PUBLIC HEALTH

Published: 24/02/2005, Volume II5, No. 5944 Page 34 35

John Denley has made a career out of knowing his subject area and, more importantly, turning know-how into improved outcomes. Nick Edwards finds out what makes him tick

Good use of information to improve outcomes has been the basis of John Denley's career - from his first job in public health research to the project that won him an HSJ Award last year.

Now assistant director of public health at North Birmingham primary care trust, John says it was 'all about information' from the start. 'Not so much that you need ultra-accurate intelligence because so much of it is estimates. But you need good estimates, and to be able to communicate that to decision-makers, ' he explains.

Born, bred and educated in the Midlands, a career in public service was always a certainty - his mother was a nurse-midwife and his father was a hospital administrator, and they both 'loved the NHS'.

After his first post in public health research in Dudley health authority, he moved into the acute sector as a clinical auditor in 1995. But he says there was still a clear link with information - 'it was about setting standards and then measuring change against them'.

Switching to cancer services in 1998, he oversaw reductions in waiting times for urgent referrals for suspected breast and colorectal cancer from about four weeks down to as low as 10 days.

The following year he made the move into management, running the clinical audit and effectiveness department at City Hospital (now part of Sandwell and West Birmingham Hospitals trust).

He then made a decision to get back into public health and apply some of the skills he had gained in using information at population level. In 2000 he joined Sandwell health authority's public health department (widely regarded as one of the best in the country at the time) as clinical governance development manager. This included a four-month secondment to Wednesbury and West Bromwich primary care group to put together an early Sure Start proposal.

When Sandwell HA split into three PCTs, John joined Wednesbury and West Bromwich PCT as clinical quality manager. As was the case in many new PCTs, he wore a lot of hats - he was the lead for chronic heart disease, mental health and risk management, as well as leading across Sandwell on clinical audit.

In hindsight, he would have preferred to have focused more on his central role of quality assessment and GP appraisals. 'I was proud of that work because it was very tough. A lot of GPs did not want to know to begin with but we got it going on time and in the end GPs did value it.

'I am aware of my enthusiasm for taking on new projects and, looking back, I might have concentrated more on the practices. I didn't get to see as much change as I wanted. In those early days of clinical governance there was a lot to do in winning hearts and minds. I think I now realise more the power of groundwork.'

That experience in working with practices paid off when he joined North Birmingham PCT in 2003, initially as a public health analyst. Compared to his previous employer, the socio-economic spread of the population was huge.

He says of his new boss Dr Jammi Rao - who he initially worked for at Sandwell HA: 'If you have a convincing argument based on evidence he will let you run with it. Also - and this is something that is not the case in other places - if it doesn't work, he will cut it. There is decisive action in both senses. It is a small department, but very influential.' This paid off in his work with the PCT's smoking-cessation team, which won the communications category in last year's HSJ Awards. When John joined the PCT it was barely a third of the way to meeting its quitters target for 2003-04, with more than two-thirds of the year to go.

Through using practice-held information and applying direct marketing techniques, it managed to beat the target of 644 quitters 'by 15-20 per cent'. The specific project that won the award involved sending 'look after your heart' valentine cards to practice registered smokers with details on selfreferring. He says the PCT is now on course to hit the target of 800 for this year.

Mass appeal

A similar approach lies behind a new project to promote healthy living. The Lifecoach scheme is being piloted with one practice and its first cohort of 15 women began this month. GP-held information identifies women with a body mass index over 28, who are then sent a 'lifestyle diary' to fill in over a few weeks.

Those who do so are invited to join a 10week programme led by a health visitor looking at nutrition, exercise, emotional well-being and other issues.

'The diary means we already know these women are motivated so, it should be very cost-effective. And It is not just a weight-management programme where you turn up to get weighed and then go away again - we are trying to address how people feel about themselves. We do not even mention weight.' Marketing is also the basis of a planned scheme to expand smokingcessation referrals into the community, using high street services such as barbers, hairdressers and nail bars close to pharmacists. These small businesses would be paid for successful quitters who they referred to pharmacists.

'I think It is going to make a real impact. We need them to be smoke-free premises but they are small businesses which can't afford to put punters off. Once we have got into smoking, we can look at other areas. If we are able to identify motivation, we could cut out a lot of the work.'

John Denley CV

1992-95 - public health research assistant, Dudley health authority

1995-99 - clinical auditor for surgical services, Sandwell Healthcare trust. Promoted to cancer services project manager

1999-2000 - clinical effectiveness manager, City Hospital in Birmingham

2000-01 - clinical governance development manager, Sandwell health authority

2001-03 - Wednesbury and West Bromwich primary care trust as clinical quality manager

2003-04 - public health analyst, North Birmingham PCT

Promoted to assistant director of public health