HIP meets Darrell Gale, Director of Public Health for East Sussex    

Across East Sussex there’s a shocking 13-year difference in life expectancy, between the lowest – in Gensing ward, St Leonards, and the highest – in Framfield, on the Weald.

Why such a disparity between a seaside suburb and a rural village? More importantly, what can be done about it?

Darrell Gale, the recently appointed Director of Public Health for East Sussex is making tackling such glaring inequalities one of his major priorities.

The primary task is to consider the big picture, examine health trends across the county and work with various agencies including, but certainly not limited to, the NHS, in order to determine the best means of addressing them. It’s a strategic role, grounded in hard evidence and statistics, to which Gale brings an unusual attribute (aside from an extremely natty dress sense) – his first degree was in architecture. This perspective on the built environment and its relationship to what he terms “the unacceptable life expectancy gap between haves and have-nots” informs much of Gale’s overview.

He’s certainly got his work cut out. Nationally, 40 years of progressive increase in life expectancy has stalled, the UK now lags behind other developed nations and in the recent budget public health (PH) services were cut by a further £200m, having already lost £500m since 2014-15.

Although only in post since July, Gale has identified Hastings and St Leonards as “presenting a very high level of PH challenge, health issues driven by inequality, it has obvious needs compared to the rest (of the county).” Parts of Hastings have “seen a constant churn of residents, in the past it’s been cheaper for other councils to house people here, with former B&Bs and large St Leonard’s houses in multi-occupation.”

The resultant issues, including homelessness and drug use, are all too readily apparent, the larger – and inevitably long-term  question being: how to solve them? The problem isn’t new. Local paper archives from Edwardian times reveal reports of “ugly predictions for the prospect of the local working classes during the winter” requiring “relief funds and soup kitchens.”

The responsibilities outlined in Gale’s job description are daunting and include such intangibles as ‘improving the health of the population.’ He’s also charged with ‘protecting public health against environmental hazard’ – remember the recent toxic gas cloud at Birling Gap? Combating ‘communicable diseases’ – for example, enacting a national strategy against TB, and the ‘support of NHS immunisation programmes’, for example flu and childhood illness vaccinations. More widely, the director of public health must ‘examine local variations in needs and outcomes and help with strategic planning.’

To achieve any sort of changes with little in the way of increased resources, Gale has analysed the major areas of need and presented a Joint Strategic Needs and Assessment report to the Health and Wellbeing Board, which includes members of East Sussex County Council (ESCC) who will draw up a list of priorities. Gale and his staff of 40, based in Lewes, will then work with local agencies to enact them. “PH is a long way from focus on just the clinical, only 15% of health outcomes are delivered via medical intervention. For the rest: family, jobs, transport, safety, housing – the PH role is ideally to stop matters reaching the point of clinical intervention,” says Gale.

“Major indicators of health are delivered by counties and boroughs – housing, jobs, social care (but) we can only deliver them in conjunction with other people; local councils, such as Hastings and Rother, and voluntary agencies. “There is,” continues Gale, “no real resistance to altering the way things are done. I’m forever an optimist; people create massive change for themselves and their neighbours with very little. They just need a nudge, it starts at a local level; small changes lead to bigger ones.”

Among the local agencies with whom he’s in regular contact is Healthwatch – an ‘independent national champion for people who use health and social care services.’

“They’re incredibly important, a huge advocate. They must give me some challenges and have a role in constantly asking for change, we have to co-create solutions. Some problems are about resources, a lot are about working together.”

Gale is determined to mention successes in local service provision: “Teenage pregnancy reduced in Hastings over the last 10 years by 50%,” in large part due, he believes, to personal relationship education. “East Sussex Children’s Services were recently judged outstanding by Ofsted, a massive jump – what the council does it does well,’ enthuses Gale.

He’s not blind to the problems facing many at the opposite end of the age scale. “This is an aging county, there’s not enough money for adult social care and post-hospital rehabilitation, and old people have particular problems with social isolation.” These examples neatly emphasise the importance of the PH role in influencing disparate aspects of policy. Public transport provision is a countywide issue and elderly care is split between social and medical provision. In each case, Gale’s role is to try and bring the agencies together and facilitate collaboration.

He has also to support five local districts and boroughs in East Sussex, to plan budgets together to avoid duplication, using a mixture of statutory powers and persuasion.

ESCC has a legal duty to improve the public’s health, and local Health and Wellbeing Boards bring together key local partners including NHS Clinical Commissioning Groups who have a duty to address health inequalities to agree local priorities. GPs often best understand local needs – for example, mums smoking during pregnancy – says Gale, whose health improvement team has a range of different resources to promote local health education campaigns.

Darrell Gale’s particularly concerned that planning departments consider the PH implications of their decision making – for example, green spaces for children’s play on new housing estates.  Such forethought currently seems in short supply. Where once Hastings’ far-sighted borough engineer, Sidney Little, built reservoirs to serve the town for years to come in the 1930s (and relieved unemployment in the process) Hastings’ planners currently struggle to hold developers to promises of building affordable dwellings.

There’s no doubting Gale’s energy, empathy and acute intellectual analysis of the detail. His interest in public health began when volunteering with community organisations in Portsmouth (another seaside town with a disproportionate share of problems). He knows East Sussex well through family connections and says: “I’m bringing a different outlook and background, having worked in many different places, this is not just a job. I can go into areas wide of the obvious PH brief; advocating for the whole county’s population, for those with the smallest voice and least access.”

He aims to create “good evidence, good data and credible networks. I’m impressed by working with councillors at all levels, by their determination, driven by doing better for people.”

No one could fail to wish him well, and yet, as a recent Kings Fund report outlines – despite the intention of moving public health to local government to join it up with other services such as education and housing: “How far this moves from aspirational vision to action will be signalled by key decisions. Will the government do anything about the cuts we’ve already seen, and about the others planned?” In the words of Professor David Oliver (clinical vice president of the Royal College of Physicians and Visiting Fellow at The King’s Fund): “From now on, every time I hear people using policy rhetoric to make the case for prevention, I’ll ask them, ‘So, what policies and funding do we have in place to back the paper talk and make it happen?’

Public Health England
Responsibility for public health was transferred from the NHS to local authorities in 2013, supported by a national body, Public Health England, with a mission ‘to protect and improve the nation’s health and to address inequalities’ and be responsible for:

making the public healthier and reducing differences between the health of different groups by promoting healthier lifestyles, advising government and supporting action by local government, the NHS and the public;

protecting the nation from public health hazards;
preparing for and responding to public health emergencies;
improving the health of the whole population by sharing their information and expertise, and identifying and preparing for future public health challenges;
supporting local authorities and the NHS to plan and provide health and social care services such as immunisation and screening programmes, and to develop the public health system and its specialist workforce; and
researching, collecting and analysing data to improve our understanding of public health challenges, and come up with answers to public health problems.

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