Interview with Knowsley's Joint Director of Public Health

Dr Diana Forrest needs two computers to access the IT systems of both the council and primary care trust (PCT) in Knowsley. But beyond the confines of her office, her twin role has heralded greater partnership working across the borough.

Joint strategies are in place to tackle alcohol and drug abuse, obesity, sexual health and teenage pregnancy and mental health. And a new high-level board, the Health and Well Being Partnership, tackles health inequalities.

Joined-up working

There are also joint teams working together on community mental health and older people, while social workers, GPs and physiotherapists operate side-by-side in Knowsley’s four primary care resource centres. Dr Forrest says:

“Public health is truly a joint responsibility for the council and PCT. There is a shared ownership of all the issues – that is reflected by staff from both bodies working together so closely. They don’t see themselves as council staff or PCT staff, but just part of their teams."

Before taking up her current post, Dr Forrest was Director of Public Health at the health authority that preceded the PCT.

“I really feel it – having worked in Knowsley before – that going to the council was going to that other, foreign organisation. Now it is one of my organisations.”

Even though it is early days for many of theses schemes, the first signs of success are already emerging. The increases in childhood obesity have been halted thanks to initiatives on food and physical activity, such as removing vending machines from all the schools.

Smoking rates remain at 35 per cent compared to the national average of 26 per cent. Access to cessation clinics has been expanded and a social marketing campaign launched. This has resulted in large increases in people coming forward to quit smoking.

Life expectancy

But more needs to be done. Knowsley has some of the highest rates of ill health and death in the country. Life expectancy is three years shorter than the national average. This year will see more initiatives, including integrating the computer systems. On the public health side, sexual health services will be revamped to create joint teams of council, PCT and hospital staff.

Sure Start

GPs are also set to launch a project to help diagnose lung cancer earlier by identifying at-risk patients and sending them for tests. Dental health is under the microscope too. A tooth-brushing coordinator has been appointed to tour local schools and Sure Start centres to help children and families into good habits. Dr Forrest says:

“Problems are identified and solutions developed in partnership. In the past one side would take the lead and have to persuade the other – that takes time. Or they would just have to go it alone, which is not nearly as effective.”

But Dr Forrest says the less obvious areas have benefited from the joint appointment as well. Emergency planning is now undertaken in partnership across both organisations. In theory this should mean any response to a disaster will be fully integrated and coordinated.

Flu vaccinations

She also says her joint role helped in the recent mass flu vaccination programme in poultry workers.

“Immunisation is obviously a PCT responsibility, but the council’s environmental health department knew who the poultry workers were. This meant we were able to get the information out quickly and effectively.”

Accountability

Dr Forrest’s position is underpinned by a joint system of accountability whereby she is answerable to both the council and PCT chief executives. And nearly three quarters of her 53-strong public health team are joint appointments. This is all part of a wider integration of staff across the two bodies. Both the HR and the marketing and communication functions are carried out by joint teams across health and social care.

Pooled budgets

The council and PCT have just launched a combined healthy workplace programme offering:

• discounted access to the borough’s leisure centres
• massages for staff
• access to health checks

The council and the PCT have developed some sophisticated governance arrangements between them, through a detailed Section 31 agreement. This enables them to develop bigger pooled budgets than would normally be possible – over £1million in some cases. It has also helped them develop a partnership with a third sector provider, Roy Castle Fag Ends, to provide smoking cessation services.

But despite the achievements, Dr Forrester says there are still lessons for other areas making joint appointments.

“I have found myself very stretched at times, attending the various meetings of both the council and PCT. We have just appointed a deputy director of public health to help me. I think this is a must in these situations.”

Representation

Dr Forrest also believes local government and the NHS should be very careful how the appointments are made in the first place.

“I would recommend that when interviewing for the post, the selection process include representatives from both the council and PCT. I was interviewed by just PCT representatives and it meant it was a little time before councillors saw me as their director of public health.”

That is not a problem these days, of course. Indeed, Dr Forrest sees herself as neither a council nor PCT employee.

“I really don’t like it if someone refers to me as the PCT Director of Public Health – I am just Knowsley’s Director of Public Health.”

Nick Triggle is an online journalist specialising in health.
email: ntriggle@hotmail.com

This article was published in March 2007.