Barking and Dagenham: ‘We’ve got the mandate to take next step’

The London Borough of Barking and Dagenham had built up around £4 million of public health money in its reserves during Covid and agreed a plan for it to be spent over a three-year period.

With social care under such acute demands, some of the money was used to support innovative practice within social care front-line services, such as the work of the improving public health priorities such as domestic abuse.

As the reserves were over 20 per cent of the annual public health budget, it had triggered the Office for Health Improvement and Disparities (OHID) assurance process. When OHID reviewed the spending, they questioned the way the money was being used and Director of Public Health Matthew Cole turned to PCH for support.

Matthew said: “We were told we needed to assure ourselves that we were properly funding the public health services we have statutory responsibility for.

“I had always seen the impact of domestic abuse through a public health lens, but I was out on a limb because no other public health department funds this area of work like we did. And like many councils we had significant pressures in social care driven in part by the impact of domestic abuse

“We turned to PCH to give us that independent oversight. I was really positive about it – I thought it could be a good way to refocus our partnership and integrated working. When you do a public health peer challenge, it is not about the public health team, it is about the impact of the local public health system.”

The council worked with a team of eight peers, including a councillor, former chief executive and public health experts. They were tasked with looking at three key areas – partnership working, use of resources and vision and strategy.

In February 2023, the peers ran a series of focus groups with staff and representatives from the council, NHS North East London, the UK Health Security Agency and the voluntary sector as well as carrying out one-to-one interviews with senior leaders, including the Director of Public Health.

A report followed shortly afterwards and the peers gave a presentation to the integrated care board and health and wellbeing board which sit as a “committees in common”, meaning they meet at the same time and place and are chaired by the same person.

“It was all done in a couple of days – the team worked very hard,” said Matthew. “But there was a massive amount of preparation work beforehand. We gathered together an immense amount of evidence covering the key lines of enquiry and documented it all, so they were fully prepared when they arrived.”

The report made eight recommendations, including streamlining executive place-based leadership arrangements, introducing integrated commissioning arrangements and boosting locality working and ‘health in all policies’ approaches. In terms of its spending, there were opportunities to invest more in the 0-19 service.

“It went really well,” Matthew said. “There were many positives about the public health function and how it was regarded by partners while also posing some difficult questions for the council and our wider place-based partnership working.

“It was basically saying that once you scratched beneath the surface of our partnership working there was still work to further our integration agenda, which is further behind than others due to legacy structures and funding, such as the health footprint across three boroughs, prior to place.

“We had lots of strategies, but needed a better integrated delivery plan – the peer team said it was difficult to see what we were trying to achieve and needed everyone to have a shared understanding.

“The recommendations gave us a mandate to do what we wanted to do. The great thing about the PCH process is that there’s no hiding. You cannot make excuses – it flushes out what’s missing.”

Changes are already well on the way to being made. A single commissioning function is being introduced and locality working is being aligned to create four localities – the council currently works across three, while the primary care networks are across six areas. Next year will see executive leadership streamlined with one person put in charge of place-based working.

Matthew said: “The PCH peers were saying we have got good foundations in place and there are lots of positives. But the message was clear: we had to take the next step and that step was the most difficult.

“And in fairness, the committees in common endorsed it. We know why we were in the position we were in – there are lots of regulators demanding different things and we could never break out of that cycle. We now have permission to do just that.”