Top tips for directors of public health and other NHS staff

1. Find out what local authority regulators (LARS) do, what their remit is and what scope they have for health links
The easiest way into this area of local knowledge for a director of public health (DPH) and colleagues is probably the director or head of service that includes environmental health, trading standards and licensing. Sometimes the officer's title will include references to these services, sometimes not. The council might use terms like ‘regulatory services' or ‘public protection'. The key will be to seek out the relevant managers and explore how the services are delivered locally. In two-tier areas, environmental health and licensing are delivered at the district level and trading standards at the county level, so you may need to approach both tiers. The LARS interviewees for this publication were passionate about health improvement and their own role in tackling health inequalities. By linking up with them, you will be making useful strategic allies.

2. Establish long-term channels of communication with LARS
All the interviewees agreed that an ongoing relationship with, for example, the DPH, was an important one in maximising the health impact of LARS. But it is also important for there to be communication among less senior operational and frontline staff. If there are no regular forums at which NHS and LARS representatives are present - for example your health and wellbeing partnership board - either ensure that LARS representatives are invited in future or make sure that new forums are established to provide opportunities not only for exchange of information but also for joint action planning.

3. Be aware of the potential for LARS to contribute to existing cross-sector activity
Your joint strategic needs assessment (JSNA) will undoubtedly have identified a range of local needs that require health service input and which are taken up in the form of targets in your local area agreement (LAA). Not only is there potential for ‘added value' by joint work between the NHS and LARS on common targets - such as the alcohol abuse aspects of crime and disorder targets mentioned in the checklist for local authority staff - but LARS can also contribute significantly to targets which appear to depend on NHS or social services' intervention. For example, there is increasing evidence to show that carrying out minor repairs in private homes - the need for which would be identified by the Housing Health and Safety Rating System used by LARS - prevents hospital admission from falls and accidents in the home. So LARS can help the NHS meet some of its most urgent and central targets while contributing to some of the services most valued by older and vulnerable people.

4. Use opportunities for joint training
Joint training enables public health staff and LARS to understand each other's roles and do some creative thinking together. Most council tax payers who don't work for a council have very little idea of the services provided by local government. Your public health colleagues may have a better idea than most, but it is likely that they won't know exactly what LARS is and, therefore, won't know their potential in relation to health. Conversely, joint training is a way for you and your public health colleagues to develop the understanding of LARS about health issues, the health profile of the local area, the evidence for interventions of different kinds designed to improve health and, therefore, their own potential to contribute.

5. Use LARS allies to assist in developing a corporate approach to health in the local authority
Well-planned health improvement work in a local authority will only ever amount to a number of individual projects unless the council develops a concerted corporate awareness and an organisational approach to health. Allies among LARS colleagues can help embed this approach, as numerous examples among the case studies indicate. This help can involve anything from funding joint posts, to educating elected members, to developing strategic policies or a ‘Health is Everybody's Business' course for the local authority. The head of regulatory services in a local authority is likely to be a chief officer, or have the ear of chief officers, as he or she is responsible for core statutory functions. This authority can potentially be put to good use by, for example, a director of public health working together with a senior LARS colleague.

6. Help LARS colleagues develop appropriate health impact assessments (HIAs)
HIAs are increasingly used as an analytical and evaluative tool by local government. Some regulatory services may be more familiar with them than others. A primary care trust (PCT) public health team can help LARS colleagues develop the most appropriate kind of HIA for different aspects of their work. This can be a way of raising awareness, as well as contributing to an evidence base for joint interventions.

7. Make use of your non-executive directors to get councillors on board
Almost all local authorities have a councillor in their cabinet with named responsibility for health and another or additional others with responsibility for LARS. They need to understand the potential for mutual support in each other's roles. Assisting your non-executive directors to establish good and regular relations with the leader of the council and these cabinet members is one way of helping councillors to understand the potential synergy between the NHS and LARS.

22 September 2009

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