IT IS sometimes said that you can’t put a price on good health.
But in an era of public sector spending cuts, it’s a sad fact that everything can be – and usually is – seen as having an economic cost, including people’s basic wellbeing.
A national tabloid recently reported that 325 ‘nanny state’ public health bosses around the country were paid £100,000 or more a year, ‘just to say drink less and exercise more’ – with many of these working for councils.
The 2012 Health and Social Care transferred responsibility for public health to local authorities, and made it a legal requirement for them to employ a director of public health (DPH) who would be in charge of efforts to make residents fitter and healthier.
But the article in The Sun clearly dismissed such officers as Government ‘fat cats’, ‘joyless puritans’ and ‘meddling busybodies’, who were paid huge salaries to do nothing useful at all.
Whether those choice words could apply to Dr Heather Grimbaldeston is not for me to say. But as director of public health at Cheshire East Council, Dr Grimbaldeston received a total pay packet of £183,328 a year, making her the authority’s second highest paid employee, behind chief executive Mike Suarez.
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As part of a cost-cutting restructuring of senior management, the role of DPH at Cheshire East is being relegated from a tier two to a tier four position, with a cut in salary to ‘just’ £86, 636. Apparently, this would be too big a cut for Dr Grimbaldeston, and she has agreed to accept voluntary redundancy, at a cost of nearly £300,000.
Dr Grimbaldeston’s equivalent at Stoke-on-Trent City Council is Dr Lesley Mountford, who was paid £148,764 in 2015/16, and it’s clear from The Sun’s article that such salaries are the norm in this field of work, rather than the exception.
Now it’s very easy to say paying out such huge amounts to senior staff is a waste of taxpayers’ money.
But if you consider the size and economic cost of the public health problems we are facing, you would see salaries of DPHs are a drop in the ocean. For example, a recent report gave the cost of hospital admissions due to alcohol misuse in Stoke-on-Trent alone as £13 million a year. If Dr Mountford could reduce this problem by just one per cent, it would virtually cover her whole annual salary.
And it’s not just alcohol. Poor diet, smoking, lack of exercise and drug abuse are all avoidable health risks that can result in sizeable costs to the taxpayer if they necessitate NHS treatment.
As someone who is relatively fit, who exercises regularly and who eats reasonably well, should I have to subsidise the poor lifestyle choices of others? I could understand why some people might not think so, but as we believe in an NHS that is free at the point of delivery, such unfairness is just something we have to put up with.
It therefore seems logical that the best way a local authority can reduce costs of avoidable poor health is by spending a relatively smaller sum on promoting good health.
But the £13 million question is: does the work of DPHs actually result in better public health? And it is here where I think there are legitimate grounds for criticism.
There have been some spectacular failures. Only 48 people signed up to the city council’s widely ridiculed Text4Change initiative, where people were encouraged to lose weight after being sent motivational texts.
The successes are harder to pinpoint. The number of people taking part in sport in Stoke-on-Trent has increased marginally, and the number of smokers has gone down slightly. Whether either of these things had anything to do with the city council is difficult to say.
But perhaps the fairest approach would be to compensate DPHs on a payment-by-results basis, ie if the cost of public health problems falls, the DPH gets paid accordingly, but if there is no improvement, they get a much more modest salary. Maybe then taxpayers will feel that they’re at least getting value for money from these ‘meddling busybodies’.
[Source: The Sentinel]
