Case study 5: Newham Healthworks
Interview with Steve Miller, Head of Public Protection, London Borough of Newham.
There has always been a close relationship between Newham Council and the primary care trust (PCT), particularly as the PCT is co-terminous with the local authority boundaries. A joint arrangement had been agreed in the mid-1990s, specifically around health and the working environment - covering the area normally known as occupational health.
Returning to work
The arrangement originated with work in GPs' surgeries, assisting people returning to work after health problems but also carrying out general health promotion. This work was funded by the PCT and involved a team of anything from two to 12 people, depending on the projects under way.
When NHS budgets were under severe strain in 2001, the PCT was obliged to cut back, particularly on this discretionary work. It offered to transfer the team to the council using TUPE arrangements. The transfer was agreed, but the team brought with it a zero budget.
The Head of Public Protection at the council was Steve Miller, into whose department the team had transferred. He decided that the best way to make the work sustainable was to set it up as a separate business. This could bid for work both within Newham and beyond its boundaries.
A new organisation, Healthworks, was set up as a non-profit company limited by guarantee, with charitable status and a board of trustees. The trustees are drawn from the local authority and the PCT and include the director of public protection.
Healthworks employs three staff directly, while others are employed on contracts for specific pieces of work. The company was set the goal by the council of becoming self-sufficient within a certain time period. Aside from some support in the form of premises and overheads, it has achieved this goal.
The setting up took approximately six months. During this time and throughout its lifetime, Healthworks has been self-sufficient, albeit with Newham Council giving support through the provision of office space.
Range of activities - smoking cessation
Since setting up as a self-sustaining business, Healthworks has branched out significantly from its origins in occupational health. There is still a connection with traditional local authority regulatory services, but the activities undertaken have gone beyond enforcement to include advice and health promotion.
For example, smoking cessation enforcement officers were employed through Healthworks. But the council has gone beyond inspecting places of employment and premises where smoking is banned. It now has a national standing for its expertise in advising on the harmful effects of smoking 'shisha'.
Shisha is a form of smoking through a hookah, practised in this country mainly by the Asian community. Healthworks started its work in Newham, particularly with young Asian women, who often mistakenly believe that smoking shisha is less harmful than cigarette smoking.
The company has now been given research funding by the Department of Health (DH) to look in more detail at the effects of shisha and to act as a national resource on the issue.
National clean air awards
Healthworks has also won the franchise to administer the national Clean Air Awards. It has helped more than 100 local businesses achieve a Clean Air Award and develop SmokeFree policies.
In the last 10 years, tuberculosis has again become a significant issue, particularly in some parts of London. Healthworks was given a grant by the Neighbourhood Renewal Fund to look at the causes of this increase in the whole of northeast London and to advise on what could be done to arrest it.
Healthworks is now contracted by the Health and Safety Executive (HSE) to provide advice on the health and safety of immigrant construction workers throughout the country. This developed from looking at health and safety issues in relation to immigrant workers on the 2012 Olympics site.
The benefits and lessons learned
Head of Public Protection at Newham is Steve Miller. He oversees the relationship with Healthworks and believes that the idea of an ultimately self-sustaining company was what sold the idea to the council's senior management and Executive Board.
"The council is keen to support partnerships that are not heavily dependent on local resources and can contribute to the local economy."
He believes it is useful to have a separate company that can make it easier for government departments to offer contracts, rather than having to deal with individual local authority treasurers. The existence of Healthworks also makes it easier to work beyond borough boundaries and to relate to a number of local authorities, sometimes at a national level - the 'shisha' project being a case in point. Miller points out:
"We're all looking to cut red tape. And it makes sense for [Healthworks] to act as national advisers on an issue on which we have a lot of experience."
The setting up of Healthworks and the transfer to the new company from the PCT to the council was made easier, Miller believes, because a jointly-appointed director of public health has been in place during this period.
Miller acknowledges that they have learned some lessons.
"It would have been better to have had some co-ownership of Healthworks by both the PCT and the council, from the beginning. For example, the staff work in council premises and are paid through the council payroll. We could do more to re-build co-ownership with the PCT, perhaps by getting together with the other boroughs that are, together with Newham, co-terminous with the PCT."
There are also risks, especially in the current financial climate, in maintaining self-sustainability. Miller points out that Healthworks has to work in a business-like way. The skills required are different from those normally needed for public protection work and have had to be learned.
However, he believes that Healthworks has gone a long way towards changing the image of regulatory services and promoting their role in health.
"Regulatory services are often not seen to be tied in with health - they're often thought of as being only about 'crime and grime'. Doing some real health work brings the value of Regulatory services into focus."
Safer Food, Better Business campaign
He gives an example where traditional food hygiene work went on to develop much more imaginatively. The Scrutiny and Overview Committee of Newham Council carried out a review of food premises in the borough. This focused originally on the litter, street mess and growing anti-social behaviour outside 'fried chicken takeaway' shops.
However, the review has been developed throughout the council to include the issue of healthy eating. The final outcome was that the council is now giving healthy eating awards to food outlets for provision of healthy eating choices on their menus.
Healthworks will also lead the 'Safer Food, Better Business' campaign in London leading up to the Olympics in 2012. Miller believes that this broader focus came about because Healthworks has a cross-cutting remit. But also because the team is co-located with the council's core regulatory services, including Environmental Health. This is a lesson that any health partnership could take on board, even without the need to set up a separate company.
1 December 2014