Good social workers are invaluable. So let’s give them proper support | David Brindle

About three in every 10 people in Britain think social workers help with household chores like cooking and cleaning, with personal care like washing and dressing, and with childcare. Two in 10 reckon they will nip to the shops for you. Asked to choose from a given list of professionals they consider important providers of mental health support, 69% of people identify psychiatrists and 65% GPs – but only 41% pick social workers.

These findings come from a ComRes survey commissioned by Think Ahead, the fast-track training graduate scheme for mental health social workers, to mark this week’s World Social Work Day. As Lyn Romeo, England’s chief social worker for adults, comments with a certain understatement, “there is still more to do to communicate the crucial role of social workers”.

That was to have been the role of the short-lived College of Social Work, set up by ministers in 2010 with plans for it to grow to become a royal college on a par with those for the most esteemed professions, but shut down in chaos five years later. News that the College of Occupational Therapists is to become royal – richly deserved, by the way – has rubbed a good deal of salt into that wound.

There is a fresh plan, however. From 2018, part of the brief of a proposed new regulator for social workers in England will be “to promote and maintain public confidence” in the profession. The mandate for the organisation, provisionally titled Social Work England (SWE), is contained in the children and social work bill currently before parliament. After a rocky start, it enjoys broad support.

One reason SWE is being welcomed is that it will give social work its own regulator again after six years under the generic Health and Care Professions Council. A second is that ministers accept it cannot be self-financing, at least in the short term, and are underwriting it by £16m in its first two years. And the most significant reason is that an initial idea for it to be run direct by Whitehall has been ditched.

Just how independent it will be remains moot: a quango accountable to government, not parliament, it will need ministerial approval of the professional standards it polices. But the social work world sees the lifting of the spectre of regulation by a government department as a clear win.

Another success being celebrated is the withdrawal of clauses from the bill that would have allowed councils to seek exemptions from children’s social care law to test innovative ways of working. Critics saw the idea as erosion of vital safeguards and mounted a strong, successful campaign against it – but the issue was almost certainly settled when Eileen Munro, the leading social work academic often cited by ministers in support of professional reform, opposed it.

However, real tensions remain between the government’s social work reform vanguard led by Isabelle Trowler, chief social worker for children, and the bulk of the sector establishment, with plans for accreditation tests for children’s social workers looming as a new flashpoint. But there is a sense of a thawing in relations.

Herbert Laming, sector elder statesman and crossbench peer who led both the seminal inquiry into the death of Victoria Climbié, which published its report in 2003, and a review of child protection six years later following the Baby P affair, hopes the thaw continues. He tells me: “What social work needs above all at this time is a bit of tender loving care.”

In a lecture on Wednesday at the University of Suffolk, Lord Laming will spell out the enormously high expectations that society has of frontline workers’ skills and judgment when dealing with vulnerable children and adults. The task, he will say, has been made infinitely more difficult by austerity, which is why he joined the call for withdrawal of the exemption clauses at this point even though he understood and backed the case for innovation.

Social workers are crying out for support and encouragement, Laming says. He is surely right. There has been too much stick and not enough carrot in the mix of late.

Good social workers are invaluable. So let’s give them proper support | David Brindle

Social care does need more funds, but there are also savings to be made | David Brindle

Ministers last week stepped in with an extra cash boost for social care. On top of a funding increase announced three months ago, they unveiled a further rise to help meet payroll costs and to help professionalise the workforce. Council leaders “warmly welcomed” the move and the emphasis on preventive support for older and disabled people.

You may have guessed this wasn’t in England. It was in Wales, where, as the Welsh Local Government Association (WLGA) observes, the policy position is “very different”. True, the sums involved are not huge. After a £25m grant increase for social care in 2017-18 set out last October, the Welsh government last week found a further £10m and raised the individual cap on homecare costs – a feature of the system not replicated in England – from £60 a week to £70, which should give councils another £4m for the year from April.

Overall, that makes £39m more against what the WLGA says would have been a £92m shortfall in social care funding. Still a problem, then, but if the Westminster government were to make an equivalent contribution towards a previously forecast £1.9bn shortfall in England in 2017-18, that would be worth £805m. As it is, measures hastily put together just before Christmas may amount to a maximum of £281m, according to the Institute for Fiscal Studies, and only £75m of that is grant.

If ministers thought a combination of face-saving package and festive goodwill would get them off the hook, they were mistaken: last week, the chairs of three influential Commons select committees sent a joint letter to the prime minister urging cross-party agreement on the future of social care and health funding, and the Liberal Democrats’ health spokesman, Norman Lamb, is expected to put the idea of a cross-party convention directly to Theresa May in the Commons on Wednesday.

Leading care charities are rallying behind Lamb with support for a cross-party “process” – note the difference – in another letter to May. “Such a process should not aim to ‘take the politics out of health and care’,” says the letter, coordinated by older people’s charity Independent Age, “but rather to make clear the costs and consequences of the political decisions that must be made.”

That is a degree of clarity May is unlikely to be comfortable with. In all her (admittedly limited) utterances on what she concedes is a need to review the social care funding system, she has been careful not to include reviewing NHS resources, too. The prospect of opening another bidding war on NHS cash plainly terrifies her. And the ease with which the hospitals lobby has slipped back into its familiar importunate mode in recent days – muscling social care aside after their brief united front last autumn – shows why.

Would social care be better off going it alone? While logic and principle suggest that the care and health system should be seen as an inseparable whole, and reviewed as such, realpolitik may dictate otherwise.

But social care should also show willingness to look at its own performance. May is convinced there remains money to be found in the system by making better use of existing resources. Although this does not obivate the need for funding reform, it is true that better value is being found in some places than others. Research by the Social Care Institute for Excellence (SCIE) in Birmingham shows that significant savings could be made if the city adopted three models of care reform pioneered elsewhere: the Living Well scheme of support for older people in the community, developed in Cornwall; Kent county council’s hospital discharge programme; and the Shared Lives concept of family-based accommodation for people with disabilities.

Using data supplied by Birmingham council, SCIE estimates that applying the three approaches could save the council £6.6m a year and the NHS £1.4m. To put that into perspective, the council has to make cuts of £78m in its overall budget in 2017-18 and the care and health economy across Birmingham and Solihull faces a £720m shortfall by 2020. But £8m is not to be sniffed at. Equally important, the kind of community support fostered in SCIE’s models plays perfectly to May’s vision of a “shared society”. If that’s the flow, social care needs to go with it.

• David Brindle is the Guardian’s public services editor

Social care does need more funds, but there are also savings to be made | David Brindle

As a thalidomider, ‘I feel I’m being treated like a scrounger’ | David Brindle and Sue Learner

For Phil Spanswick, who has lived all his life with shortened limbs, three fingers on one hand and four on the other, as a result of the thalidomide scandal, it was galling enough to have his benefits cut after reassessment. But it was doubly so to discover that the assessor had put his condition down as genetic.

“She was 21 and had trained as a paramedic and asked me three times how I had got my disability and what age was I when I got it,” says Spanswick. “She didn’t even know what thalidomide was, that it was manmade and babies were born with it.”

It is almost 60 years since the thalidomide drug was first licensed for use in the UK to counter the effects of morning sickness in pregnancy. By the time it was withdrawn within three years, in 1961, hundreds of babies in Britain and tens of thousands worldwide had been born with limb defects caused, it later transpired, by a component of the drug inhibiting the development of blood vessels and stunting growth.

The scandal became a cause celebre. The drug’s manufacturer in the UK, Distillers (now Diageo), fought a lengthy legal battle with the families affected and it was only after a campaign by the Sunday Times that compensation was settled in 1973 for most of the children, who were by then entering their teens. A long-awaited government apology finally came in 2010 and it was only after half a century in 2012 that the German inventor of the drug, the Grűnenthal Group, issued a statement saying it regretted the consequences.

Remarkably, people are still coming forward with claims for compensation. But as Spanswick’s experience suggests, the thalidomide story is slipping from the consciousness of even health and care professionals and the drug’s survivors – known as “thalidomiders” – are certainly winning no special favours from the reformed benefits system.

Spanswick, 54, has had his lifetime award of disability living allowance (DLA) downgraded under the reassessment process carried out as part of the benefit’s transition into the new personal independence payment (PIP). He is not alone: the Thalidomide Trust, set up as part of the 1973 settlement to administer compensation and represent the interests of survivors, knows of three other cases and suspects there are “quite a few” more.

“The effects of thalidomide are not well understood and the new assessment process can be difficult for individuals to understand and navigate,” says Deborah Jack, the trust’s director. While her team has been able to help other thalidomiders to protect their DLA awards, she explains, it was unaware of Spanswick’s case before it was too late.

Spanswick, who lives with his wife, Rachel, and two grown-up children in Lambourn, Berkshire, has one leg five inches shorter than the other, no left hip, virtually no arms and no thumbs. He is unable to tie his shoelaces, wash his hair and body, or use the oven or washing machine. He needs assistance to get dressed, although he has mastered the art of putting on a sock by using his other foot. 

When he falls, which can be quite often, he cannot put his arms out to break the fall and so tends to hit the ground, injuring his head. He is incapable of getting back up by himself. Yet despite this, he has been assessed under PIP as being entitled to the standard mobility component, worth £21.80 a week, rather than the enhanced rate of £57.45.

Back in the 1980s, Spanswick was awarded higher-rate DLA for what he believed would be the rest of his days. “Up until then I had to keep having medicals, but the doctor said I obviously had a disability that was not going to get better and would only get worse –so they awarded me DLA for life,” he says.

Three years ago, however, the government began to roll out PIP as a replacement for DLA for people with a long-term health condition or disability. The reform meant compulsory testing regardless of previous lifetime DLA.

In December last year, the assessor, working for private contractor Atos, came to Spanswick’s house. “She filled in multiple-choice questions and asked me how far I could walk,” he recalls. “I have one leg shorter than the other, so it all depends. Cobbles are really hard and I can walk further if there are benches along the way so I can sit down and have a rest. These questions cannot be answered with a simple ‘yes’ or ‘no’.”

A few weeks later, on Christmas Eve, he was shocked to receive a letter saying he was eligible only for the standard mobility component. As a consequence, he has lost free car tax worth £515 a year for his vehicle and automatic entitlement to free parking. If he had run a car under the Motability scheme for disabled people, rather than his old, adapted 4×4, he would have had to forfeit that too. He asked for the mobility assessment to be reconsidered. At the end of February, he was informed that the decision had been upheld. He then lodged a formal appeal, but a tribunal has rejected his case.

A Department for Work and Pensions spokeswoman says PIP is a fairer and more objective system than DLA. “Decisions are made after consideration of all the evidence, including an assessment and information provided by the claimant and their GP”.

Spanswick who still gets the higher-rate “daily living” component of PIP, worth £82.30 a week and receives an amount of compensation through the Thalidomide Trust that he prefers not to disclose, says he used to have faith in the system, but now feels “completely let down” and the victim of injustice. “I feel like they are treating me like a scrounger. These assessments try and pigeonhole you, but you can’t pigeonhole disabled people.”

His battle with the DWP has also brought back bad memories for Spanswick’s elderly father. “My father is so upset at this as he feels he had to fight for me when I was young for something that was caused by a drug company. Now I am having to fight all over again.”

Thalidomide: the facts

There are currently 465 thalidomiders on the books of the Thalidomide Trust, but people are still coming forward with potential cases – at an average rate of one a week over the past two years.

Deborah Jack, director of the trust, admits that even she is amazed. But she explains that people who were born with relatively limited physical disorders, and have been able to cope for more than 50 years, may now be struggling.

“One of the most common minor disabilities caused is absence of thumbs, or really tiny thumbs,” Jack says. “While you may have been able to manage with that, after all this time the strain of using your hands unnaturally to compensate starts to tell on your hands.”

By no means all claims for compensation are accepted after investigation. Many similar disabilities have other causes.

The trust administers investments of £130m provided by Diageo and a separate fund set up by the government in 2012, worth £80m in England over 10 years. Payments are made to thalidomiders according to the extent of their impairment.

As a thalidomider, ‘I feel I’m being treated like a scrounger’ | David Brindle and Sue Learner

Grownup care providers at breaking point as squeeze on funding requires its toll | David Brindle

Oxfordshire county council has for the previous 4 many years pulled out all the stops to avoid passing on a 38% minimize in its grant for providers for homeless folks. But now the authority says it has nowhere left to turn and is reluctantly planning to phase in the reduction, including stopping all funding for dedicated support for those with substance misuse difficulties.

“It is not one thing I like to do, but we’re not uncommon in performing it,” says John Jackson, the council’s director for social and community companies. “The reality is that I have to shield providers for men and women I have a statutory responsibility for.”

According to new investigation published right now, Oxfordshire’s choice is emblematic of the state of adult social care services across England. Findings from a survey of adult social care directors reveal that half say that fewer people are getting solutions barely a single in three says they are safeguarding the size of the individual budgets older individuals and disabled adults acquire to pay for their care and support, and 6 in 10 directors are braced for much more legal difficulties.

The Association of Directors of Adult Social Companies (Adass), which conducted the survey, has hitherto been notably measured – critics may say overly so – in its response to cuts ordered by the coalition government since 2010. But now it warns that the social care program is on the brink of becoming unsustainable. Its president, David Pearson, calls on wider society to say how far it is ready to shield “a great number of vulnerable individuals who will fail to obtain, or not be ready to afford, the social care providers they require and deserve”.

Recalling that earlier this year the National Audit Office (NAO) questioned no matter whether councils had been approaching the limits of their capability to soak up pressures on social care budgets, Pearson says: “Our survey shows past doubt that we have reached the point in which we are unable to absorb the pressures they, and our survey, have recognized.”

The survey adds to the sense of financial crisis. Demands for extra cash for the NHS are mounting and this week the Neighborhood Government Association (LGA) warns that councils in England face a £5.8bn funding gap by March 2016 due to even more cuts in grant – forcing twelve.5% savings in 2014-15 alone – and escalating demand for services, especially for older folks.

The funding gap for adult social care on its very own will be £1.9bn by March 2016, the LGA estimated. Following yr, 2015, is “make or break” for social care with the introduction of the government’s Better Care Fund, expected to pool more than £5bn of current money from councils and the NHS to devote on integrated companies that are created to hold individuals out of hospital. Recent government funding for social care is £14bn.

Pearson, even so, says the scale of the challenge far outstrips any benefit that may possibly come from integration. “It is not the directors’ occupation, but that of the country as a complete and its politicians, to debate how significantly, in times of the most serious adversity, vulnerable people should be protected from the consequences of that adversity by the introduction of new cash into social care.”

Norfolk gives a flavour of the challenge. The county’s population is projected to rise 25% by 2033, but numbers of people aged 65-74 will increase 54% and numbers aged 75 or above will soar by 97%. Significantly of this growth will be in isolated rural communities in the north of the county.

Norfolk’s grownup social solutions department already reviews development of 53% in referrals above the past 5 years, collectively with a near-tripling of demand for intensive homecare assistance of ten hours a week or more, at the very same time as it has been creating £72m cost savings, which contains cutting the numbers of social perform posts and paring back preventive services. Nevertheless, it says paying on frontline care has been protected.

With more cuts of £59m in Norfolk social providers planned in excess of the following three years, nonetheless, continuing to safeguard care is no longer practical. Some £14m is coming out of people’s personalized budgets, £6m from support for people with learning or physical disabilities and £4.5m from the contract with the council’s very own residential care firm.

Asked what the future holds, Sue Whitaker, Labour chair of Norfolk’s adult social services committee, says: “I have a feeling that attempting to provide anything at all on best of what is needed statutorily is going to be exceptionally hard, if not impossible.”

This displays the national image painted by the Adass survey. Primarily based on returns from directors in 144 councils with adult social care responsibilities, 95% of the complete, Adass calculates that an additional £266m (1.9%) is becoming taken out of services in 2014-15, producing a complete 12% real-terms minimize in investing given that 2010 whilst demand for companies has risen 14%. The net effect, for that reason, is stated to signify complete cost savings given that 2010 of 26% or £3.5bn.

Questioned about the most likely affect in excess of the subsequent two many years, 47% of directors say men and women who employed solutions would get smaller sized individual budgets for their care and assistance 48% say fewer men and women would be ready to get solutions 50% forecast greater pressure on the NHS 55% expect care providers to encounter financial problems and 59% anticipate receiving more legal issues to cuts.

With most provision of care these days outsourced, 19% of directors admit not being aware of if all their contractors paid the national minimum wage and only three% are assured that all paid the larger, unofficial residing wage. As numerous as 75% say they commission some homecare visits of just 15 minutes, despite the fact that 90% of them say this kind of visits were merely to check on an individual’s wellbeing or medication.

Richard Humphries, assistant director of policy at the King’s Fund thinktank, says the survey rings painfully accurate. “This is the consequence of the 2010 paying settlement that supposedly protected the NHS but left the social care technique totally exposed,” he says. “It was all completely predictable.

“What we are seeing now is a double whammy with each the NHS and social care simultaneously facing a crunch year up coming yr. Most people cannot see how to get beyond this without extra income – not just funds for much more of the exact same, but for transformation of companies. The Better Care Fund is Ok, but it truly is a extremely modest step in direction of a lot larger measures that are needed.”

Back in Oxfordshire, Jackson thinks the county council has a sustainable – if unpalatable – 4-yr strategy for social care. His political boss, Conservative cabinet member Judith Heathcoat, has advised the Oxford Mail she is “as relaxed as I can be” with the planned 38% cuts in housing-associated support, which are component of a £64m financial savings package across the authority in excess of 4 years.

Other cost savings will come by means of less expensive help for men and women with finding out disabilities, moving them both out of residential care or perhaps from two-man or woman flats to shared accommodation for five. Older people will also be hit: individuals attending overall health and wellbeing centres might up coming year be charged £20 a day.

Jackson’s dread is that growing numbers of legal issues will be incurred over people’s statutory rights to care. “In the end we cannot not meet people’s care requirements” he says. “We would want to do that morally anyway, but the law is really clear about it. We will not require the courts to tell us that.”

Grownup care providers at breaking point as squeeze on funding requires its toll | David Brindle

David Behan: a reluctant rescuer of crisis-hit care regulator | David Brindle

“We are at the starting of a journey to excellence, not the finish,” says David Behan, twenty months into a task that some regarded as impossible, and several thought career poison as chief executive of the Care Good quality Commission (CQC).

Behan, together with CQC chair David Prior, who arrived six months soon after him, are extensively credited with getting stabilised the crisis-prone overall health and care inspectorate, reeling as it was from damning criticism in excess of its roles in the Winterbourne See and Morecambe Bay hospitals scandals.

Behan himself admits it is the toughest issue he has ever completed. “We have attained a lot, people have worked extremely challenging, but there is a long way to go,” he says. Earlier this yr, the Commons well being select committee concluded that the commission had “a renewed sense of objective” and had moved decisively on from a position exactly where it had been “a case study in how not to run a regulator”.

Central to this modify has been the CQC’s new technique that set out to move inspection away from tick-box compliance towards a concentrate on suspected chance that foreshadowed the abandonment of generic inspection teams in favour of specialists and that promised a new technique of ratings for all care providers. Last week, inspectors had been reorganised into specialist teams and the commission is these days publishing a series of handbooks for consultation that set out how it proposes to carry out the new-type inspections and to decide ratings for each support from hospitals to care residences and dental practices.

“We’re going to be altering the way we examine at most likely the most tough time for health and care solutions in terms of demographics, public expectations and engineering – and all of that in a context exactly where cash is going to be as tight as it has even been in my occupation,” says Behan.

Austerity notwithstanding, the commission will be taking on 500 additional inspectors this year and investing £10m on coaching and advancement of its 2,000-plus personnel, as effectively as “experts by knowledge” (users of providers) and other folks from outside the organisation who now join its expanded inspection teams.

One factor of the CQC that is seldom appreciated is that most of its workers function from house when they are not out on inspections. This presents particular challenges.”We’ve lost that variety of social glue they had when they had been practising nurses or social employees. Now they communicate by phone or e mail”, says Behan, himself a social worker by background.

He believes firmly in the need to have to bring workers together at occasions this kind of as a managers’ meeting final week, which was held at the Emirates stadium of Arsenal football club and addressed by wellness secretary Jeremy Hunt. “I will get hit on how significantly it price, I suppose, but if we can not eyeball every single other and have a conversation across CQC, then I am not performing my job.”

When he asked 340 senior managers at the event how several of them had been familiar with the organisation’s stated values, just one particular individual raised their hand. It left him in no doubt that the commission demands a fresh set of principles that employees can determine with. And final results of the most recent staff survey, carried out in February, show that there continue to be troubling issues of organisational culture and particularly of bullying and harassment – the topic of an independent report commissioned by Behan soon after his arrival. Even though 77% of staff both strongly agree or agree that they feel proud to work for the CQC (a striking rise of twenty percentage factors on the preceding survey last summertime) only 35% think morale is great (up from 24%) 47% say they truly feel recognised and valued (up from 37%) and 20% say they have witnessed bullying or harassment at perform in the past 6 months, with 10% claiming to have been bullied or harassed themselves.

Behan admits that the bullying figures appear nevertheless worryingly high and is ordering a lot more function on it, employing outside experience. His belief in opening up the commission to external influence extends to bringing in critics and whistleblowers: James Titcombe, the father of a child who died at a Morecambe Bay NHS foundation trust hospital has been operating for the CQC as security adviser and Dr Kim Holt, the paediatrician who tried to increase the alarm about failings at the north London clinic the place Baby P, Peter Connolly, was treated shortly ahead of his death, has joined on secondment to advise on the new inspection regime and react to personnel who increase issues.

“James asks me questions that make me truly feel truly uncomfortable, like: ‘While you are making up your mind [about the safety of a hospital unit], would you be happy for your child to go in there?’”, says Behan. “I feel we are much better for that sort of challenge within the organisation.”

Challenge is presented, also, by the CQC’s restructured governing board, which still contains Kay Sheldon, who fell out spectacularly with the previous leadership and obtained £60,000 compensation in return for withdrawing an employment tribunal declare. She was subsequently reappointed to the board by Hunt.

With a wholly revamped executive group all around him, plus the 3 new chief inspectors of hospitals, grownup social care and basic practice, Behan says he is for the initial time ready to look forward rather than back. He accepts that CQC processes are still too bureaucratic, having recently sat with a registration assessor – doing work from her house – and counted some 50 clicks of her mouse as she carried out the basic job of shifting the title of the registered manager of a dental practice. “I think that is about 48 too numerous,” he says. “And I consider that’s what staff imply when they say programs and processes never always aid them to do the work.”

The commission carried out a record 39,000 inspections in 2013-14, with warning notices issued in 1,588 situations – a rise of a third on 2012-13. In a crackdown on care residences working with no a registered manager, 228 residences have paid a fixed penalty of up to £4,000. The cash goes direct to the Treasury. But Behan is pleased with the commission’s price range settlement for 2014-15, a complete £223m including a £120m grant from the Department of Health up from £80m.

Whilst Behan insists his task is “brilliant”, and he is paid effectively (£185,000 a year) for performing it, he fails to answer right when asked if he would get the submit now knowing how challenging it has been. Coming from modest roots – his dad and mom worked in the Lancashire textile market – he professes to be relatively bewildered at how far he has risen and to be unpleasant speaking about himself. He says: “I cringe doing this kind of factor, to be trustworthy. This isn’t me,” he says. “If I never ever had to do one more Newsnight interview or go on the These days programme again in my daily life, that would be just fine.”

Age 58.

Lives Kent.

Loved ones Married, two sons.

Training St Mary’s School Roman Catholic grammar school, Blackburn University of Bradford (BA utilized social research and CQSW).

Profession 2012-current: chief executive, Care Top quality Commission 2006-twelve: director basic for social care, Department of Wellness 2003-06: chief inspector, Commission for Social Care Inspection 1996-2003: director of social providers, Greenwich council 1996: director of social providers, Middlesbrough council 1994-96: director of social companies, Cleveland county council 1989-94: assistant and then deputy director of social providers, Cleveland county council 1984-89: venture leader (kids and households) and location manager for north Bristol, Avon county council 1978-84: social work manager/social worker, Wakefield council.

Public life CBE for companies to social care, 2003. (2002-03: president, Association of Directors of Social Companies)

Interests Cycling, foods, family members, travel, Blackburn Rovers FC.

David Behan: a reluctant rescuer of crisis-hit care regulator | David Brindle

John Middleton: "Public health is about producing ordinary lives richer" | David Brindle

John Middleton is England’s longest-serving public health director. He retires at the end of the month following 26 many years in the job in Sandwell, in the West Midlands. He has presided over striking improvement in a lot of, however not all, of the borough’s health indicators. But he leaves deeply anxious about the prospective customers for continued improvement, in certain amid younger people, who have suffered years of joblessness given that the economic climate crashed.

“It became clear in the early 2000s that middle-aged Sandwell guys have been dying prematurely simply because their lives had been robbed of work, activity and hope by the Thatcher recession,” says Middleton. “Now that pattern will be repeated for the virtually one million below-25s who are unemployed and with out hope these days.”

One could infer from this that Middleton – “Dr Johnny” as he is known locally – is an unashamed campaigner for public health and against people who undermine it. He believes that the last Labour government did much to enhance public health with policies such as Certain Begin for youthful kids, the minimal wage and the National Service Framework for decreasing heart condition, and he fears those gains are at threat as the NHS struggles with reform and paying curbs, and as revenue inequality stays stubbornly substantial. “It’s not who your mothers and fathers are, but how deep their pockets are, that will establish how wholesome you can be,” he says.

1 good thing that the coalition government has accomplished, in Middleton’s viewpoint, is to return public well being to nearby government – “back the place we belong”. This is not a view universally shared: a survey by the British Medical Association last week recommended that, considering that the transfer final April, a lot more than one in two public well being consultants had regarded quitting the specialism out of frustration. But Middleton, vice-president of the Faculty of Public Health, which covers the Uk and Northern Ireland, sees tremendous positive aspects in such places as Sandwell, in which neighborhood councils have seized the initiative and commenced to weave public health into the local government tapestry.

Driving about Sandwell, which is encircled by Birmingham, Walsall, Wolverhampton and Dudley, he factors out continuing investment in leisure centres, social housing improvement and industry gardens that help to educate men and women about (and provide) healthier meals – tasks usually delivered by the solidly Labour council in partnership with both the private or voluntary sector.

At Neptune Overall health Park, created on the internet site of a forge that created heavy chains for ocean-going liners, you can arrive by narrowboat for a GP appointment, blood check or X-ray, or to join a wellness-promoting guided stroll. Some individuals do. “They employed to say we had more canals than Venice and a lot more derelict land than the Bronx,” says Middleton. “Neither was probably ever correct, thoughts you.”

He admits that some of the £20m in public overall health cash provided by the NHS last 12 months is being employed by Sandwell to avert cuts in other providers that have a public well being dimension. “I am not conscious of any council that isn’t utilizing some of the money to prop up budgets,” he says, “but there are approaches of doing it. You can do it as we do right here by means of some kind of negotiation, and a inventive description of what councils can do for the public’s health, but then there are some councils just saying: ‘We’ll consider £2m off [the public overall health spending budget] and which is it.’ That is genuinely quick-sighted.”

Public overall health cash, he argues, could justifiably be diverted into meals safety inspections if those inspections also looked at the salt or trans body fat content of what was being served. “With the number of low-cost fast-food takeaways close to colleges, the dilemma now is not meals deserts but excess fat swamps,” he says.

Similarly, funding could fairly go into leisure companies if it was conditional on them creating a more active contribution to people’s fitness and mobility, monitoring and measuring their progress. However the present ringfence round transferred public health income need to keep, he says. “Nationally, there is wonderful variability about how councils are making use of the money and about their knowing of public wellness. There is a modest group of councils that genuinely will not want to know.”

Middleton has identified the move from the NHS into regional government a revelation in some crucial respects: the high quality of procurement and legal skills far exceeds that in the NHS, he believes. He has also discovered it a good discipline to have to justify paying priorities to senior colleagues and elected members.

“I have to acknowledge that some items I believed have been working well turned out, when they had been scrutinised, not to be carrying out what I expected,” he admits. “The place we had invested in neighborhood health networks supporting minorities, for example, we found that the Indian neighborhood had moved on and have been aspirational and in a lot of approaches self-reliant, but eastern Europeans had been not currently being covered at all.”

Partly due to the fact of this, TB rates in Sandwell are 50% over what they were in the late 1980s. Prices of HIV infection are also causing concern. But Middleton can level with fulfillment to hugely positive trends on headline indicators this kind of as teenage pregnancy – on which he thinks the Sure Begin result might currently be commencing to demonstrate – and heart condition: a programme of identification of at-threat men and women has led to the conserving of some 70 lives a 12 months since 2007.

Possibly his single greatest contribution to wellbeing, though, was making sure that every GP practice in the borough had access to welfare rights suggestions, enabling poor households to declare their total entitlement and bringing hundreds of thousands of lbs into the neighborhood economic climate.

Leaving will be a wrench. But one particular point he will not miss is operating with NHS England. He describes the entire body created in final year’s well being service shake-up to run the NHS across England as “a dysfunctional organisation that actually is not match for any goal I can see”.

He has a lot more time for the equally new Public Wellness England, exactly where he thinks chief executive Duncan Selbie is performing a good work in difficult situations, but, like a lot of operating in the health field, Middleton is normally exhausted by structural modify. “I’ve had 13 reorganisations in 26 many years, seven of them nationwide, so I have by no means been in a position to get to the level the place I consider I am doing the identical issue twice,” he half-jokes.

Sandwell has changed beyond recognition because he joined the well being authority in the late 1980s. Then, there had been even now 18 foundries and 88 scrapyards supplying them. Today there are just three foundries and, although manufacturing and metal recycling survives, the borough’s newfound growth is based on its dormitory housing for Birmingham commuters, its resilient minority-ethnic communities and its surprising green spaces.

Middleton will host a ultimate local well being summit on his final functioning day this Friday, at the vast Balaji Hindu temple in Tividale, prior to heading off for retirement, when he hopes to have a lot more time for his other great passion, the blues harmonica. Following a prolonged and wealthy tradition of “blues medical doctors”, Middleton is an achieved frontman with Dr Harp’s Medication Band. Blues doctors, he says, “present individuals a good time, creating ordinary lives richer and more healthy”. He hopes he has done that.

Age 58.

Lives Coventry.

Household married, a single daughter, one son, two stepdaughters.

Schooling Ecclesbourne school, Duffield, Derbyshire University of Southampton (BMed) University of Liverpool (tropical medicine diploma) University of Birmingham (occupational medicine certificate).

Profession 2012-existing: director of public well being, Sandwell council 2002-12: director of public health, Sandwell main care believe in 1988-2002: director of public wellness, Sandwell well being authority 1987-88 consultant in public health, Sandwell 1983-86: registrar in public health, West Midlands 1979-83: different junior doctor posts, principally in hospitals in Liverpool and Salisbury.

Essays Medical doctor, Create Me a Prescription for the Blues.

Interests Blues harmonica, cricket.

John Middleton: "Public health is about producing ordinary lives richer" | David Brindle