Q and A with Director of PHE, Duncan Selbie

July 3, 2014

As Public Health England reaches the one-year mark of its establishment, Christy Craig from the IANPHI U.S. Office is honored to speak with Director Duncan Selbie about the NPHI’s first year in action.

What challenges have you overcome in getting PHE started? What recommendations would you give to others who are creating NPHIs?

I would start by conveying my sense of privilege of working with so many people and organisations that have come together to form PHE.  Each has brought wisdom and a track record of achievement to give PHE a truly great foundation on which to further build.

On April 1, 2013, PHE took responsibility for the staff, functions and services from over 100 organisations. An obvious early challenge was managing the transition of staff from their existing employers, around 4000 from the NHS to local government, and 5000 to PHE, and to other roles in the new public health system, including addressing natural concerns about their terms and conditions of employment and helping them adapt to differences in environment and culture.

One major challenge was maintaining the day job of protecting the public from infectious disease at the same time as taking on a much wider new responsibility to improve the health of the people and to reduce health inequalities. 

Is there anything PHE did in the establishment process that you would do differently if you could do it again?

It is probably too early to make that judgment. There is no doubt that the expectation of us has been great, and probably outpacing our readiness, but as we enter our second year we expect to find our voice on the biggest priorities facing England, having now very definitely found our feet.  So expect us to be very active around obesity, alcohol, tobacco, dementia and a good start to life for children, alongside TB.

In March 2014, PHE announced the launch of its collaborative TB strategy. Why did PHE choose to prioritize TB prevention and treatment?

Simply from the evidence that we were failing as a nation to address the prevalence and incidence of this highly treatable disease.  TB incidence in England is at its highest since the 1980s, higher than most other western European countries, and nearly five times greater than the US.  

How will PHE engage with the government, NHS, and other sectors to implement the TB strategy?

We are working closely with NHS England and are committed to working in partnership with the NHS, and with local authorities, whose leadership through their directors of public health and health and wellbeing boards is critically important in bringing together all the local agencies, including clinical commissioning groups (CCGs) and third sector partners.

A collaborative TB strategy has been launched for consultation and aims to bring together best practice in clinical care, social support and public health to strengthen TB control, and provide support to local clinical, preventive and social care services in the NHS, local government and wider health and social care system.  An effective strategy to improve TB control in England will need to learn from these international examples, be tailored to our particular epidemiology and health system, and build on current examples of good practice.   

How has the establishment of PHE strengthened the public health system of England?

Our primary duty is to protect the public from infectious diseases and other environmental hazards and on this we will remain at all times alert and ready.  This plays to our unique strengths in world-class science, disease registration, screening and vaccination programmes and surveillance systems, and our experts in emergency preparedness and response. 

Our second responsibility is to improve the health of the people and reduce health inequalities.  Good health is more than the absence of illness and disease and importantly is not synonymous with health care, a common belief but in error. 

Efforts to promote health and wellbeing, and tackle ill health, will have a better chance of success when they are framed in a way that aligns with how people think about the structure of their lives: their own choices and behaviours as individuals, and the importance of their environment, and of the communities around them.  We believe that all three – people, places and communities – are key to improving health and wellbeing.

How have the IANPHI-PHE-Uganda, IANPHI-PHE-Kenya, and PHE-Sierra Leone projects demonstrated the value of NPHI partnerships?

Working with Uganda, Kenya and Sierra Leone has demonstrated that, despite enormous differences between countries in terms of context, culture and challenges, the values held by a committed NPHI remain the same. We are such a new organisation. We have a lot to learn from our peers, especially those working in resource-poor settings, as we adapt to a more challenging economic climate.  It also means that we are able to empathise with colleagues who are still in the process of building or strengthening their NPHI and provide practical advice and suggestions based on our own experiences. 

In Sierra Leone, for example, PHE has taken the lead in supporting the Ministry of Health and Sanitation and other NPHI partners (Fiocruz and the National Institute of Health, Mozambique) to begin mapping out the first steps towards the creation of a new NPHI there.  Similarly, in Uganda, PHE has supported UVRI in developing and using a communications strategy to unify staff across multiple organisations, improve media relations and increase collaboration across the organisation, having just been through the process of bringing together multiple different groups under a single organisation ourselves. In both these cases, we benefited greatly from learning how our colleagues overseas operate and through the self-reflection and self-evaluation that such partnerships afford.

What have you seen as highlights of those projects?

The highlight of working with Uganda, Kenya and Sierra Leone has been building relationships through the course of the project, and afterwards through continued mentoring.  It is incredibly important to invest time in getting to know our colleagues from other NPHIs, and in seeing how our projects develop over time.  Receiving our first copy of the ‘Director’s Message’ from UVRI -  a key part of their new Communications Strategy - was a great moment!  The relationships we have built so far are crucial for effective global health work, and are of utmost importance to Public Health England.