Top tips for local regulators
These ‘top tips' are based on the case studies and the lessons that the interviewees feel they have learned in the course of their work in linking regulatory services with health improvement. They were each asked about what they thought were the key success factors in establishing good and sustainable working relationships. They were also asked what they might have done differently if starting again and what lessons they thought were most important to pass on to colleagues in other areas.
Top tips for regulatory service staff
1. Get involved and design partnerships around existing cross-sector activity - find the 'nodes'
Your local authority and primary care trust (PCT) will already be involved in your area's joint strategic needs assessment (JSNA), on which the local area assessment (LAA) is based. To involve only children's services and adult social services in developing the JSNA is a real missed opportunity. Regulatory services should link their work to the needs of the area and to promote its relevance to health. Equally, all of the local authority and the local NHS are partners to your LAA. There will be targets in the LAA that offer the potential for joint action by the public health team and regulatory services. Note that these targets will not always explicitly mention either health or local authority regulators (LARS). For example, targets relating to crime reduction provide obvious areas of activity for both, in relation to alcohol abuse among other issues. In every area, there are 'node points' like this at which everyone's priorities come together. Binding health and LARS partnerships into overarching agreements, such as LAAs, where there is organisational and resource commitment, is one way of ensuring sustainable relationships. These will not solely depend on the energy and passion of one or two individuals.
2. Think about joint training between public health and regulatory staff
Several of the interviewees mentioned that joint training sessions had brought staff together, helped them to understand each other's role and stimulated creative thinking. The catalyst is the opportunity to take time out of everyday work; ‘lift people's heads' from what they see as their core ‘must dos' to enable them to see the wider impact of their work. In addition, the idea is to make links and talk about new approaches. Training can range from the ‘leadership for public health' course attended by one local authority chief officer, to joint courses designed and run by the council or PCT for frontline staff on the health impact of their work.
3. Use health impact assessments (HIAs)
HIA has become an important tool in the public health professional toolbox over the last decade. It enables those carrying them out to understand that their work has a health impact, and what that impact might be. It can also show what they can to do improve health and, importantly, reduce health inequalities between different groups. There is now a whole armoury of technical methodology for HIA, but it is perfectly possible for people not familiar with this to take a non-technical HIA approach. Some councils have used HIA as the basis of training to develop a corporate approach to health.
4. Develop an evidence-based approach
It is important to be able to show that the work of regulatory services has a health impact. Evaluative research and tools for impact assessment are a key part of showing that regulatory services can play a health role. The interviewees for this publication have emphasised the importance of these for elected members, senior colleagues and other partners. An evidence-based approach is also important for establishing credibility with public health colleagues, most of whom have been trained in a scientific discipline. This increasingly relies on finding evidence before committing resources.
5. Don't underestimate the power of co-location
Locating public health staff with local authority regulatory staff can help each to make connections between their work and the other's. This can develop into mutually supportive work programmes and ways of working.
6. Build on your own expertise
The regulatory services that are doing innovative work have moved beyond their enforcement role, albeit into areas that still relate to their core functions. Supporting smoking cessation services being an obvious example. Also think about drawing on the skills that regulators develop as part of their training. For example, using the persuasion and negotiating skills of regulators to help others understand the impact of their work beyond the immediately obvious.
7. Offer economies of scale within and beyond your own local authority's area
Several of the interviewees pointed to economies of scale produced by thinking about health throughout local authority services. An example is a smoking cessation programme that involves licensing, housing and leisure services. This can make use of regular contacts with the public that would happen in any case, as part of ‘core services'. A health issue that is prevalent in one area, such as 'shisha' smoking in Newham, may be found in smaller pockets throughout the country. This provides an opportunity for a local authority's regulatory services to offer a regional or national service. This will help avoid duplication and may also bring economies of scale, and a reputation for innovative practice could be established.
8. Shamelessly exploit sympathetic individuals
All the interviewees agree that it is important to develop links between regulatory services and public health professionals that are sustainable and not dependent on one or two individuals. However, it is also clear that many of the now sustainable relationships started off through the enthusiasm and energy of committed individuals. These individuals took the opportunity afforded by serendipitous meetings and conversations to forge initial links.
9. Take risks
People who work in enforcement services may have a tendency to be risk-averse because they understand only too well the legal and human consequences of not following rules. Several of the interviewees, however, have emphasised the importance of taking risks in setting up the kind of relationships that they feel have been most fruitful. The risks may involve working with a sector or people you would not traditionally work with. Or putting resources into areas that don't have an obvious connection with your core work - but do have a connection, nonetheless. Or setting up new structures such as joint posts or social enterprises. Whatever form the risks take, the lesson from the interviewees is: take them.
10. Remember the importance of winning hearts and minds
All interviewees stressed the need to get chief officers and elected members ‘on board' when developing new relationships between regulatory services and public health staff. The role of jointly-appointed directors of public health (DPHs) is seen as vital, because they usually sit on the chief officer groups of both PCT and council. Where this is not the case - for example, in district councils - the DPH is still an important ally. But it is all the more important to educate chief officers and elected members and make the links with what they themselves are passionate about. Some interviewees said that they had found it difficult to woo members away from their focus on the NHS as a ‘sickness service', to thinking about the broader social determinants of health. But once the message had got across, members were quick to grasp the issues, because of their knowledge of the social and economic circumstances of their constituents and their instinctive understanding of the health impact of these circumstances.
11. A little money can go a long way
It would be naïve in the present financial climate to pretend that resources are not an issue for LARS. These are thinking about developing their enforcement role to a broader understanding of its health impact. However, several interviewees made the point that even a small amount of funding can help 'oil the wheels' and bring a disproportionate return. For example, making a contribution to a jointly funded health coordinator, paying for staff to attend short training courses, or even providing support in the form of premises for co-location with public health colleagues. Even a small contribution towards specific health objectives can show a willingness to engage and a commitment that is worth its weight in gold. Often such contributions bring a return many times over from a PCT when public health colleagues become aware of the potential for added value from regulatory services.
12. Be opportunistic and entrepreneurial
As one of our interviewees put it, it's important to ‘use the teachable moment'. This means taking advantage of opportunities when regulatory staff come into contact with different sections of the public to put across a health message. Evidence suggests that people are more likely to be willing to hear such messages in locations they are familiar with. An example is smoking cessation clinics for men at football grounds that have been better attended than those held on NHS premises. In this respect, regulatory services have a real advantage, as their work takes them into the ‘home ground' of many different sections of society.
1 December 2014