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Archive for July, 2012

Does Local Healthwatch offer a fresh start for democratic accountability in healthcare, or more of the same structural problems that lead to tokenism and a lack of inability to have real influence? This was the question at the heart of the debate about democratic accountability at the 2012 FPH conference. The workshop was chaired by Professor Mark Gamsu of Leeds Metropolitan University, who specialises in tackling health inequality through strong citizens, local government and the voluntary sector.

Mark talked about how government policy often focuses on the ‘manual’, or process of delivery, rather than outcomes and impact. He – partly in jest – apologised for his part in the inclusion of Joint Strategic Needs Assessments as a duty in the Health and Social Care Act, because in his view it is only a tool – and tools should not be legislated for. It might have been better to have a duty requiring local strategies and commissioning to be based on local intelligence. There is also a tendency for all new governments to assume they are starting from a ‘year zero’ positionand therefore a danger that the achievements and experience of the present and past is not recognised and built on sufficiently.

Mark looked at the challenges and opportunities offered by Local Healthwatch, which launches in April 2013 and will take on the work of the Local Involvement Networks (LINks). Healthwatch and public health are potential allies. They share some characteristics, not least because they are both comparatively small and achieve much of their impact using evidence to influence change.

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.
This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks.

There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

There is also a tendency for all new governments to assume they are starting from a ‘year zero’ position, so that new systems are required regardless of how well the existing ones are working or how much time and effort is put into reorganising systems.

Public health: from transition to transformation

Reorganising health systems is not always a good use of resources: Mark Gamsu

This led to lively discussion of what drives commissioners, and the kind of leadership that can be expected to make the new systems work effectively once they take effect in 2013.

This will have a direct effect on what Healthwatch can realistically achieve, given that its lack of statutory powers mean it could face the same problems of tokenism and inability to effect change that have affected LINks. There a was both positive and negative experience among delegates, who included commissioners and current LINks members, about how likely it was that Healthwatch could have the necessary influence to hold local services to account. As one LINks member put it, very few people in his area had heard of the service, or knew what it did.

Mark gave an example of how important it is that information reaches the people who need it. Sheffield Mental Health Citizens Advice Bureau gives advice to patients on mental health wards, helping to bring the outside world into an institutional setting.

Ultimately, Healthwatch’s success matters for public health professionals because without local accountability for health services, there is a risk that health inequalities will be increased. Healthwatch’s success will be measured in part by how complaints are heard and acted on. With the final report from the Staffordshire public enquiry due in October, there is still much to be learnt about how statutory bodies act on the information they receive.

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Ancient Greek philosophers can teach us a considerable amount about living a fulfilled life, according to several speakers at the wellbeing workshop at the FPH conference in 2012.

Professor Sarah Stewart-Brown, Chair of Public Health at the University of Warwick, began the debate by looking at how different traditions define wellbeing. Her starting point was that Descartes was wrong – and the mind and body are very much connected.

The Greek traditions of Aristole and other philosophers, along with the Eastern belief systems of Buddism, Hinduism and Islam all offer differing perspectives on wellbeing.  Aristotle  framed wellbeing as being about our responsibility to live in a way that allows us to flourish. For this to happen, we need positive relations with others, confidence self-acceptance  and autonomy and we need to feel that we can influence our environment. Dr Martin Seligmann, founder of positive psychology, says wellbeing is about authentic happiness and being able to do more of what makes you happy. All these approaches suggest that the key to wellbeing lies within ourselves.

Many social scientists argue that wellbeing is determined by external factors social conditions like income and GDP, but  some economists, including the new economics foundation (nef),  have shown a very tenuous relationship between wellbeing and GDP. Stewart-Brown talked about how the Warwick-Edinburgh Mental Well-being Scale, which she developed,  is very popular because it focuses entirely on the positive aspects of mental health. For many years, the focus of mental health has been on the negatives – i.e. mental ill health, not positive outcomes about what good mental health or wellbeing looks like. Focusing on positive outcomes can be an intervention in its own right.

This focus on positive outcomes was reiterated by the second speaker; journalist, author and academic Jules Evans, who you can hear talking about his presentation here. His interest in wellbeing came about through his experience of Cognitive Behavioural Therapy (CBT) which helped him with  his anxiety and panic attacks. He found Freudian psychotherapy focused too much on the problems of the past, and not enough on how to enjoy the present.

He travelled to New York to interview Aaron T. Beck, one of the founders of CBT, about the Greek philosophical origins of this form of therapy. Essentially, he believes that while we cannot choose what happens to us, Greek philosophy gives us the tools to choose how we react to it. The Stoic philosopher Epictetus’s ancient habit of keeping a diary is one we can continue in modern times: it helps us keep track of our emotions and progress in changing behaviour.

It also demonstrates the value in putting effort into conscious decision making, which takes much more effort than our automatic habits. For example, for someone giving up smoking or trying to lose weight, they can chart their progress objectively, rather than assuming the worst if their resolve fails.

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Health protection is a global issue – and there are lessons to learn and share from all incidents, wherever they occur. That was the message from the global health protection workshop at FPH’s annual conference in Cardiff on 19 July.

Delegates heard how the Health Protection Agency (HPA) has built a worldwide reputation for its work, in part because the global nature of health protection means that planning needs to go beyond national borders. The World Health Organisation has 10 collaborating centres in the UK, while the HPA has sent teams on international secondments to South Africa, India and Australia. One of the speakers talked about how the HPA had been involved in giving high-level advice to government agencies after the earthquake and nuclear power failure in Fukushima.

Closer to home, the delegates heard from Dr Sarah Finlay about how she and her colleagues from the charity Festival Medical Services dealt with an outbreak of H1N1 at the Glastonbury festival in 2009. The festival had a population of 135,000 ticket holders, and 35,000 artists and staff, many of whom were the kind of healthy, young people most likely to contract the virus. The infrastructure of the event meant that living conditions were poor. People’s behaviour, as would be expected at a music festival, was not typical. The combined circumstances meant that it was easy for communicable diseases to transfer.

Risk was mitigated by following the protocols for managing H1N1, having immediate access to antiviral stocks and good transport to the onsite medical facilities, despite the mud. Good advice was given to festival goers before, during and after the festival, stressing the ‘Catch It. Kill It. Bin It.’ message and the importance of using the hand gels that were available across the site.

Information was circulated via the Glastonbury festival website, music press and general media. Just as the HPA team working on Fukushima had regular updates throughout each day to share information, so the Glastonbury health team relied on situation updates three times each day.

There were six cases of swine ‘flu at Glastonbury in 2009, all of which were confirmed by laboratory test results and each of whom left the site for further treatment. One of these cases was a 16-year old girl who had been sharing a tepee with 12 other people, each of whom had to be tracked down in the chaos of festival life.

In the circumstances, the team felt the outbreak had been well managed, and the lessons learnt from this example of mass gathering medicine were shared with the organisers of the Berlin World Athletics and the Hadj.

Dr Finlay summed up by saying that the success of the festival’s approach to H1N1 was due to having a well thought-through approach, early detection, awareness of the issue and by sharing the lessons learnt.

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