An interview with Alice Wiseman, Director of Public Health, Gateshead Council.
Key messages
- Organisations are increasingly recognising the damaging effect of health inequalities and now need to do something about it. It is important to not lose momentum and to identify big measures.
- As political organisations, councils are ideally placed to hear from all populations – including the most marginalised.
- Harness the power of local communities – they came together in the pandemic to help each other because they understood how important it was.
Alice Wiseman started her career as a teacher in inner-city Newcastle where the unfairness of inequality and the wasted potential of many of the children was obvious. Alice became passionate about inequalities and wanted to do more to change systems. She took a job as a teenage pregnancy coordinator and was supported by an “amazing” DPH to make public health her career. She worked as a public health consultant in the NHS and moved to local government as a consultant before becoming DPH in 2016.
The move to local government
The move to local government was really exciting. Rather than tinkering round the edges there was a real chance to influence how people live.
Alice indicates that the shift to the council was a learning curve, and the learning continues. Public health had to understand how councils operate, which is very different from the NHS in processes such as commissioning, contract monitoring and audit control. Councils had to understand the role of public health, and through this developed a better understanding of the wider health system.
The door was already open for public health when it moved to Gateshead Council. Planners had already introduced health criteria into the local plan, and the licensing and environment divisions were already signed up to address health issues. Public health soon became a natural part of the council. The DPH leads the Health and Wellbeing Directorate, reports to the chief executive and is part of the senior management team, which means that public health is fully embedded in strategic decision making.
Councillor Martin Gannon, Council Leader
Protecting and improving residents’ health and wellbeing is Gateshead Council’s fundamental purpose, reflected in our strategic approach which aims to ‘Make Gateshead a place where everyone thrives’.
150 years ago, many lives were lost to cholera, typhoid and smallpox due to shocking living conditions. In the 1930s, slums were cleared as part of planning developments that many local authorities made to improve the public’s health. While our public health challenges may feel somewhat different now, it is sadly still the case that the drivers of ill-health remain driven by wider social inequalities. This can only be addressed with action on education and skills, jobs, homes and communities.
The COVID-19 pandemic has been tough, but together with local partners, we have demonstrated what is possible when we share and commit to protecting and promoting health and wellbeing – especially for those who need us most.”
Changes since the move
We came into the council as a public health team; now the council is a public health organisation that has help from the public health team.
Alice says that health and wellbeing have become a core theme throughout the work of the council. Gateshead’s health and wellbeing strategy ‘Good jobs, homes health and friends – why to treat people and send them back to the conditions that made them sick?’ is also the corporate strategy for the council. The whole council is signed up to improve public health, and strategic directors have responsibility for health in their roles.
Acting based on evidence is fundamental to how public health operates in Gateshead. Public health is a small team with limited resources and must target time, energy and funding at interventions that will make the biggest difference. Good evidence also allows the council to be clearer about the policies it embraces – for instance endorsing the All Party Parliamentary Group on Smoking and Health report on tobacco control.
The team uses tools, such as health equity audits (HEA), to assess the impact and value of interventions on the most disadvantaged groups and people who are less able to navigate health, care and wellbeing systems. For example, after a HEA, weight management services in primary care were decommissioned because they were found to be mainly used by people in higher-income groups, who have access to alternative support, rather than those from deprived areas. The decision was difficult because GPs valued the ability to refer to the service.
Primary care and the development of primary care networks are a good opportunity to develop a locality model for tackling health inequalities. PCNs in Gateshead are coterminous with NHS and council integrated health and care. As PCNs develop, the next stage is to develop relationships and align improved local health data with a qualitative understanding of communities to establish shared, targeted approaches to improving health.
Alice believes that, nationally, health inequalities are not sufficiently a priority for primary care. GPs in deprived areas have no more time per patient than those in more affluent areas, but the people they support often have multiple health and social problems. In Gateshead, some GPs are part of the UK Deep End movement for primary care for practices with the highest levels of socioeconomic deprivation. Deep End campaigns for fairer funding and to promote developments that tackle inequalities.
The Health and Wellbeing Directorate has taken on management responsibility for additional services that impact healthy communities – community safety, emergency planning, libraries and culture and leisure services. A HEA showed that only 8 per cent of the population use libraries, and only 14 per cent use leisure services regularly. Overall, the people who use services tend to be from the more affluent areas of the borough. A consultation is taking place on a strategic shift to an asset-based approach involving local communities and focusing on improving health, wellbeing and tackling health inequalities. The proposed model proposes replacing some libraries with community hubs which provide a range of health and wellbeing support, as well as access to books and media; hubs would be managed by community organisations with support from the Council. The focus in leisure services will be on a joined-up approach to activities that promote physical health, mental wellbeing and reduce health inequalities.
For the first time, people took off their organisational badges and worked across boundaries on a shared priority.
Key achievements
- Gateshead has taken a broad and robust approach to use planning policy to improve health. Planning policy does not allow new hot food takeaways in areas with more than 10 per cent childhood obesity (around 10 per cent of areas in Gateshead). No new takeaways have been accepted in these areas since 2015.
- Gateshead has had a longstanding partnership arrangement with Teeside University involving embedded research to develop asset-based approaches in communities experiencing significant health inequalities. An initial project focused on working with a local anchor organisation and resulted in community-led health initiatives such as a healthy food social enterprise, links with Gateshead International Stadium, and safe travel around primary schools. The project was extended with Big Lottery Funding to a neighbouring area. Anchor organisations have been successfully used as community hubs during the pandemic. Researchers focused on prevention in adult social care have now been embedded in two neighbourhoods, supported by Arc Research Collaborative.
- Public health’s responsibility for emergency planning and community safety has been very helpful in the response to the pandemic. There has been great collaboration across the council and partners.
Sheena Ramsey, Chief Executive
"The evidence-based approach of public health has transformed the way that policy decisions are developed, made and evaluated within the Council.
Starting with a comprehensive understanding of residents’ needs, with a particular focus on hearing from communities who don’t always have a voice, has provided a robust foundation for decision-making.
This approach has been even more crucial in recent years as austerity has meant we have had to reprioritise our reducing resources on the things that are most needed and most likely to have a positive impact at the population level.
To help maximise the impact of public health advice, the Director of Public Health reports directly to me and is a core member of our Corporate Management Team."
Future plans
- A key priority is to deliver an inclusive recovery from the pandemic with a particular focus on health inequalities that have worsened during COVID-19, such as the impact on children, young people and families, and mental health and wellbeing. The understanding of health inequalities across all organisations increased during the pandemic and provides a good opportunity for partnership work. For example, public health is pump priming a tobacco control project in secondary care.
- Gateshead Council is shifting attention to implement the broad approach to tackling inequalities set out in the health and wellbeing strategy/corporate plan. The model will involve developing locality-based working with co-located staff and neighbourhood management, with close connections with the voluntary and community sector.
- Public health will continue to work on a new model for libraries, culture and leisure services focused on joined-up community-led approaches and proportionate universalism.
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To make a real impact on health inequalities, Alice believes it is essential for the NHS to “get bolder” and shift resources and activity so they are proportionate to need, with prevention embedded at every level.
Would you choose the same path?
Yes! I love this job, and I wouldn’t change it. My dad said one thing I should avoid is a job where I wished my life away Monday to Friday – being a DPH is very far from that.
