Rise in public health directors’ holding negative view of NHSE

A survey of members by the Association of Directors of Public Health, published on Wednesday, found that, while relationships with clinical commissioning groups have improved — with 83 per cent saying they are positive compared to 79 per cent in 2017 — relationships with NHSE continue to be weak.

Just 27 per cent said the relationship is positive, the same as 2017, and a greater proportion said it was negative this year (26 per cent) compared to the last survey (15 per cent).

Ongoing issues with access to NHS data, insufficient data sharing arrangements and delays in intelligence sharing were highlighted as particular barriers, with just only over half (55 per cent) reporting they had sufficient access to data.

Just 60 per cent of directors of public health in areas with sustainability and transformation partnerships said they felt positive about the role of public health in the process, which has been led by the NHS.

In areas where STPs have developed into integrated care systems, the proportion feeling positive abut the role of public health was slightly higher at 68 per cent.

There was a drop in positivity about relationships with the nine regional Public Health England centres. In 2017, 87 per cent of respondents said they were positive about relationships compared to 76 per cent this year.

The report added: “Relationships with centres are hugely variable and dependent on local relationships.

“Issues mentioned continue to be around duplication of work, an imbalance between local and national jurisdiction, and a lack of understanding from PHE centres of the local government context.”

However, the survey received positive feedback on the role of public health within councils.

Despite 67 per cent saying they report directly to the council chief executive, compared to 73 per cent in 2015, those who said they had direct access to chief executives increased from 94 per cent in 2017 to 97 per cent this year.

The survey, based on responses submitted throughout June and July, found the fall in direct reporting to chief executives “masks a web of complex arrangements where line management does not necessarily reflect access, influence or accountability” and survey results reflected “healthy and increasing levels of influence within local authorities”.

A greater proportion of directors of public health said they had day-to-day control of the public health budget, up to 96 per cent from 88 per cent in 2017.

There was a slight increase this year in respondents who said they are part of the council’s senior corporate management team, from 57 per cent in 2017 to 60 per cent. This is described as low “particularly in comparison to other influencing measures”.

There has also been an increase in directors of public health taking on additional responsibilities, with 53 per cent managing services such as adult social care, community development and leisure.

“Despite the time pressure, these extra roles are overwhelmingly regarded as positive, offering increased influence and credibility,” the report said.

Aside from public health, poverty, early years and education and skills were directors’ top three priorities for national investment.

A total of 99 responses to the survey were received from directors of public health across the UK, with 71 submitted by those based in England.