“You need a different outlook on life to be a director of public health in a council organisation,” says Greg Fell, who has just taken over the reins in Sheffield and was mulling over why finding the right candidate is becoming increasingly difficult since responsibility for the role transferred from the NHS in 2013.
“You still need technical expertise, but working in these kind of environments is more about political acumen – what you can and can’t do, what is and isn’t appropriate, when you should and shouldn’t talk to elected members.”
As Sheffield’s first new public health director for a decade – Jeremy Wight, who resigned from the £100,000-a-year post in January 2015, had been in the role since 2006 – Greg admits he is still finding his feet since coming to the city from Bradford, where he was a public health consultant.
“I know my way around public health, but I’m new to the job of director, so I need to work out: ‘What are they supposed to do?’
“But also I’m new to Sheffield as well. So I’m basically trying to meet as many people as I can to get to grips with who’s who, what’s what, what does Sheffield think are the major priorities, and then where can I usefully add my time and energy.”
Greg has worked in public health for the past 20 years ‘in various shapes and guises’, since finishing a degree in biochemistry which is ‘neither use nor ornament now’.
In Sheffield he controls a £32.5 million budget, and one of his first tasks is to prepare a five- to 10-year strategy setting out where resources should be focused.
“This is a big and complex organisation that already does a whole range of activities that improve the health of the public – what we do in parks, leisure services, what we do to create a growing, vibrant, stable economy.
“What I’ll need to do is think ‘Where can our expertise and worldview add value to what the council already does?’ I think in my strategy I’ll suggest there are probably four or five metrics that I think are more important than all of the others.”
These are likely to include life expectancy, the death rate among young children, teenage pregnancy and, chiefly for Greg, the number of smokers.
“We would be silly to ignore it, because it’s such an important thing. We’ve got pretty good services, but we need to do more and we need to make sure the NHS really goes to town on that. This wasn’t in Sheffield, but a year or so ago I asked a roomful of 150 cardiologists ‘When was the last time you referred somebody who was a smoker to the stop smoking service?’
“One hand went up. That was embarrassing, I gave them a lot of grief for that and quite rightly too – they all scratched their heads and looked at the floor. I’m sure we could tell the same story in Sheffield, so we’re going to push on that quite hard.”
Greg will also be looking at the city’s policies on transport and fast food businesses, while efforts to make residents take more exercise as part of the city’s Move More campaign are likely to be stepped up.
But he admitted: “Those kind of things usually appeal to people who already do London Marathons and things of that ilk – point taken, challenge accepted. If that Move More message lands in Dore, great, but if it doesn’t land in Darnall in the right way then we’ve missed an opportunity.”
Meanwhile, on his third day in the job, the council’s chief executive John Mothersole asked Greg to ‘scale up’ Sheffield’s approach to health inequalities.
“Probably an impossible challenge, but I’m going to have a go. At its heart, there is a 20-odd year gap in healthy life expectancy between one part of town and another. That’s probably not acceptable, and it’s not just Sheffield – you could paint the same picture in any town up and down the country. There’s no unknown message there.
“The response is that we need to think long term – life chances basically, so poverty, joblessness and all those kinds of things. Medium – term it’s broadly thinking about lifestyles, so helping people do the right kind of thing with regard to stopping smoking, exercising more and all that kind of stuff, so that the healthy choice becomes the easy choice. Not that it’s going to be easy.”
Supporting the health service to better manage patients with high blood pressure is an ‘immediate goal’ in tackling inequality.
“We probably under-implement some of the interventions. So my job becomes to push, chase, chivvy and help the NHS.”
Contributing to the overhaul of primary care in Sheffield, such as GP services, and planning to spend more money on prevention – creating ‘less need for expensive care packages when someone is in crisis’ – are also on Greg’s to-do list.
“I’ve never seen such commitment to that agenda in any NHS or local authority until I came here, and it’s clear it’s a big deal for a whole bunch of reasons. But the reality is, it’s the best value thing to do with the taxpayers’ pound.”
The prospect of a bigger budget to achieve these goals is unlikely, however.
“There’s never any more money. As an old mentor of mine once said ‘The money’s run out, now we’ve got to think’. Not in the last five or so years, but certainly in history, there was more money to throw around than we knew what to do with, and now there’s none. That’s great, because we’ve now got to think really hard about this job, so I’m relaxed about there not being any money.
“The reality is, we are shrinking the state. Whether that’s a good thing or not, I don’t know, but we are, there’s no secret there, so let’s make the most of the resources that we’ve got.”
In an investigation by the British Medical Journal two years ago, Sheffield Council was accused of ‘playing fast and loose’ with its public health budget, after diverting £3 million to pay for services, including libraries, following Government cuts.
“Having seen it first hand I kind of disagree, to be honest,” says Greg.
“I don’t think any of it was used to plug a gap. The money was used smartly in a fairly legitimate way.”
Greg believes increasing life expectancy over the next five years will be ‘the measure of doing a good job’.
“I’m struck by how ambitious Sheffield is. The council expects to be challenged – not overtly and confrontationally, but I think all organisations would expect the challenge and the offer of support: ‘This is rubbish, you can sort this, I will help you sort it’.
“That’s constructive challenge, and I think the council is up for that.”