Duncan Selbie: The energy of devolution

The NHS plays a part in keeping the country well – but when it comes to places and their people, local government has a major role to fulfil. PSE’s Luana Salles hears from Duncan Selbie, chief executive of Public Health England (PHE), on what truly matters to keeping England healthy.

Duncan Selbie has an impressive track record in the NHS: he began his career in the health system at the young age of 17, working his way up to chief executive of South West London & St George’s Mental Health NHS Trust and, later in 2007, of Brighton & Sussex University Hospitals NHS Trust.

But despite his largely health-driven background, he is a big advocate for local government – a passion which now fits in neatly with his role as chief executive of PHE, the Department of Health & Social Care’s arm’s-length body fashioned from the consolidation of a number of health agencies, but which now deals mostly with councils since budgets changed hands in 2013.

For Selbie, local government has a fundamental role to play in shifting the focus to place-based health – rather than cultivating an overreliance on the NHS – because of its inherent ability to speak to the public.

Speaking to me before his keynote speech at last year’s New NHS Alliance action summit, the PHE boss pointed out the importance of the event’s core message: the value of health creation to building happy communities. In other words: helping people stay well for longer, stay at home for longer, and – when they become unwell – stay out of hospital for longer. It all comes down to place-based, or population, care.

“The whole thing is about how to help people in their home and in their community. And the best way to help the NHS is to use it smartly, and not to be using it when there are genuine alternatives. That is at the heart of a health-creating community,” he explained.

“Prevention, in days gone by, would’ve meant how to help people quit smoking or drinking, focus on what they’re eating, that sort of thing – or it might’ve been thought of as how to help people get out of hospital faster or avoid admissions. But it’s much more than that. It’s about how to help people stay well for longer. The way I frame it is, it’s not so much about what the matter is with people, but what matters to them.”

This could be anything from staying in work and having money in your pocket to simply having a meaningful reason to get out of bed every day or a friend to turn to – someone to care for and about. “We know that there’s as much or more science underpinning people remaining well by having a job or a friend than there is anything we do in healthcare,” continued Selbie. “That isn’t to say healthcare doesn’t matter; it’s just not all that matters.”

A step on the journey

This was, in part, the reasoning behind creating sustainability and transformation partnerships (STPs), which seek to integrate health and care by bringing together partners from the NHS and local government. Or as Selbie put it, rather than being about how the healthcare system comes together, STPs are about the NHS recognising that it needs to speak to others.

“It goes back to the [Derek] Wanless Report in 2004: if we want a sustainable NHS, then we need to invest in the public’s health and be concerned with these wider issues: housing, economic growth, jobs, and how to help the education system to support young people getting into work. And the NHS depends on that,” he explained. “STPs are, if you’d like, an advanced form of planning for the NHS, but it’s only a step on the journey to recognising that it’s people and place, rather than treatment and diagnosis and illness and conditions, that matter.”

Public health is also a crucial piece of the jigsaw, of course, but it does not tell the full story. “It’s about what matters: economic growth, inclusive growth, inward investment, creating jobs that local people can get. It’s a very local thing.”

Because of his perspective on what drives good health, Selbie’s view on the much-anticipated Industrial Strategy, released late last year, is also unique: with its relentless emphasis on equal growth – across the Midlands and the north as well as in the southeast and London – it is as much a public health strategy as anything else.

It’s all about the place

Naturally, then, due to his focus on place and people rather than on institutions, the PHE boss is a strong proponent of devolution and all that comes with it: elected mayors, combined authorities and localised powers.

Asked if the burden to recognise the importance of place should fall only on the NHS or if councils should contribute to this culture shift, Selbie argued that it must be both, as they provide two “completely interdependent” functions.

“The NHS has got further to travel in knowing that it can’t do this on its own,” he added. “But local government know how to talk to the public. They know how to consult the public. If the NHS goes to a local authority once they’ve developed their plan and says ‘here’s my plan, I would like you to agree to it,’ it’s a far more difficult thing for a council than to say, ‘here’s what we’re facing, can we work out how we can best deliver this together?’

“What I’m asking for is a focus on place. It’s about a place budget – it’s not an NHS budget or a council budget or a police budget. It’s about a Birmingham budget or a Newcastle budget or a Cornwall budget – new forms of localism at scale.”

This is, in effect, what STPs are seeking to do, but they lack the same democratic powers and accountability that already exist on a local political landscape. “It becomes magical when they get it, but they need each other. STPs are a necessary but early step – devolution, combined authorities, elected mayors, that’s where the most energy is, and that’s what we should be focusing on.”

Of course, not every part of the country has been blessed with the powers to pool budgets, with a recent government review into devolution deals even finding that no new agreements were reached between April 2016 and March last year. But Selbie doesn’t believe that should stop areas from thinking locally, and is quick to refute the claim that their hands are tied by Whitehall.

“There is a deal to be had for parts of the country that are willing to rise above their own particular area, join with others and be more in control. But it’s not so much about a bigger share of the budget; it’s more about saying ‘we just think we can do it better.’ And I think they’re right – but they have to take that responsibility at a local level. The whole point of devolution is about doing what matters at scale,” he argued.

“And although places like Cambridgeshire and Peterborough, North of Tyne, Greater Manchester and so on are finding their own way to achieve that, every single part of England is on this journey.”

Top Image: Joe Giddens, PA Images




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