An interview with Dr Somen Banerjee, Director of Public Health, London Borough of Tower Hamlets.
Key messages
- Public health must be part of a community to help build the foundations of health and wellbeing.
- ‘Safety’, ‘satisfaction’ and ‘connection’ are the guiding principles at the basis of what public health is trying to achieve.
- Community engagement is a vital part of public health and should be seen as “a marriage not a one-night stand”.
Dr Somen Banerjee started his career in medicine. When he considered his choice of specialism, he wanted a fulfilling role that fitted with his values – promoting social justice, being part of a community, and being able to make a difference across the big picture. He was also very interested in the use of evidence and insight to inform health improvement. Public health was the obvious choice. Somen became an interim DPH in the NHS and then moved into Tower Hamlets Council.
The move to local government
The expansion of opportunity in local government was both exciting and daunting. There were great expectations from myself and my team. It was like being a kid in a sweetshop – where to start?
Somen says that he underestimated the cultural change involved in moving to a local authority which was like starting a new job. Public health became part of a larger organisation with different hierarchies and ways of operating. Working closely with politicians was very different from in the NHS, and he had to learn how these relationships could work most effectively.
He particularly enjoyed the close relationship between the council and the community, finding that engagement was both wider and deeper than in the NHS. Good communication with citizens is fundamental to councils – to work well they need to respond to the expressed needs of communities and understand their assets. This fitted perfectly with public health.
The range of potential partners was also far broader than in the NHS, not just across the council but beyond. There were many opportunities to expand the reach of public health, and the issue was identifying the priorities. The council was extremely supportive and welcoming but expectations on public health were very high and there was a process of developing an understanding of its role, skills and capacities in local government.
Councillor Rachel Blake, Cabinet Member for Adults, Health and Wellbeing
The transfer of public health to local government marked a major shift in the way that public health services were provided, moving service delivery right to the heart of our communities, and enabling public health teams to work with communities promoting healthy lives rather than simply treating ill health. Having public health as an integral part of local government means we have local levers to tackle local issues, for example in tackling the huge health inequalities that COVID-19 laid bare. Bringing public health teams into councils has changed local government for the better and put health and wellbeing at the centre of local decision-making.
Changes since the move
Over time it has been very exciting to see the circles of influence get bigger and bigger.
As public health became fully embedded in the council, the range of partnerships and fields of influence grew considerably, and the pandemic brought about a “seismic” expansion. Partnerships with schools, business, regeneration, the voluntary sector, leisure, planning, housing, community safety, substance misuse, workplaces, poverty unit, communities, the faith sector and many others can be built upon and extended.
Working with deprived communities has been an important area of work for public health and came into its own in the pandemic. Somen believes that an important guiding principle is that working with communities must be sustained and long-term. For example, it has been important to support COVID-19 champions on a regular basis.
When public health was in the NHS, Somen found that it was very close to general practice, and it was easier to engage with GPs and other resources. The relationship with the NHS remains good, embodied in the strategic partnership Tower Hamlets Together, but, over time, the constant ongoing reorganisation of the NHS has created barriers to consistent engagement and borough focus. The development of PCNs will provide an opportunity to re-energise joint working at a local level.
Tower Hamlets public health division was reviewed after a few years to make sure it was fit for its purpose in local government. This involved extending reach rather than taking on additional duties. The division was shaped to mirror the council structure of health, environment and communities; families and children; and adults.
Local authorities are all different. Every DPH has a unique journey of challenges and opportunities, moments of triumph and despair!
Some key achievements include:
- Tower Hamlets’ public health and NHS were involved in one of the new care model vanguards, working with the Institute for Health Equity. The three-year pilot involved integrating individual-level data on the social determinants of health such as housing and benefits with primary and secondary care data. The aim was to go beyond routine data sets to provide more detailed, granular data about the wider determinants and health outcomes in communities. The challenge is now to embed the approach as business as usual, involving PCNs, to escalate a neighbourhood approach to data.
- Tower Hamlets delivered a structured and evaluated community-asset based programme, Communities Driving Change, as one of the main priorities of its health and wellbeing strategy. The programme started with Well London pilots in two areas and developed into a three-year programme in twelve of the most deprived neighbourhoods in the borough. It brought together health data, identifying issues that matter to local people, recruiting residents with energy and passion to make a difference and working with local community organisations. Resident-driven initiatives include women’s groups and walking groups. The programme has been evaluated by the University of East London to help mainstream the learning across the council. During the pandemic, the focus shifted to targeting support in deprived communities, such as food deliveries, wellbeing calls, home learning packs, and referrals to additional services.
- Tower Hamlets is involved in ActEarly, a five-year collaboration with a range of academic partners including Queen Mary University London and University College London, funded by the UK Prevention Research Partnership (UKPRP) and also involving Bradford City Council. The aim is to promote a healthier, fairer future for children in deprived areas by improving environments that impact health through system-wide prevention solutions. The collaboration also examines how research can deliver practical, effective results to inform public health. Activity includes healthy street mapping and citizen science – encouraging children to undertake experiments in air pollution.
- Tower Hamlet’s Take a Breather project involved nearly 300 partners from across the borough, led by the Tower Hamlets Together Partnership. The project used quality improvement methodologies, including engaging with children and young people. It achieved a 22 per cent reduction in unplanned hospital admissions due to asthma; an increase in asthma care plans from 40 per cent to 75 per cent; and 92 per cent of high-risk children improved their control. The project has been adopted nationally and won the Local Government Chronicle Public Health Award for shifting from treating disease in secondary care to prevention in the community.
Will Tuckley, Chief Executive
Reassuming the main responsibility for public health was going back to the origins of local government. As a result, we have successfully reconnected with the fundamentals of the wellbeing of our citizens (clean air and so on), a trend especially important during the pandemic, and have linked public health programmes with the wider determinants of health in housing, employment and community. Public Health has brought us a strong emphasis on evidence and the use of data. The value of research, testing and evaluation in local public policy has never been clearer than it is now.
Future plans
- The public health division has considered the future and asked the question, what is its DNA? Two key areas have emerged:
creating the conditions for staff to flourish
the definition of public health, as working as part of a community to help build the foundations of health and wellbeing in the borough. - Before the pandemic, a start had been made to refresh the framework for the health and wellbeing board and the health and wellbeing strategy and this will continue. Tackling health inequalities exacerbated by the pandemic will be a key theme. Health inequalities will be reframed to make a more explicit connection between inequality and injustice, using the World Health Organisation concept of the Right to Health.
- Public health will continue to be strategically connected to the work of the council, identifying and seizing opportunities. Tower Hamlets is a small, highly developed borough that is experiencing “enormous regeneration”. Every asset, such as schools and pocket parks is important; every space and place counts.
- The development of north east London ICS and PCNs in Tower Hamlets provides an opportunity to deepen the work of Tower Hamlets Together. As yet, there is a focus on integration and health and wellbeing in the places/boroughs within the ICS, rather than PCNs. Further engagement and coproduction are needed to draw on the potential of primary care for improving health in communities.
- Data recording has improved during the pandemic, particularly about ethnicity, but more work needs to be done, such as recording disability data more systematically.
- The ADPH network in London is strong both pan-London and in north east London. DsPH have supported each other well through the pandemic, and there is great potential for further joint work on shared priorities.
A key challenge to future progress includes uncertainty over funding. Nationally improved training, competency progressions and portability of skills would be helpful.
In the wider context, Somen feels that this is an important time for public health. COVID-19 has provided a unique opportunity to reconceptualise and rearticulate public health so it can work even more effectively. “A paradigm shift is in the air”.
Would you choose the same path?
Yes! This role is fulfilling and creative; every day brings new challenges. But it is important to look after yourself, get the support of colleagues and remember to care for each other.
