adaptive-strategic-public-health-leadership

And the video of my guest lecture on this is here http://blogs.herts.ac.uk/online-distance-learning/2014/03/17/public-health-guest-lecture/

Finally

I stress that all of this work is essentially “on the way”. I’d love to know what you think. Equally, I’d love to know where you think you have a better way forward

I feel we need a bunch of us to work together on this. My own view is getting this right will move us forward.

Public Health Leadership 2…on being useful

Helen Wilding, a colleague from Newcastle, kindly sent me an article on  preparing leaders in public health to work in a flatter and more distributed world. It’s a good read. And I think it chimes well with both my previous blog on this and the research I’ve been doing, summarised on powerpoint, for our public health leaders of the future at the University of Hertfordshire.

It prompted me to blog the learning I have had from a fantastic peer learning/mentoring set, which has now had its final meeting.  A small number of local govt officers with two private sector folk and some third sector people met every month to work through our strategy and challenges with each other. We did it quietly, and it worked. This, along with being asked by my boss to be the Sponsor from our Strategic Management Board on one of the new cohorts of our own LEAP leadership programme, have been amazing experiences.

The last two months we worked through the special feature on Influencing in the Harvard Business Review from July 2013.  Not what you’d think our usual reading but actually it explained

We each presented our challenge, our strategy and our ambitions for our services and there followed 90 minutes of critical and helpful feedback from our peers, once we had all read (before attending) and then spent 90 minutes discussing the section and especially a really good article on how experts gain influence by Annete Mikes et al (HBR,July/August 2013,pp 71 – 74.)

Members and senior officers often say to me that if all Public Health does is commission what it did in the NHS and no more then we have missed the biggest opportunity in over thirty years. I agree. The big question is, given how small public health functions are, how do we influence across big organisations and wider stakeholders and partners effectively?

We’re not the only ones facing this dilemma. Auditors, housing staff, lawyers, safeguarding, HR, equalities and facilities people all face similar challenges. So we fell on this article with interest and worked through it to see what we could glean.

Time Four Ts: the four competencies of successful expert influencers

Basically, the article looks at some financial institutions and suggests that experts (like lawyers, public health people etc) are good at gaining influence by using four competencies, all starting in T:

  • Trailblazing – finding new opportunities to use expertise
  • Toolmaking – developing and deploying tools that embody and spread expertise
  • Teamwork– using personal interaction to take in others’ expertise and convince people of the relevance of your own
  • Translation – personally helping decision makers understand complex content.”

Those most effective, unsurprisingly, were those experts able to combine these four competencies into useful products and outcomes for others in the organization.  In other words – they added value.

The opportunity for Public Health from this model

This strikes me as a key opportunity for public health, because this kind of stuff should be tailor made for us. But I so often heard colleagues in the learning set and people not in the set but in an outside public health in other areas talk about how public health is not influencing, isn’t getting purchase or indeed is seen as having lost its way or “advising not helping.”

But there is a another side needed to this model

But one thing our learning set reflected on, was on how to be effective in doing this, you really need to get yourself inside the head and mind of the organisation you find yourself in. One of the things we all had in common was that each of us had had a great and clear boss who knew what they wanted, some training or mentoring on specific things, things, knowledge and content about our sector which, in combination with leadership training, made us essentially “armed” with a clear sense of what we needed to achieve and a very clear sense of the tactics, mechanisms and tools we needed to get there. (Hence my working with others to co-produce a strategy, bringing in a four engines of public health model,  identifying the existing system leaders [my amazing partners] and getting work going with partners.)

Armed and dangerous in local government?

I was lucky to go on a series of introductions to local government constitution, finance, procurement and law over the past few years. I was also lucky to go on the Public Health Leadership Programme. And my doctoral studies group is immensely helpful in helping me work through the technical challenges of projects (what do I do about physical activity? What works?) and the tactics of getting it done.  There is a blend I am trying to get to of the science of public health and the art of getting it done.

Leadership programmes for Directors of Public Health are coming, which is great. Colleagues at the Local Government Association will also tell you about the Commissioning Academy and the LGAs own productivity and leadership opportunities. Not many DsPH on these so far, it seems. This will do one facet of helping and supporting us.

To do my small bit towards some of the other stuff (content, mechanisms, tools) I’ve been really luck to work with the good folks ADPH, LGA and LFPHWM to create the first two of  what I hope will be a small series of events to help DsPH become “armed and dangerous” – the rough guide/ boot camp introduction on local government law, one in London and one in Birmingham. These two law seminars are being offered pro bono by two senior local government partners of Bevan Brittan, a law firm which has a justly good reputation. They saw the opportunity and the need immediately when our lawyers approached them, and I have to say I have been impressed by how Bevan Brittan, Herts CC lawyers, and the indefatigable trio of ADPH, LGA and LFPHWM have seized this.

So, what did I learn about the four competencies?

I learned obviously that you need both sides of the coin – the four competencies and the “armed and dangerous” stuff.  On the four competencies I learned enough to create four objectives for my next year’s work. Some of this I am still planning.  I also learned enough so that my Monday early morning “what am I doing this week?” and my Friday evening “how did I do this week?” reflections have changed to incorporate these, and I have used them with some of my team.

Immediately, here are some of the things we have done and are doing:

  • Trailblazing – finding new opportunities to use expertise – applying public health skills to the JSNA, the health and social care integration agenda, helping spread behaviour change tools across the organization, and improving the health of children and older people – these are just some of the opportunities we are trying to deliver
  • Toolmaking – developing and deploying tools that embody and spread expertise – developing easy to use guides to finding and using evidence, running roadshows and helping people be confident in using it,  easy comparators to compare local areas on health outcomes. We need to do more. Pathways and tools for health across the lifespan (early intervention on self harm and mental health, for example) need to come
  • Teamwork– using personal interaction to take in others’ expertise and convince people of the relevance of your own – we get better results when we do this. For example, countryside walks funded by public health are being run by the countryside management service. Who better?
  • Translation – personally helping decision makers understand complex content – an easy guide to public health, explaining what it means, explaining what can be done.

This is just a snapshot. Essentially the whole public health strategy is an exercise in trying to be useful not just commission exactly what we commissioned in the NHS and no more.

And it also reminded me that being useful needs to understand the context one is working in, so that I can understand not only what is useful but how it can be useful.