As 2018 draws to a close the work of the commissions designing Public Health Scotland is gaining momentum. In the new year the Programme Board will start to turn its energies to the task of joining up the different contributions. This will be a challenging but exciting task where we will start to get a sense of what Public Health Scotland will look like, how it will work.

As the Programme Board comes to this work we will need energy to absorb all of the detail and the contributions from the Commission, but we will also need to be pragmatic in thinking about what we can deliver between now and the day the Public Health Scotland starts its work. In many respects, the job of the Programme Board is to get Public Health Scotland to the starting gates – the job of integration, transformation and evolution will continue under the new leadership of the organisation well beyond December next year.

This work in the new year will only be possible because of all of the hard work that has been done over the course of the last 12 months, the significant investment in time and energy from all of those contributing to this reform. I have been really encouraged by the commitment and the enthusiasm that people have shown for what we are trying to achieve. I know that when you are knee-deep in the work to pull together a deliverable or a document it can be hard to be enthusiastic, but so many of the people I speak to are positive about the aspiration and the opportunities this reform presents. That is translating into outputs and deliverables that will enable us to move to the next step in the development of Public Health Scotland.

Building Public Health Scotland

The majority of the commissions and projects will conclude their work in December. The Programme Board will then have the job of trying to bring all of these disparate strands of work together to begin the process of describing what Public Health Scotland will be and how it will work. To do that, the Programme Board will use a Target Operating Model – or ‘TOM’ – approach. The TOM will set out how Public Health Scotland will work, how it will be structured, what things it will do itself and what things it will commission others to do for it, how it will relate to and support the wider system, and how it will be governed. The TOM will draw the road map for the next stage of this programme: the implementation phase.

One of the key messages I have tried to give people in recent months is that it is important that we don’t view the development of the new body as simply a merger or a continuation of the status quo under a new name. Public Health Scotland does not yet exist. Some functions that Public Health Scotland will be responsible for at a national level, are currently supported by existing organisations, but Public Health Scotland will also have new functions, and the delivery of existing functions may evolve and change once the body is established.

All of us need to understand that there will be no status-quo – this will be a step change in approach and profile for public health at the national level in Scotland, and the Programme Board is keen to ensure that we seize the opportunities it offers, that we will be bold and ambitious in our collective endeavour.

We know that Public Health Scotland will be established as a special health board but as a programme board we are clear that the new body’s governance and accountability will be different, particularly in the relationship with local government. We know too that the day-to-day business of the body will evolve from what colleagues across the system currently do. Innovation to be at the core of the new body but in doing so, we are mindful of the need to build on and strengthen the areas of public health that are currently working well.

In developing the Target Operating Model for Public Health Scotland, the Programme Board will not only need to bring together the large volume of material that has been generated by the Commissions, it will also need to balance competing challenges, resources and our high level ambitions.

Relationships the foundation for success

The other message I have been keen to give people involving in the work of public health reform is the importance of working with colleagues and partners from across the whole public sector and beyond, and the importance of building effective relationships. Public Health Scotland will have to maintain those relationships that currently work well, but it undoubtedly have to build new relationships, or evolve and strengthen existing partnerships.

Experience from the work of the commissions reinforces the importance of language and the need to understand the different perspectives that different colleagues, organisations and partners can have. Many of you will know this already, but the challenge in the fury of activity and reform is to maintain the empathy and discipline of thoughtful inquiry to see things from the other perspective. I have always seen public health as a discipline and a profession that can make connections across boundaries – we will need to do more of that across new frontiers if we are to be successful, and we have tried to design the commissions so that they start to do that, so that we bring different perspectives together, sometimes so that they challenge each other, always so that they demand collaboration. We are trying to build in the sorts of behaviours and engagement that we need to see Public Health Scotland promoting and delivering. This is not always easy, but it is necessary.

Looking forward

The coming months promise to be an exciting and challenging time. The Programme Board will develop the Target Operating Model and we will begin to see Public Health Scotland taking shape, the tangible emerging from the abstract. There are two others important developments that will be instrumental in shaping Public Health Scotland.

In the new year, the Scottish Government will undertake a consultation on the legislation that will need to be introduced to establish Public Health Scotland. The consultation will set out how we see Public Health Scotland working, its role and its governance. This is a necessary step ahead of any new legislation, and Parliament will expect us to sought the views of those with an interest in what we propose.

In reality this consultation is going to be of most interest to those who will be working in Public Health Scotland, and those people from organisations involved or interested in improving the health of the population. We are keen that we get as much feedback as possible – we will update the programme website once the consultation is launched.

Secondly, our commission looking at the wider specialist public health workforce – that is, those public health professionals working in NHS Boards and Local Authorities – has recently started work, with a two-day workshop in early December. On the theme of building relationships as we take forward reform, this Commission is being co-led by Local Government and the NHS – Audrey Sutton, who is Head of Connected Communities from North Ayrshire Council and Dona Milne, Director of Public Health in Fife, are co-chairing the Commission. 

This project is tackling complex questions about how we should best employ and deploy our specialist workforce in the future to deliver the impact we need to see. The work of the Commission is involving a wide range of professionals from across and beyond the professional public health workforce and we are clear that the solutions and conclusions must be co-produced. This work has a longer time-scale than the Commissions to develop Public Health Scotland, and it is not likely that we will begin to implement any recommendations until later in 2019, but we are clear this Commission has a mandate and the potential to make recommendations for significant change, if this is judged to be what is necessary.

As 2018 comes to an end my reflection is that as a programme, we have made significant progress toward creating the conditions for a thriving Scotland. This is mostly down to those of you involved in supporting the work of the programme over the last year. The challenges and demands will increase as we move into 2019, but so too will the opportunities. This will be the biggest change in public health in Scotland for a generation, and 2019 is the year when the next big development will occur.

On behalf of the reform team I would like to take the opportunity to wish you all the best for the holidays and look forward to working together as our reform journey continues in 2019.


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