Weight of expectation: Eustace de Sousa, children's lead, Public Health England

From October, local authorities will take over responsibility from the NHS for commissioning public health services for the under-fives. As the man in charge of Public Health England's children, young people and families work since April 2013, the transfer of the public health responsibilities will be a significant marker in Eustace de Sousa's career.

"The transfer of commissioning responsibilities to local government is absolutely the right thing to happen," he says, before adding he is "confident" that local authorities are ready for change.

But for a man who likes to ride a motorbike around Europe in his spare time, de Sousa admits there have been a few bumps along the way. "It's a large scale transfer and has been challenging," he says. "We're working with local government on how we maximize the opportunities the transfer brings and looking at the synergies with existing council services.

"Local government will have a greater holistic overview and responsibility for their communities and their families.

"Through their commissioning capacity they have greater ability to co-commission other services, and further integrate the Healthy Child Programme with other types of services, such as family support and parenting programmes, the Troubled Families programme and housing services."

De Sousa attributes his "insight into the bigger picture" to his varied experience in the NHS, local government, private and voluntary sectors, working across a range of vulnerable service user groups. For him, the question is not whether the transfer should have happened at all, but why it has taken so long to come about.

"I'm really excited about it and I believe it is a shame it hasn't happened sooner," he says. "When you think of a family living on an estate in a particular area, they are less concerned about who is providing the service and more about who will best attend to their needs. What this offers is an opportunity to bring it together in a more structured way."

The scale of the challenge awaiting local authorities was highlighted earlier this month with publication of a National Children's Bureau (NCB) report that showed the huge variation in the health and development of children under five across different parts of England. The report - which drew its findings from data supplied by Public Health England (PHE) - highlights the important role PHE plays in identifying national and local health trends. PHE pieces together data collected by the NHS and others to get a national view, and then its nine regional centres filter down the local picture to councils and other public agencies.

De Sousa says the NCB findings reinforced that "there are significant poor health outcomes for many children because of deprivation", but also highlights that it is not the only factor. To illustrate this, the report identifies three local authority areas - Hartlepool, South Tyneside and Islington - that have low rates of tooth decay (compared with their statistical and geographical neighbours) despite high levels of deprivation.

Complex tapestry

De Sousa explains this variation by saying: "Health outcomes are predicted by a number of factors, of which deprivation is one. But it's a complex tapestry with outcomes affected by your parents' education attainment, levels of income poverty, quality of housing, access to social care, the quality of primary care services.

"An authority might appear to be doing quite poorly compared with its statistical neighbour on a particular outcome, but when you look at it across another outcome it might be doing quite well. So it is not the case that just because an authority is not doing well on a particular outcome against a statistical neighbour they are doing poorly across all outcomes."

De Sousa is also quick to point out that good health outcomes are not always linked to the quality and availability of services, but says work over the past 20 years has shown that local health systems, if properly focused on addressing specific needs, can make great headway in tackling problems. This has been seen with reductions in teenage pregnancy, and drug and alcohol use by children. "There's been a steady downturn across the country in teenage conception rates and that's because local partnerships, including councils, have made a concerted effort to address the issue - they've not seen it as unsolvable."

De Sousa explains this has happened because good quality evidence has been gathered about the scale of the problem and what works in tackling it, which has informed decision makers over the need to act. He says: "For those issues the conditions have been perfect for three reasons: the (prevalence) data has been robust - so we know with a good amount of certainty about the current position; the evidence base and our awareness of what works has improved; and there's been concerted action - because people are aware of the problem they have got together at a local and national level to address it."

De Sousa describes this as the "planets being aligned", which he says is yet to be the case for some of the immediate health challenges facing local authorities. For example, while the data shows unequivocally that childhood obesity has risen in prevalence over the past two decades, the picture is less clear over what works in tackling it.

He says: "Child obesity rates have been up and down in different authorities. There are peaks and troughs, and it is difficult to see whether the trend is going in the right or wrong direction.

"In addition, many of the teams and services to tackle it are still in their infancy when you look at other types of intervention programmes."

Latest national data showed obesity rates rose across the board for children up to the end of primary school age, but have stabilised for some groups of older, more affluent children.

Is this a sign that the tide is starting to turn? De Sousa opens his laptop to consult data gathered through the child measurement programme before answering. "We have seen some early positive signs for some groups of children but they are flatlining at dangerously high rates, so there's no room for complacency.

"What we have found from looking at the trends over the past five years is that the obesity rates for children in the poorest areas are double those of children from more affluent areas.

"The scary figure for us is that one in 10 children arrive in reception obese and by year 6 that increases to one in five. And the rates are even higher for children from poorer areas."

Carrying such levels of obesity into adulthood are likely to have a significant negative effect on the individual's health and life chances, and public services, so de Sousa says PHE is helping health and wellbeing boards to develop prevention strategies.

"Childhood obesity is one of boards' key concerns and they are already well sighted on it," he says. "We're continuing to gather the evidence on what works and are working with the research and clinical community, both in prevalence and types of interventions."

Another issue that is high on PHE's priorities is children's mental health. De Sousa sat on the government-commissioned taskforce on the issue last year, which resulted in the Future in Mind national strategy and additional funding of £1.25bn to turn around the ailing child and adolescent mental health system.

De Sousa says that he was encouraged that throughout the process mental health was not just seen as a clinical issue. "What Future in Mind did successfully was to see the whole spectrum from good mental health through to meeting needs when they arise," he adds.

He also says the Department of Health's transformation fund will lead to the development of innovative approaches by local areas in improving child mental health services. "What really encourages me is that these plans require endorsement and sign-off from health and wellbeing boards. It recognises the solution rests with partnerships and is not just down to a single service, whether in the NHS or council. We have to see this in the whole."

So with such major child health challenges, how realistic is it to expect local authorities and their partners to make significant headway in an era of shrinking budgets?

De Sousa says it would be "unhelpful" not to recognise the financial pressures councils are under, but says the transfer of commissioning responsibilities offers the chance to organise services more efficiently.

"If the commissioning responsibilities had stayed in the NHS there was a risk that the management of the efficiencies could be quite fragmented. What the transfer does is to manage this more effectively.

"Many local authorities are already ahead of this. They have been impatient for October and already gone ahead with working in a much more synergistic way, bringing a range of different health, social care and education professionals together."

EUSTACE DE SOUSA CV

• April 2013: National lead for children, young people and families, Public Health England
• 2006-13: Associate director for child health, NHS North West
• 2005-06: Assistant director, child health, continuing care, learning disabilities, safeguarding at Cumbria and Lancashire Strategic Health Authority
• 1992-03: Assistant director older people and community services, Manchester City Council
• 1988-92: Advice and research worker, Greater Manchester Low Pay Unit