Making the visible invisible – Well North, Public Health England and Health Inequalities
This blog is about the way Public Health England commissioned Well North
To be clear – I am not criticising Aidan Halligan – I am criticising Public Health England – but that will be obvious.
The story
In February 2015 Aidan Halligan a charismatic, passionate and visionary public health champion announced at a conference in Chester that:
“Duncan Selbie has sent me to the North of England to make the invisible visible”
Aidan was announcing the establishment of a programme called ‘Well North’ that was going to support local authorities in the North of England tackle health inequalities. The scheme was to be funded by £9m of Public Health England money over 3 years with the intention of 9 participating local authorities matching this.
Well North (A full description of Well North is available here) with Duncan Selbie as the Board Chair was launched in July 2014
The ideas around Well North built on Aidan’s work on the Homeless Pathway in London, Hot Spot Analysis at Aintree Hospital and high performing teams informed in part by military training methods, the last of which informs some of the ethos of the NHS Staff College where Aidan was the principal.
From Briefing to Oldham Health and Wellbeing Board Alan Higgins Director of Public Health
Like many I was surprised that this initiative had appeared – it had not been publicly requested or tendered for – The Due North Report report (published Sept 2014 and commented on by me here) had been produced by the ‘North coming together’. It makes no mention of ‘Well North’ even though both were in preparation at around the same time and both funded by Public Health England. Yet Duncan Selbie in his Friday Message from 18th of July 2014 which had been endorsed by Felicity Harvey (Department of Health Director General for Public Health) was able to say:
“There is a need to address the causes of ill health as well as seeking to cure the consequences. This has inspired the North to come together in a programme, led by the Academic Health Sciences Centre in Manchester, they are calling Well North, a strategically collaborative programme which seeks to tackle the wider determinant complexity of the whole problem, making visible the previously invisible (predominantly inner city) at risk people and attempting to solve rather than only manage their illnesses and anxieties.”
PHE Management Cttee Paper – Michael Brodie April 2015
A number of people in the Voluntary Sector were irritated – they had been lobbying Public Health England with little success for funding support and suddenly saw £9m go to an initiative that no one seemed to have requested!
A couple of FOI requests later and I was none the wiser.
The report they eventually sent me says that the original idea and approach came from Professor Ian Jacobs, the then Dean of University of Manchester and Director of the Manchester Academic Health Science Centre.
When tragically, Aidan died suddenly and unexpectedly Well North seemed to grind to a halt. It felt as though the whole programme was built around his energy, presence and ideas.
On November 6th 2015 Duncan Selbie in his Friday message told us that:
“Aidan had been the Founder of Well North, he was also the inspiration for its ambitious vision to radically change the life chances of thousands of our citizens who face some of the worst health inequalities in the country.“
More recently PHE commissioned a Rapid Review of Well North. This has been completed by a team made up of past and present members of Bromley by Bow led by Lord Mawson.
The Review does identify a number of positives – not least the energy and commitment of some of the pilot local authorities. What will be galling to people like Judy Robinson (ex Chief Executive of the sadly missed Involve Yorkshire and Humber – victim of the cuts two months ago) is the emphasis that the review places on shifting resources from the public to voluntary sector, which is a message she and others have consistently championed with PHE.
There are criticisms – if you want an example of how to deliver these diplomatically just read the executive summary – here are some of the key points with my translation.
Lessons
In order to ensure sustainability and impact of any project it is best if:
- Key Stakeholders from the communities concerned are directly involved in identifying what the problem is and have had a role in co-producing the solution
- There is an explicit and public procurement process – not a reliance on ‘who you know’
- The commissioned service is not built around individuals but organisations
- Its always good to make sure that your left hand knows what the right hand is doing
What do you think?
So disappointing (to say the least) to see money that could have a real impact in reducing inequalities, spent on an initiative that lacks grassroots involvement or support. (On the plus side, can we have more of your ‘translations’ please Mark?)
Thanks Gareth – always happy to offer translations!
Interesting read. £3m from PHE, matched funding from (only) 3 engaged LA DPH’s, arms length accountability and unclear commissioning/tendering arrangements; never mind the delivery focus – what’s the money delivered to date? to whom and by whom?
Is there a view from the Well North lot? – does such a body exist or have they done their bit in Blackpool and the report? And/or the DPH body? meanwhile not in lala land people in local places continue to face life’s challenges in austerity, VCS no doubt juggling to make ends meet never mind think about development and growth. #It’spants.
Thanks Simon – I agree it is concerning. I do think this is a classic example of trying to impose a clever solution on local circumstances. It does rather surprise me because there have been so many initiatives over the years – Health Action Zones, Neighbourhood Renewal, Single Regeneration Budgets…. I could go on; which have tried to do the reverse. They have started from the point of view of trying to work out what is going on and then capture the learning and share it. Another example occurs to me – Chris Bentley’s work on the Health Inequalities National Support Team. Which focussed on understanding what was happening, systematising it and sharing the knowledge across peers. I also find the commissioning process ‘unusual’ for such a large amount of funding.