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By Renu Bindra FFPH, Consultant in Communicable Disease Control, Public Health England @RenuBindra

The Selection Centre: the night before

Hurriedly pack suitcase to get to the selection centre by 4pm. Two dull hours on the motorway enlivened by an aeroplane that looks like it’s about to land on top of the car – the selection centre is in Loughborough and very close to East Midlands airport. Gets me every year. This year – and for the third year running – I’m marking the written exercise. All candidates are assessed by written test, group exercise and six (!) panel interviews. As a bonus (sarcasm intended), written selectors have to sit the test themselves a few days before selection, and Sunday afternoon is when we meet to compare answers and iron out any niggles (questions have already been peer-reviewed). Very relieved to find that I got all the answers right – the exercise requires good basic mathematical skills so I would have been mortified to have screwed up! The exercise also assesses qualitative analytical skills which are harder to mark – thankfully, a rigorous and well-tested framework helps us structure our marking. We finish by 5.30 – a quick change of clothes and I hit the hotel gym – only to find it closes at 6. Manage 20 minutes on the treadmill which I choose to run on an incline (ouch) in vague preparation for the Yorkshire 3 Peaks later this spring.

The Selection Centre: Day One

Quick breakfast where I meet Liz – public health consultant and fellow selector from the Highlands and Islands. I wonder if she’s had the longest journey to get here? Talk about our relative working environments; I thought some of my work journeys were long but hers definitely win! Head over to the morning briefing where we go over the selection process from start (application) to finish (offers issued in March). All candidates are assessed at every station against a range of skills: organisation and planning, conceptual thinking and problem-solving, communication skills, learning and professional development.

Walk past a nervous-looking gaggle of candidates about to go into the panel rooms. I’d love to stop and say something nice, but reassure myself they are being escorted round by a team of lovely and calming public health registrars who have experienced the process themselves.

Meet up with my fellow selectors where we get into our allocated pairs and go through the running order. As with all of public health we’re a diverse bunch working in defence public health, community provider organisations, academia, local authority and Public Health England. At around 10am the first batch of scripts arrive and we get stuck in. It takes a while to get into a good rhythm but we eventually get the hang of it and within an hour we’ve cleared the first batch. All scripts are double marked and at the end of each batch we work with our partners to compare scores. Where there is marked deviation (very rare) we work through the marking schedule to see if we can moderate our answers, referring to the lead if we get stuck.

Top tips for the written exercise from today’s selectors:

  • Stay calm and read the question carefully
  • Make sure you answer all questions – allocate your time!
  • If you mainly use a computer at work, practice your handwriting – we can’t guess the answer if we can’t read it!
  • Try and structure your answer as clearly as possible, using all the space available.

Five cohorts marked today and then we are done! Time to treat myself to a longer session in the gym followed by a dip in the pool, before we repeat the whole process again tomorrow. Good luck to all candidates!

By Dr Emily Dobell DFPH, Public Health Registrar

The start of 2018 has been an exciting time to work with the Faculty of Public Health. In a team of policy and communications specialists, registrars and a hugely experienced advisory board, we’ve spearheaded a campaign to ensure that Brexit, one of the biggest public health issues facing this country, will ‘do no harm’ to public health.

I applied to join the team in December, realising that this was going to be a real opportunity to learn about influencing national policy as part of my registrar training – and it’s proved to be exactly that. Brexit is a watershed moment and at FPH we’ve been campaigning to make sure that the assurances made about post-Brexit public health are set out in legislation as part of the EU (Withdrawal) Bill.

On the 31 January, it was thrilling to see Crossbench Peer Lord Crisp, former CEO of the NHS, make the case for a ‘do no harm’ amendment to the EU (Withdrawal) Bill during its Second Reading. (This was the moment Peers could debate any aspect of the Bill and signal their intention to make amendments.)

The next day, Lord Warner tabled it as an amendment to the Bill which will be discussed at Committee Stage on or around the 26 February. This is when every line of the bill is scrutinised and proposed amendments are voted upon. I’m proud to be part of the team that has supported Lord Warner and co-signatories Lord Patel, Lord Hunt of Kings Heath and Baroness Jolly who are now working tirelessly to back this amendment in order to secure our existing high level of public health.

So what exactly is the ‘do no harm’ amendment and why do we need it?

The ‘do no harm’ amendment will guarantee and protect the health of future generations as we leave the EU. While the current Secretary of State for Health has outlined the Government’s commitment to ‘maintain participation in European cooperation on disease prevention and public health’ – an assurance that is appreciated – conversations with the public health community have highlighted that concerns still exist about the potential impact of the Bill on the public’s health. Without the safety net of EU law, and in the context of significant cuts to public health and wider health budgets, we fear the gradual erosion of our existing high level of vitally important public health legislation, policy and practice.

If included in the Bill, this line of legislation would be a golden opportunity for the Government to provide much-needed reassurance to the health community that Brexit will ‘do no harm’ to the public’s health and will not put increasing pressure on the NHS.
We have made huge progress in public health during our time in the EU and the public needs assurance that their health is of paramount importance as we leave. The ‘do no harm’ amendment could be the most important piece of legislation we see passed in our lifetime.

Please join FPH in supporting this amendment and encourage the wider public health community to do the same. FPH will be tweeting throughout the Committee Stage debate, so please add your support by following @FPH on Twitter and using the hashtag #BrexitDoNoHarm.

On January 24th 2018 the Turkish Medical Association (Türk Tabipleri Birliği, or TTB) released a brief, non-partisan statement titled “War is a public health problem”. The statement highlighted the numerous negative health impacts of warfare, and expressed the principle that as members of a profession sworn to protect and preserve health the TTB were opposed to armed conflict.

Since the release of this statement, the TTB central council have been publicly denounced as traitors, received multiple death threats, and many of them have been arrested.

We, the undersigned, support our Turkish colleagues’ freedom of speech and wholeheartedly endorse their message. War is a public health emergency, and as such health professionals have a right and a duty to speak about it. Both the direct effects of physical and psychological trauma, and the indirect consequences (such as displacement, malnutrition, infrastructure damage and infectious disease outbreaks), are extremely harmful to human health and must not be ignored or neglected by those in positions of power.

We welcome the TTB’s statement on this matter, and call upon all parties to support the development of a political climate in Turkey in which health professionals can speak out on important public health topics without fear of violence, persecution or imprisonment.

Signed,
Daniel Flecknoe [Chair of the Global Violence Prevention special interest group]
on behalf of the following organisations:
British Medical Association
Faculty of Public Health
Medact
Primary Prevention of War Public Health Working Group

By Grace Norman, Specialty Registrar in Public Health  

In August 2017, I saw an email looking for public health registrars to work on one of two policy campaigns with the Faculty of Public Health (FPH): public health funding and Brexit. While both have broadly similar objectives at their core (ensure public health is protected and prioritised at a national level and members’ voices are heard and acted upon), I was drawn to the Brexit role because it seemed like an opportunity to try out one of my career options – making lasting health improvements through upstream, national-level policy change: embedding health in all policies.

I was lucky to be selected to join the 10-strong team and, since November, we’ve been working together to agree the three policy asks: 1) calling on the Government to amend the EU (Withdrawal) Bill with a ‘do no harm’ clause; 2) maintain a relationship with the European Centre for Disease Prevention and Control (ECDC) and; 3) secure health-focused post-Brexit trade agreements enabling the UK to improve health.  I’m currently working on the first of these projects and needless to say, this isn’t an ordinary placement.

As Brexit negotiations started last year, the project has been fast-paced. Two weeks ago, I was listening to Lord Crisp talk about the importance of Brexit on public health and since then, ‘do no harm’ has been tabled as a possible amendment to the EU (Withdrawal) Bill and will be discussed at Committee Stage in the House of Lords in the next couple of weeks.  This is genuinely upstream public health and it’s rewarding to see decision makers taking public health seriously.

The timescales for the project are incredibly tight, so there’s often a sense of urgency and a need to get things done now, which I enjoy, and with an increasing work-load, we are always prioritising to maximise impact. To date, we have had meetings with Peers, and written briefings and proactive and reactive press statements. Next up on my list of things to do is writing a speech for a Peer; this isn’t an opportunity I would have got elsewhere.

The potential health consequences of Brexit are so wide-ranging that it needs a team with varied expertise working collaboratively – I’m giving public health input into comms messages while learning about the parliamentary process. This is a genuine example of ‘the whole is greater than the sum of its parts’.

The FPH Policy and Communications team is a very hard working team, but the office ethos is light and fun, so coming to work is a real pleasure.  I feel like part of the team – my (terrible) hand-drawn self-portrait is on the office wall alongside the others’.  Not only am I gaining evidence for policy and management learning outcomes, but I’m learning how to motivate others, develop teams and chair meetings.  I feel that my self-development is prioritised and the office is a safe environment to learn how to be the best version of me.

It’s been incredibly exciting to be so closely involved in this project so far and I’m looking forward to the work that’s still to come this year.  If this sounds like something you’d like to get involved with, the FPH Policy and Communications team is on the lookout for more people like me to get involved in the campaign on a regular basis. The kind of things they’d be looking for help with are:

  • Asking for your views as they develop policy
  • Helping to decide which campaign messaging works best
  • Championing FPH campaigns on social media
  • Speaking up at conferences and events you’re attending
  • Responding to questionnaires and surveys that they will be doing throughout the campaign

If you’d like to find out more, please contact Mark, FPH’s senior policy officer, at MarkWeiss@fph.org.uk. And finally, don’t forget to keep an eye on Twitter over the coming months to follow progress on the ‘do no harm’ amendment and wider Brexit campaign. You can follow FPH here and you can follow me here.

By Andy Rhodes, Chief Constable, Lancashire Constabulary and the link between health and the local policing community in National Police Chiefs Council for the police and health consensus

Let me start out on this blog by acknowledging how I feel about prevention and partnership working most days. It’s complicated and challenging both professionally and personally. It’s helpful to know how people like me feel, and it’s even more important for me to understand how my people are feeling and how other organisations are feeling. I think we (the police) drive other organisations nuts sometimes, and I can reassure you the feeling is mutual!

But here’s the important thing. It’s because it’s complicated and difficult that it’s worthwhile… if it was easy everyone would already be doing it, so I thought I’d set out three reasons why a police and health consensus is worthwhile investing your time and energy into.

Number 1 – Listen to your heart
As a police officer I have seen first-hand the harm late intervention can cause. We are rarely surprised when we see young people who have grown up in an environment where trauma is their constant normality emerge as vulnerable victims and offenders, often with tragic consequences. Our hearts tell us this is wrong, yet our involvement can all too often be at the crisis end. It’s like watching a train hurtling towards a fallen bridge without any sense of hope that you can stop it. But we know we can. Throughout my career I’ve met countless professionals who share this burning desire to prevent escalation, and the evidence and research that sits behind the consensus shows us how much amazing work is going on, despite austerity. What those people deserve is leadership, evaluation support and total clarity from the very top that prevention is everyone’s job. Great leaders roll their sleeves up and do the hard work for the future. They don’t sit around commentating on the situation like a passive bystander. Our values are present throughout the consensus.

Number 2 – Listen to your head
If number 1 doesn’t work for you I won’t judge you because I think I may know why. If you’re in the police you’ll be seeing 80% of frontline work now supporting very complex client groups with mental health issues, exploitation and domestic abuse. You are being asked by those good folk whose job it is to ask hard questions, things like: “Do you understand your current and future demand and have you got the capacity and capability to deal with it?” And it feels overwhelming. Am I right?

Guess what? Police data isn’t as good as health data in terms of predicting harm. Guess what? The interventions that work best are the cheapest and earliest. Guess what? You don’t know it all. None of us know it all. The difference with the consensus is the reliance on evidence and data as well as a landscape review providing insights into how the system is adapting despite our best efforts to maintain a status quo that has never actually worked. Take this as your starting point to help influence, negotiate and shape our system.

Number 3 – Influence, accept and control
System change only happens when we place the end-user at the centre of our decision-making and to do that we need to see the system from their perspective. Standardised responses to variable need don’t work. So the consensus sets us the challenge of working across systems that are already under huge pressure… we are trying to fix the plane whilst it’s flying, so to speak. I don’t expend too much energy on things I have to accept (there is a fair bit on that list). As a leader I look at what I can control and where I can influence. But before we rush off in true completer-finisher style, take my advice: “Don’t just do something… stand there.” Use the consensus to stimulate enquiry, to challenge some of your assumptions, and hopefully this may lead you to a shift in thinking which basically looks like this.

Please use the consensus to add weight to your negotiations locally through the established partnerships at a strategic and local level.

If we don’t invest in working together to prevent escalation today the consequences for tomorrow will be devastating. Not just for your organisation but for society as a whole. End of.

I’ll end with a Gandhi quote which is on our meeting room wall. It’s there because we mean it, and our consensus gives us confidence that we are on solid ground with the evidence base and points us to innovation across the country deserving of our attention. Time to turn a piece of paper into action or go and get an easier job.

“The true measure of any society can be found in how it treats its most vulnerable members.”

 

 

 

 

 

By John Middleton, FPH President

John Middleton 2 web

I wanted to let you all know about the progress we’ve been making with our two flagship influencing projects and to ask you, our FPH members, for help.

You may recall that in June last year I let you know that we had decided to focus the efforts of our small, but perfectly formed, Policy and Campaigns Team on two vital public health priorities – Brexit and Public Health Funding.

This followed a significant policy consultation and prioritisation process with our members through the first half of 2017.

Before I tell you where we’ve got to with these two campaigns it might be helpful to remind you that these two issues aren’t the only two policy areas FPH is working on. We also have five policy committees and 30 (and growing) Special Interest Groups all developing and shaping policy and making the case for a very broad range of public health issues.

In terms of the Brexit and Public Health Funding projects, since June last year we’ve done a number of things in order to be ready to start campaigning at the beginning of 2018.

We’ve talked with a range of different public health stakeholders – including the Public Health Minister, Steve Brine MP – to find out where they thought we should focus our efforts within these two large policy areas. Through this consultation process we drew up ‘long lists’ of possible policy asks.

We’ve also created two campaign project groups, made up of staff and – for the first time – specialty registrars on placement at FPH. As well as giving us more capacity to deliver both campaigns, we’re keen that these projects provide an opportunity for our public health trainees to learn about, and play a vital part in, campaigning for policy change at a national level.

We’ve also created two Advisory Boards of senior FPH members – one for each campaign – to ensure we’re able to draw from the vast expertise we have on both these issues. I won’t embarrass the Board members by highlighting particular people but trust me when I say that both Boards are packed with very senior, experienced FPH folk.

The Advisory Boards met in November and December and shortlisted three policy asks for each campaign. I’m very pleased to announce they are:

For Brexit:

1. We are calling on the UK Government to introduce a ‘do no harm’ clause into the EU Withdrawal Bill – with the effect that the Government commits to ensure that the Bill’s powers are not used to reverse or amend regulations critical to the health of the population.

2. We are calling on the UK Government to ensure the UK’s future relationship with the European Centre for Disease Prevention and Control – we think it is vital that we can continue to work in close partnership with our European partners to tackle serious cross-border threats to health security, e.g. blood borne viruses, pandemic influenza, viral haemorrhagic fevers, and chemical and radiation incidents. In so doing, we will provide a model for the UK as it considers how to continue to play a significant role in other EU public health agencies.

3. We will be calling on the UK Government to ensure that the impact on the public’s health is a vital determinant in our post-Brexit trade agreements – we will develop with the public health community a set of evidence-based public health principles for negotiating ‘healthy’ trade agreements. We will call on the UK Government to adopt these principles as it negotiates our future trading arrangements.

For the Public Health Funding campaign:

1. We are calling on the UK Government to invest in a public health ‘transformation and innovation fund’ to support the upgrading of prevention and population health services in local authorities – FPH members are telling us that they have gone to heroic lengths to deliver more with less and less but they cannot make the ‘radical upgrade’ in prevention services asked of them without additional dedicated funding. This is needed to enable their teams to make the step change in the types of services they provide and how they provide them. We think this fund will need to be in the region of an extra £1bn per year but the exact figure will be determined during the policy development phase.

2. We are calling on national governments to conduct a review into NHS spending on public health and prevention – our aim is to ensure that the approximately £2 billion spent in England annually on prevention and public health services ‘in the NHS’ is spent appropriately and as effectively as possible. We’ll also be looking at what an increased funding settlement for prevention in the NHS might look like in order to help deliver the radical upgrade. As part of this we will be encouraging STPs to focus more on the prevention agenda.

3. We are calling on Public Health England, and other relevant national bodies, to develop an improved ‘dashboard’ for public health services – we want to ensure updated dashboards include what our members think are the key public health performance metrics and indicators. We hope this dashboard will enable the public health community to agree what a ‘good’ public health service looks like, where it is occurring, and to further encourage the sharing of best practice between different areas and sector-led improvement.

Over December and January both campaign project groups have been pulling together their campaign plans for the first year of what will be three-year long campaigns.

These plans have now been signed-off by our Advisory Boards and, as a consequence, I’m delighted to say that at the end of January the Brexit campaign took its first steps and started to make the case to Peers in the House of Lords for our ‘do no harm’ amendment.

It’s been incredibly exciting to be so closely involved in the journey FPH has been on over the past year to get us to this stage and there’s an awful lot of campaigning activity to follow in 2018 and beyond.

And that’s where you come in!

We’re looking to create informal networks of FPH members who are particularly interested in Brexit or Public Health Funding (or both) who we can involve in each campaign on a regular basis.

The kinds of things we’d be looking for you to help with are:

  • Asking for your views as we’re developing our policy thinking – i.e. acting as an informal sounding board as we’re testing our draft ideas and thinking, so that we can be confident that what we end up saying in public and to governments is closely informed by what our members think.
  • Helping us decide which campaign messaging works best – eg. which messages do you think are most inspiring? which messages are likely to play best with local and national decision-makers? which hashtag do you like most? We want to know what you think.
  • Championing our campaigns on social media – eg. retweeting and commenting positively about tweets FPH sends out and saying supportive things about our campaigns on other social media.
  • Speaking up at conferences and events you’re attending – to highlight the importance of these issues and our specific asks.
  • Responding to questionnaires and surveys we will be doing throughout the campaign.
  • Introducing us to your networks – if you play Canasta with Philip Hammond, table tennis with Jeremy Hunt, or go paint-balling with Jeremy Corbyn then please do let us know.

If you’d like to find out more, then please email our Policy and Campaigns Team via policy@fph.org.uk and tell us which campaign you’d like to get involved in.

Thank you so much in advance for your help and watch this space for future updates on both campaigns. We’ll be updating you very soon on our Brexit activities so far in the Lords.

 

By Jamie Waterall, National Lead for Cardiovascular Disease Prevention and Associate Deputy Chief Nurse at Public Health England, and Honorary Associate Professor at the University of Nottingham

Over recent weeks, we’ve seen constant media reporting about the increased pressures our health and care system is experiencing.

There’s no disputing that the NHS is facing ever greater demands, often linked to our aging population and many more people living with long-term conditions such as heart disease, diabetes, dementia and certain cancers.

But it’s worrying that most of the news reports only focus on the need for more acute hospital beds and ambulances, rather than discussing the need for a radical upgrade in prevention to reduce demand on these services.

As public health professionals we know that there are no easy solutions to the pressure on our health and care system. These are complex problems, requiring a whole-systems response.

However, we also know that many of the health issues keeping our hospitals so busy are preventable. Having worked in acute medicine and cardiology for a number of years I witnessed the scores of patients I treated who were admitted to hospital with conditions that could have been delayed or avoided altogether.

And when working in the acute trust environment, I would have agreed that more beds and acute services was the answer to our problems. It was not until I was working in primary care as a nurse consultant that I became more aware of the need for an increased focus on prevention.

So I frequently ask myself; how can we better harness the skills of our trusted front-line professionals, ensuring we all get behind this radical upgrade.

Our research informs us that there’s real appetite to build more prevention into our daily practice, however it also shows us that there can be barriers and challenges.

Time and resource is of course an issue, but we’ve heard that some professionals can be apprehensive about talking to members of the public about their weight, for instance, or whether they smoke or keep active. We also know that there can be uncertainty about the availability of local lifestyle services to refer patients to.

With all this in mind, Public Health England has developed All Our Health, a framework which supports all health and care professions to get more involved in the upgrade in prevention. It provides tools and advice to support ‘health promoting practice’ with quick links to evidence and impact measures and top tips on what works.

Based on user research we’re making improvements to All Our Health as well as forging new links with universities and Health Education England, so we can build more prevention into the way we train our future professionals to practise in this different world with new expectations and opportunities.

We also hope All Our Health will help health and care professionals to engage with the local public health system, including getting involved in the development of prevention initiatives.

Surveys of the public constantly show that our frontline health staff are amongst the most trusted professionals in our communities. Just imagine the impact if our estimated two million health and care staff built more prevention into their practice. We could truly achieve the radical upgrade we so urgently need to see.

For further information and to read more about All Our Health, click here.