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.
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.