Local authorities have just seen the most significant organisational changes in public health for decades.

From 1 April this year councils took responsibility for improving public health from the NHS.

This was a major shift in this country's approach to public health and a huge challenge to take on a large number of functions that are so important to our residents.

The diverse list of responsibilities that transferred over covered three main areas.

Firstly, the commissioning of services including sexual health, drug and alcohol, stop smoking, family planning and NHS health checks. 

Secondly, providing support to GPs through Clinical Commissioning Groups and the use of health intelligence to forecast the need for services. 

Thirdly, we took on the important role of ensuring that services including responsibility for health protection including health screening, immunisation programmes and emergency planning arrangements were being provided appropriately to our residents. 

Where Harrow differed from most local authorities is that we saw an opportunity to create a more efficient and effective service by combining Harrow's public health service with neighbouring Barnet Council. 

Our decision was based on the fact that we shared many the same characteristics in terms of vision and the health of our respective populations. 

We had similar visions and strategies for improving public health and wellbeing and similar health issues among residents including low rates of physical activity and a high proportion of elderly people and black and minority ethnic groups. This meant we shared many of the same health risks such as high rates of diabetes and heart disease.    

While the joining together of two boroughs as part of the transfer of public health responsibilities meant more work in the short time, the benefits were significant in terms of raising quality and making efficiency savings – to put it simply, doing more for less.  

Our inter-authority agreement for a shared public health service has delivered a 15% efficiency saving in terms of costs and future savings by having a wider sphere of influence and taking advantage of economies of scale. 

By having a larger team spanning two boroughs, we also benefited from greater specialist expertise, improved resilience and improved recruitment and retention.  

The challenge was bringing two separate operations together under one roof and involved a large transition including 45 staff, hundreds of contract novations, property transfers, IT, finance and a major data transfer.

With a transfer as complex as this, good preparation was undoubtedly always going to be the key to success.

We started our preparations more than two years before the switchover. We created Harrow's Health Integration Board and a shared Harrow and Barnet public health transition Board early on to work closely with partners including NHS North West London and the West London Alliance (of local authorities). We also made sure that members, senior officers and stakeholders were briefed on the process at an early stage to secure their buy-in.

The principle that each separate borough maintained individual autonomy and sovereignty over decision making was important in making the shared service a reality.

Simplicity was the key when dealing with the transfer of information and we took some early decisions that reaped rewards further down the line. 

For example, we agreed for an ‘as is' transfer of contracts which made for a smoother transition by not having to re-procure new services in the first year of operations. A year of ‘shadow' operating before transfer also proved to be very useful and a comprehensive induction programme for the whole team has been very successful.

We also had a big focus on disaggregating NHS contracts with providers and making sure we were clear on the responsibilities we were taking on, and those which would be provided by another part of the NHS. By being clear from the start we reduced the chances of challenges further down the line and the legal costs associated with them. 

Of course, with a change of this scale not everything went smoothly. While the benefits were clear in the long run, adding a joint team layer added complexity to the transition. 

The inter-authority Agreement was worth the effort though – it is a robust agreement that describes a clear way of working but is underpinned by trust and a not-for-profit principle.  We are still working to introduce new performance reporting systems and are learning the new HR policies and procedures particularly regarding recruitment. Evolving national guidance over the year prior to the transition added to the challenge.

We are now looking forward to the next major piece of work where we will use our commissioning intentions processes in both boroughs to ensure that the public health grant is used to really make a difference to the health and wellbeing of our residents. 

My advice to anyone having to oversee a large change in any organisation is to prepare well, get your partners and stakeholders on board early on and look at how you can add value to the service. The transfer of public health services gave us a unique opportunity to restructure the service for the next decade, and it is one we have taken with both hands.
 
Dr Andrew Howe is director of public health at Barnet and Harrow LBCs