Calderdale Council Chief Executive Robin Tuddenham on why the director of public health is such a vital part of his team – and what his fears are for them in the coming decade.
Councils are fundamentally public health organisations.
Robin Tuddenham became a council chief executive in 2017 – part-way through the decade marking public health’s return to local government. As director of communities and service support he had worked alongside the director of public health at Calderdale Council and knew how important the role was when he moved up to take the top job.
“I say this to every single member of staff, I talk about local government, place, environment and public health and my starting point is that councils are fundamentally public health organisations. They are driven by public health outcomes. The place leadership role and delivery of service are basically both driven by being a healthy place.
“So I see the director of public health as having a key role in the organisation – setting strategic direction and purpose. In Calderdale the director of public health reports directly to me. They are the lead on climate and the lead along with others on good economic growth.”
Public health and the Industrial Revolution
Mr Tuddenham describes directors of public health as 'positive disruptors'.
“My director of public health is always pushing me and asking questions. Are we putting the individual at the heart of what we’re doing? Do we need to be more participative and inclusive? How are we addressing inequalities in everything we do? She will talk about climate – not just reducing emissions in buildings and creating sustainable travel, but also how we encourage behaviour change in how people live their lives.”
He said the importance of public health principles being pursued by local government could be seen in the Industrial Revolution.
“What drove the Industrial Revolution was creating an environment where people could work and remain healthy – it was about drainage, infrastructure, good housing and the public realm. That helped to transform society and it can do the same again.
We are facing some real challenges in the coming decade. The huge numbers of people not in work because of ill-health needs addressing. We have huge amount of people on the waiting list and struggling with mental health problems.
“Good employers should want to invest in the health of their local population and I think councils and their directors of public health can help make that shift in the coming years.
“We also need to think about the priorities of the NHS and the need to invest in prevention. We’ve seen a bit of this spoken about with the 75th anniversary – when the NHS was set up in the 1940s the nature of illness and disease was so much different. So many people are now living with long-term conditions – out of every £1 spent by the NHS, 70p to 80p goes on people with long-term conditions. It is clear we need to focus on improving healthy life expectancy in the coming years for the good of all and to enable a sustainable health and care system.
“We need sustained focus and effort to reduce the number of people who are smoking, tackle loneliness and get people active.
“As chief executives we need to be making that point very strongly in the coming years and question where the money is spent. It is the same for the Department of Work and Pensions budget. It is not just the spend on benefits for those out of work, but those who are in work and getting in-work benefits to top up their income. We have too many people in poorly paid jobs in the hidden economy, and women in particular in low paid employment.
“If we can unlock some of that money to invest in public health, it will more than pay for itself. But we have to make that case, evidence it and be bold in how we invest in long term outcomes for our population.”
My fears for the future
He says he does have some concerns about the turnover being seen among chief executives in local government – and the impact that may have on public health.
We need to retain corporate memory of how and why public health came into councils, and why it’s important.
So what advice would he give those new chief executives? The first is a piece of advice he himself was given when he started in the role.
‘Spend time engaging and talking to the NHS and about how we can work together as public health organisations to improve the health of the population. I remember an experienced chief executive telling me and some others who were new in 2017 that the biggest thing she regretted was not spending more time on this.
“You have to think about how to position the director of public health in your local authority – they are a key strategic and corporate adviser. Personally, I would not have them reporting to anyone else. There are always other ways to make things work, but this is what works for me.
“And finally I would stress public health outcomes are a core mission of local government – don’t forget that.”