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Overseer of a less prescriptive future?

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Under the Labour government, Duncan Selbie was the Department of Health’s director of programmes and performance. When NHS bodies looked as if they might be slipping on a key target, such as cutting hospital waiting times, he would be the man asking chief executives questions.

Mr Selbie is now chief executive designate of Public Health England, due to become operational on 1 April next year.

If the Department of Health’s assurances are to be believed, the job will require him to trust local authorities to determine their own priorities and how to address them.

Words such as ‘leopards’ and ‘spots’ may well spring to mind, but Mr Selbie is on a charm offensive.

“I know what performance managing is, and Public Health England is emphatically not going to be doing it,” he says.

But with arch localist Eric Pickles having announced planning reforms that can only be viewed as hugely centralising, talk is cheap. So how real is Mr Selbie’s commitment to localism?

While he stresses that councils will be free to decide their public health priorities, it is clear that PHE’s approach will be far from hands off.

“Our role is to say to councils: ‘From the evidence, what have you chosen to concentrate on?’ There will be conversations going on all the time,” he says.

He also has strong views on health problems councils should seek to address. “I’d expect every local authority, every health and wellbeing board, to have a focus on mental wellbeing,” he says.

“We know mental well­being, or the absence of it, is the third biggest killer in this country.”

He adds that he would also expect councils to address the causes of cardiovascular disease and cancer, the other major killers, and to focus on the health of their poorest residents.

“Where you’re born is still the biggest determinant of how long you live,” he says.

Alongside this, he will come to an agreement with the secretary of state about “two or three things we need to be asking [councils] about”. This is likely to include sexual health and diabetes, he says.

Mr Selbie insists he is “drawing a distinction between telling [councils] what to do and asking: ‘What have you chosen?’”

But as well as keeping an eye on the health issues councils have chosen to focus on, PHE will also monitor whether they make improvements in these areas.

This could prove to be a difficult balancing act. There are concerns within the NHS, raised at this year’s NHS Confederation conference, that some authorities could go “independently wild”, putting the public’s health at risk. There have also been calls for a strong performance management regime (LGCplus.com/5046295.article).

Allaying these concerns will need to be set against a desire in local government for freedom and a light touch.

Mr Selbie’s responses to questions about performance and improvement suggest he is keenly aware of this balance. “I think the move from the Audit Commission to self-improvement is absolutely right,” he says.

“But is it sufficient? No. There will be times when we need to intervene. We need to do that as early as we can.”

Mr Selbie says it is not yet clear what form intervention would take but stresses his intention to work with the sector. “We haven’t worked through planning for when it really goes wrong. But we would do it with local government and the LGA,” he says.

“I have more confidence in local government in knowing how to address failure [than the NHS]. They’ve got more experience, more maturity.”

Earlier this year, the DH published the Public Health Outcomes Framework, the document that summarises the outcomes ministers want to see from the new system.

While Mr Selbie insists that league tables form no part of his vision for public health, the document says the PHE will have a role in publishing data on a regular basis about councils’ performance against centrally defined measures. There will also be “tools that support benchmarking of outcomes between and within areas”.

Whatever doubts may linger about the government’s ability to truly step back from micromanaging the new public health system, Mr Selbie is eager to make it clear that he trusts local government to get public health right.

“I’d expect us to see improvements against the outcomes framework within three years,” he says. “I’d expect to see those improvements as irreversible within five years, and within 10 years the conversation should be, why didn’t we do this before?”

He says improvements on these timescales will be how his success at PHE is measured. Staking his reputation on councils’ performance could be a signal of his faith in local government. Equally, it will provide a strong incentive to keep a close eye on their work.

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