Case study 2: Metropolitan Borough Council
Interview with Adrian Watson - former Chief Environmental Health and Licensing Officer, currently on secondment to a joint post between Environmental Health [within Planning and Regulation services] and the council's Performance and Development service.
Adrian Watson was Chief Environmental Health and Licensing Officer at Rochdale for seven years. He has found himself increasingly involved in the wider health and wellbeing agenda. The publication of 'Environmental Health 2012' in 2002 came just at the right moment, he believes. It gave legitimacy to his own attempts to take a more holistic view of environmental health, which had a somewhat narrow focus on enforcement that put it in danger of ‘going down a blind alley'.
Adrian Watson's grandfather had been a sanitary inspector and chief public health inspector, qualifying in 1934. Then there was still a widespread recognition of local government's pioneering work in public health. So it seemed natural to Watson that the profession should return to its roots: looking to the impact of the environment and other factors on the whole person and on people's health. In other words, what is now regarded as the ‘wider determinants of health'.
Exploring these issues with senior colleagues, Watson found a willingness to move the service to a more holistic approach, oriented to population health. An early success was the setting up of a joint post between the primary care trust's (PCT's) public health directorate and the council's Environmental Health service, to lead in smoking cessation work.
At the same time, the whole service adopted a more preventive approach. For example, the Food Hygiene team stopped seeing themselves just as regulators. They positioned themselves as supporting businesses in taking a proactive approach to healthy eating.
A healthy food award, with gold, silver and bronze categories, has been developed and a food promotion officer has been appointed. Watson is keen to point out that this has all been done without additional resources. He says:
"It's possible to develop more of a health focus without huge additional resources."
"We have to do it this way - we know we're not going to get any more funding without at least demonstrating, through pilot initiatives, that our work can have a real health impact."
Influenced by the need to demonstrate achievements and the NHS's moves to a more evidence-based approach, Watson began to consider how to measure the health impact of Regulatory services. An integrated impact assessment has been developed, which builds on the methodology of health impact assessments (HIAs). Watson says:
"This started off as an idea for a tool for environmental health and is currently at an embryonic stage. Eventually we hope it could be used across the whole council."
Rochdale is a very deprived borough with very challenging health and wellbeing issues. Watson increasingly came to believe that the council could do more to contribute to the health of the population.
He supported the identification of health and wellbeing as a priority in the new sustainable community plan when it was renewed in 2008. He joined and later chaired a corporate ‘health think-tank', contributing to the development of a health and wellbeing strategy.
At the stage where the strategy was about to be approved, there was a realisation that a delivery plan was needed for the council-wide agenda. This resulted in the joint funding - by Environmental Health (within Planning and Regulation services) and the council's Performance and Development service - of the post to which Watson is now seconded. Watson will work initially for 12 months with the likelihood of a further extension.
Support from wider sector
There are very good relations with the Department of Public Health and support from the PCT for the council's health-related work - the jointly-funded ‘tobacco free' post being an example of this. Watson sits on the relevant commissioning and partnership boards and is seen as a ‘champion for health' within the council.
Does this mean there's a danger that if he left, the health focus of Regulatory services and throughout the council would lose momentum? He believes the answer is 'no'.
"Because we had developed a shared vision about the broader role of Environmental Health, now that I have left the department, the vision is still there."
"A council Health Improvement group has now emerged from the think-tank and all services are expected to be involved, including ‘internal' services like human resources."
A joint health unit, funded by the PCT, is co-located with Adrian's post at the council.
It is through the Health Improvement group that Watson is establishing a process of ‘peer challenge' for all services. This will be based on the IDeA's Healthy Communities peer reviews and also on the peer framework for Regulatory services developed by Coventry City Council, Westminster City Council, LACORS and others.
It will challenge each service ‘from the bottom up' about its contribution to health. A report agreed between the service and the ‘peers' will be agreed at the end of each review. This will be the basis of the service's contribution to health in the next planning cycle. Currently, the peer challenge process is being piloted with the Planning and Regulatory services of the council. The intention is to invite the IDeA to carry out a full Healthy Communities peer review in 2010.
"It is important to remember the role of members in this health agenda."
He believes he has good relations with members and can engage them in the broad health agenda. This is because they understand that their constituents are suffering the related consequences of deprivation and poor health. The Health Overview and Scrutiny committee has just revisited its work programme for the coming year and has agreed that every meeting of the committee will have at least one council-focused agenda item, looking at the council's contribution to health.
"Our councillors have realised that they have a multi-million pound organisation that can have a huge impact on people's health, in areas like sexual health, alcohol reduction and so on. They are gradually moving away from a default ‘medical model', where health is the business of the NHS, to a more psycho-social model in which all public services play an important role."
Building on regulatory skills
Watson believes that getting fully involved in health and wellbeing means that regulators can use the full range of their skills and training.
"Being seen as ‘just regulators' is missing a trick and fails to draw on all of our skills."
He makes the point that regulators' skills can be useful in delivering projects aimed at improving health.
"Persuading the Education department to prioritise health is not so different from going into a food business to get them to promote healthy eating. We need to show that our training is useful in helping to champion change generally. Regulators should revisit our skills sets and value systems and think about how they can be put to use in achieving the objective of improving the health of the people we serve."
Otherwise, Watson believes that what he sees as a ‘massive opportunity' for regulators could turn into a threat to their services, if they don't see themselves as ‘part of the wider world'.
7 April 2015