The plan to impose regulations on local authorities about the employment of Directors of Public Health (DPHs) is wrong on so many levels.

It gives the message that local authorities cannot be trusted to employ independent professionals. There are many roles in local government which carry personal responsibility and authority. Section 151 officers, planning officers and monitoring officers have a long history of acting with professional independence. Their decisions may from time to time thwart councillors or other officers but they don’t get sacked for it. It also demonstrates how little DH understands Localism. The imposition of more regulations isn’t just an irritant for local government it sends out a corrosive and damaging message that central government doesn’t trust it to do a simple job well. That will hardly build the confidence of DPHs at a time of transition.

The plan has clearly been developed in response to anxiety on the part of DPHs about moving to another universe – local government. The right response to that understandable anxiety is to allay fears and build bridges, not for DPHs to look back to the shelter of the NHS. The NHS hasn’t always been very nice to Public Health. DPHs may find that local government is rather nicer. Times are hard in local government but there is some very good work going on to meet the challenges. Many DPHs are already joint appointments and many others have already made very successful transitions into local government and are beginning to enjoy themselves in their new environment. Most local authorities are still very good places to work and most chief executives are very good people to work for. Good working relationships, built on mutual trust and respect, will ensure the successful transition of public health to local government. In the unlikely event that things do go wrong for a DPH, because of a personality clash or performance issues, an obligation on the part of the local authority to have regard to regulations will be no help at all.

Nicola Close’s comment about the need for DPHs to be free to speak out on behalf of communities reflects a fundamental lack of understanding of the way local government works. Councillors speak out on behalf of their communities. That is what they have been elected to do. It is their job and they do it with the professional advice and support of their officers. DPHs will be supporting local politicians to argue more effectively for their communities on health and wellbeing issues and providing them with the data and analysis needed to make difficult choices. This will be a lot more powerful than being a disregarded lone voice.

The negative tone of the discourse about the transfer of DPHs demonstrates the extent to which sight has been lost of the main goal of the changes. DPHs know more than anyone about the importance of the wider determinants of health – housing, employment, environment – than anyone. Those lie within the remit of local authorities and DPHs will be able to harness resources, create synergies and maximise impact in the battle for better outcomes. They know that we need a radical realignment of services towards prevention, early intervention and re-ablement and that change will only happen if there is an integrated approach, across public health, social care and the wider NHS. That work is being led locally by the Health and Wellbeing Boards, of which DPHs will be key members. In local government DPHs can have the sort of influence that they only dreamed of when they were running a peripheral service in the NHS.

Catherine Staite (Director of INLOGOV)
Catherine provides consultancy and facilitation to local authorities and their partners, on a wide range of issues including on improving outcomes, efficiency, partnership working, strategic planning and organisational development, including integration of services and functions.

I should have gone to Ladbrokes and put money on it. I used to do undergraduate admissions, so I know these things – and I’d have cheerfully bet 50 quid that,come the end of January, there’d be fistfuls of stories headlining how university applications had plummeted this year, “in the face of the hike infees”. And of course there were. They were dated 30^th January, but for all the detailed notice they took of the actual figures released the previous day by UCAS (the Universities and Colleges Admissions Service), they might have been written three months ago, along with the follow-up swipe at the Coalition in general and Nick Clegg in particular.

The message they convey is wilfully misleading. Even so, I was busy doing something else and was going to let it pass – until Mariella Frostrup pushed me over the edge. She presents Radio 4’s ‘Open Book’ programme and, ever topical, was discussing a couple of recently published campus novels – both Oxbridge, almost needless to say. At one point she asked her guests what they thought the implications were of “the UCAS report that applications are down by 15 per cent this year” (2^nd Feb).  Despite supposedly knowing something about students and one being a York University professor, neither guest even questioned the figure, but embarked instead on increasingly frenzied speculations about two-tier systems and universities becoming accessible only to the privileged few.

Heaven only knows where the 15% came from,but the programme covers “the best of new fiction and non-fiction”, so presumably it hopped across from the fiction bit. The figures most of the media used – certainly for their headlines –were the 7.4% fall in total applications compared to the same time last year,or, if they wanted to rub it in a bit, the 8.7% drop in UK applicants.  Even allowing for the likelihood that lastyear’s baseline was somewhat boosted by students applying at the earliest opportunity in order to avoid the fees increase, these figures do seem concerning – or at least they do for the three minutes it takes to read on tothe other stats UCAS released and the interpretation they provided. But –surprise! surprise! – few did.

What most missed, therefore, is the childishly simple point that there’s a crucial difference between application numbers and application rates. The clue is in the word ‘rates’, suggesting a relationship between two variables – in this case the actual number of applications and the potential number.  Divide the number of applications from an age group by the size of that group in the population, and you get the proportion of the group who’ve applied: not only a direct measure of demand, but a way of measuring fluctuations in demand without any effect ofyear-to-year changes in the group size.

Ah yes, those year-to-year changes. You might think that anyone who’s lived forany time in the UK would be at least vaguely aware of the post-war baby boom and the generational bulges it produces in our population pyramid. Unfortunately, UCAS didn’t think to produce one, or even the statistics for the changes in age group size that they used to calculate their application rates – so I’ve done so for them.

Estimated and projected age structure of the UK population, 2010 and 2035

Even with a 10-year scale, it’s easy enough to see what’s happening. The baby boom generation are now in their sixties,their kids are in their forties, and grand-kids in their twenties – having been through university during the nearly 10 years from the turn of the century, in which their age group and therefore university applications were increasing in numbers virtually every year. We’ve now gone into reverse. This year and for some time to come the 17-20 age group will shrink each year, and, without anything else changing at all, we would expect university applications to fall.And that’s the point of using application rates to measure demand – to control for those year-to-year changes.

Time to look, then, at this year’s application rates, as reported by UCAS, but not by most of the media.  In England, application rates for 18-year olds were down not by 8%, but just 1%. OK, not that big a drop, but concentrated presumably in the most socially disadvantaged parts of the country, discriminating even further against those already severely under-represented in our universities? Well, no again. There was a larger decrease in the application rate from the most advantaged areas than from the most disadvantaged.  It would seem that allthe headlines about £9,000 fees didn’t entirely drown out the Government’s message about no first-time undergraduate having to pay any fees at all up-front.  Beastly, isn’t it, when you wait months for the facts, and then, when they do arrive, they refuse to fit the story!

Chris Game (Visiting Lecturer)
Politics of local government; local elections, electoral reform and electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.