Published: 20/03/2003, Volume II3, No. 5847 Page 30 31
Covering everything from child protection to contaminated land, Matthew Cole's remit in public health has never been so wide. He talks to Nick Edwards about 'the second most demanding job' in primary care trusts
Name Matthew Cole
Job Acting director of public health for Barking and Dagenham primary care trust
Describe your job It covers a huge range of roles, from identifying the health needs of the community through tackling inequalities to commissioning services and doing research. My department consists of a vacant consultant post in public health medicine, two senior public health specialists, a specialist in health promotion and two advisers, who also take a lead on promotion. We host some shared services for Havering PCT, which involves me managing a specialist in statistics and another in nutrition. I am also responsible for three research and development staff and a three-person Healthy Schools team. The PCT covers a population of 163,000, with a mix of residential and industrial sites, plus the deprivation of an inner London borough. We have a 12 per cent ethnic minority population - and large and growing percentages of young and elderly people. The Thames Gateway development, which will see up to 50,000 people move to the area in the next 15 years, will have a huge impact.
What do you like most about your job?
It is an extremely challenging and wide portfolio - everything from child protection to contaminated land. There are a lot of what we call 'wicked' problems - the large number of single-handed GP practices is one. And we have a population which is not particularly empowered to challenge. A big part of my job is communication with the local community. I would go as far as saying that after chief executive, being the director of public health is the most demanding job in a PCT.
What was your career path?
I studied sport and recreation at Staffordshire University before getting a job with Redbridge health authority in 1990 working with schools - on sex and drugs. In 1994 I moved to the BHB Community Healthcare trust, working on health promotion and eventually becoming its head. I moved to become assistant director of public health at Barking and Havering health authority in 2001. When that authority split, I moved with the public health team to the new Barking and Dagenham PCT. I have done a masters in health service management and health promotion.
Is your non-medical background still unusual?
As far as I know, the only other directors in London who are non-medical are in Camden and Tower Hamlets. There are strengths and weakness in both. I think a non-medical background gives you a better view of the wider determinants of health inequality such as social exclusion and housing. It is also true that these days directors of public health have to be better at management, at negotiation, and to have a greater sense of the corporate. They also need to form relationships with non-NHS bodies such as councils.
What are the biggest challenges facing you?
Redesigning services to cope with a lack of capacity, and on the back of the second biggest financial settlement in the country. We have to look at the wider public health issues around regeneration. Also there are the targets set out in the planning and policy framework, which emphasise public health, while also needing to look at issues such as epilepsy, which though not national targets are important locally.
What has been the high point of your career?
I am very proud of the work we did here to improve our cervical screening. But in terms of making a real impact on people's lives, I think right back to working in schools on sex and drugs education. Pupils I taught sometimes still recognise me, often now with their own children.
And the low point?
The times when I have had to discipline staff - it has to be faced up to but it is never pleasant.
How do you relax?
I try to run a fair bit and spend as much time as I can with my eight-year-old daughter - my wife is midwife so I tend to take on a lot of parental duties at the weekend.
Where do you see your career going?
I am applying for the joint post of director of public health for the PCT and Barking and Dagenham council.
What is your best piece of career advice?
Make your career before you have children - it is difficult to balance family with a demanding job. The graveyard's full of people who have given their all. l Just the job Title: Primary care trust director of public health.
Who are they? Traditionally coming from a medical background, the growth in public health's profile at primary care level has meant an influx of non-medics, often with backgrounds in health education.
Distinguishing features: formerly a very close knit group, but increasingly included on PCTs' 'top table' - and correspondingly more 'corporate'.
Prospects: Now that public health is a key part of the priority and planning framework, DPHs have the ears of chief executives - and the vocal support of public health minister Hazel Blears.