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Archive for March, 2018

By Mark Weiss, Senior Policy Officer, Faculty of Public Health, markweiss@fph.org.uk

Last week, cross-Party Peers debated the ‘Do No Harm’ amendment to the EU (Withdrawal) Bill in the House of Lords, and FPH’s Senior Policy Officer was there to watch. A ministerial assurance that there will be no rollback of public health standards is welcome. We now call on the Government to put that assurance on the face of the Bill.

Responding at the despatch box on behalf of the Government, Lord Duncan made a ministerial commitment to the spirit of the amendment, assuring the House that “there will be no rollback of [public health] standards”. The Government’s “intention to secure the highest possible engagement on matters of wider public health” will, he set out, be a “cornerstone” of the Brexit negotiations, and the UK’s leadership role in public health will continue to be a “beacon” to the EU.

Yet this ministerial reassurance stops one step short of a simple, necessary, and, as Baroness Jolly asserted, “Brexit-neutral”, commitment to put on the face of the Bill the “high level of human health protection” that would guarantee its practical effect – to protect against a gradual erosion of our vital public health legislation, policy and practice. As former Coalition health minister Baroness Northover observed, if it is the Government’s intention to not roll back on public health standards, then it should “enshrine that in the Bill”.

In calling on Lord Warner to withdraw the ‘do no harm’ amendment, the Minister reasoned that such a commitment is unnecessary, since it is already Government policy, simply replicating the Secretary of State’s existing duty to protect the public’s health. In fact, the amendment is broader than this duty in a number of important ways supportive of the Government’s intention. And, at committee stage, a large number of cross-party peers united to outline how.

Lead Peer Lord Warner outlined that the duty to ‘do no harm’ is placed on the whole of government, including a wide range of public authorities – a very important distinction that is far broader than the Secretary of State’s existing duty. It further covers, as Baroness Jolly set out, the whole of the UK, “irrespective of whether legislation is made or adopted in Westminster, Belfast, Cardiff or Edinburgh”. It reminds a wide range of interests that they must continue to protect and ‘do no harm’ to public health.

The public need, peers stressed, an “effective legislative provision to challenge in court the Government, devolved administrations and public bodies when they fall down on the job of protecting public health”. Landmark cases, such as the failed challenge by the tobacco industry to the Standardised Packaging of Tobacco Products Regulations 2015 show that the amendment, which is based on the high level of protection under Article 168 the Treaty of Lisbon, is such an effective legislative provision.

In that example, Article 168 was used to interpret EU tobacco products law as well as the powers to implement it. Article 168, the High Court emphasised in its judgment, places the protection of public health “at the epicentre of policy making”. In this way UK courts would be under no misapprehension about what Parliament expects them to continue doing after Brexit.

While the Minister offered assurance that the Government will be addressing existing protections for public health as part of the negotiations, Conservative Peer and Chair of the Committee on Climate Change, Lord Deben, cautioned that whether or not the UK upholds the highest standards of public health “will not be part of the negotiation at all”. We cannot, he made clear, have a system whereby law is “affected by the whims—or sensible policies—of Ministers”.

The EU (Withdrawal) Bill, Baroness Jolly made clear, “is where our constitutional stability and certainty will be secured within the UK legal system”, and is where the amendment should sit. It would not be sufficient, as Lord Hunt asserted, for the duty to be placed within a “theoretical health and social care Bill which may be introduced” at some future point. Peers further agreed that health, alongside the security of the nation and our economy, are surely the most important duties of any Government.

The duty would also be supportive of the Department of Health and Social Care in ensuring that the public’s health is a key part of the Brexit negotiations. Baroness Jolly noted regret among Peers that the Secretary of State for Health and Social Care “is not a member of the Cabinet committee for EU exit and trade”.

An issue of particular concern, the negotiation of future free trade agreements, was raised by Peers. While the Minister offered reassurance that our “values and principles [will not be] traded away”, Lord Brooke focused attention on the 760 treaties with 168 countries that the Government will need to negotiate – many of which will affect the public’s health and our national health service. Baroness Northover warned that public health standards “could be out of the window” should the UK decide to lower them “in an effort to increase competitiveness”.

Baroness Finlay noted the unprecedented and co-ordinated effort by transatlantic think tanks to secure the “ideal” trade arrangements “which would involve the UK diluting, for example, its existing standards on food safety”. The precautionary principle, she said, may be under serious risk. In turn, Lord Warner asserted that the duty to ‘do no harm’ has already been used in the High Court to determine the standard according to which freedom to trade versus public health is balanced.

Ultimately, while a ministerial reassurance is welcome, the Minister cannot offer reassurances that we have nothing to worry about while at the same time making clear that future Governments might decide on a different path, one perhaps that didn’t put the health of the people of this nation at its heart.

This amendment does not seek to preserve EU law and regulation. It simply ensures we have some legal precedent and interpretative guidance on which to draw when protecting the public’s health in the future. British courts, on the basis of our doctrines of parliamentary sovereignty, will decide the future interpretation of the law. This, as Baroness Jolly put it, “should give remainers a rosy glow [while] Brexiteers will be grateful that the amendment puts a marker down: British law for British people.”

In closing her speech, Baroness Neuberger – former CEO of the King’s Fund and Fellow of FPH – said that she could not “remember the public health community coming so strongly together on anything since tobacco packaging”. As we approach the report stage of the Bill in mid-April (when peers get a chance to vote on amendments), we need your support more than ever and ask again for your help. There are a number of ways in which you can get involved:

1. Tweeting your support for the amendment using #DoNoHarm and following @FPH
2. Talking to your professional networks about the amendment and encouraging their support
3. Speaking about the amendment at any conferences or events you’re attending
4. Talking to Parliamentarians you are in contact with and, if possible, introducing them to FPH
5. Sharing intelligence on grant funding opportunities enabling us to do bigger and better things.

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Natalie Lovell, one of the authors of What makes us healthy? An introduction to the social determinants of health, writes about distilling such a big topic into a quick guide

SOME people might think it’s a bit ambitious to attempt to produce a ‘quick guide’ to the social determinants of health – the social cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age. But, despite the vastness of the topic, we decided to give it a go.

The social determinants of health: what are the key messages?
Firstly, we should care about good health because it’s essential if individuals, society and the economy are to thrive. I recently read that “all members of a community are affected by the poor health status of its least healthy members”. Whether your cause is social justice or economic development, or you’re interested in social cohesion, good health is a relevant piece of the puzzle.

Secondly, health is about more than healthcare. When people are asked about health, their thought process often leads them straight to illness, medicine, and treatment of disease. But many of the drivers of health sit outside health and social care. As Michael Marmot puts it, “Why treat people and then send them back to the conditions that made them sick?”

Thirdly, as individuals, we have less control than we think. The factors that make us healthy sit largely outside individual control, and it is the conditions in which we find ourselves living that make us healthy or unhealthy – consider the greater density of fast food outlets in deprived areas in England. This is echoed in a recent report by Guy’s & St Thomas’ Charity about inner city childhood obesity, which found “it is in these areas in particular where people are bombarded with opportunities to eat high energy food and have less defence against ‘obesogenic’ city environments that promote unhealthy choices”.

Finally, collectively, we need to create the surroundings that give people the opportunity to be healthy. As set out in our quick guide, the evidence shows that many people and sectors have the levers to improve people’s health and reduce health inequalities (the differences in health outcomes that exist between groups in society). These include people sitting across government, the voluntary sector, the private sector, media, advertising and local communities. But if we don’t understand and act on this knowledge, we will never overcome our biggest health challenges.

What is already happening?
Many people can make a difference. It could be a charity that helps a group of people feel less lonely, an employer who decides to become a Living Wage employer, or a councillor who puts cyclists and pedestrians first when coming up with an action plan to tackle congestion. The list of those with the power to influence our daily lives for the better (often through structural changes), and therefore our health, is long.

We uncovered some great examples, particularly at local and regional level, of where, despite the odds stacked against them (such as severe budget cuts in local government), action is being taken that will improve people’s opportunities for healthy lives.

Read our quick guide, What makes us healthy? An introduction to the social determinants of health, to find out more about:

  • how local councils are using innovative inclusive economic growth techniques
  • how local councils are making the most of planning and transport policies to design and create healthy places
  • how charities and businesses can influence health
  • what approaches national governments are taking.

What’s the aspiration for this quick guide?
My hope is that this quick guide will make its way to those people across society who have the potential to influence people’s health, and that they might pick it up and think, “This is about me and the work I do.” Perhaps a public health expert will pass it on to a Director of Economic Development and Planning, who will pass it on to a business leader or employer they are working with, who might then be able to ask themselves important questions such as, “Did the last decision I make have an impact on people’s health?”

The quick guide sits within a broader programme of work at the Health Foundation. It offers a broad overview of the interconnectedness of virtually every aspect of people’s daily lives and their health – and therefore, the dizzying potential that exists for people across society to take action.

Order a free copy of the quick guide now. It will fit right into your pocket.

Oh, and the answer as to how you eat an elephant? Piece by piece.

Natalie Lovell is a Policy Analyst for the Health Foundation

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By Neil Squires, the elected International Registrar on FPH’s Board and member of FPH’s Brexit Advisory Board

Neil Squires web cropI am very pleased to have been re-elected for a second term as International Registrar. The past 3 years have helped to demonstrate the real potential of FPH members to contribute to public health development in other countries and opportunities for members to engage globally are now beginning to increase. Over the last couple of years we have delivered training in Odisha, India, which has provided public health leadership skill training to 300 senior personal in the Government of Odisha. That work sparked requests for similar support in other States and an invitation for FPH and PHE to support the development of India’s MPH curriculum – an important in-road in to developing the next generation of public health leaders in India.

Similarly, the Pakistan Special Interest Group (SIG) has been increasingly active, working alongside PHE, developing a mentorship programme for health leaders in Pakistan. Stronger links have been made with both the National Institute of Health and with Academic Schools of Public Health, laying the foundation for future capacity building work. This programmes of work were commissioned using Overseas Development Aid (ODA) funding, and respond to needs identified by host countries. In addition, the Africa SIG has made strong connections with the Public Health Foundation of Africa, meeting public health leaders from across Africa in Nigeria, and has developed a network of health professionals who will be the cornerstone of future efforts to build on African Public Health Assets to strengthen Regional capability.

In addition to work with resource poor countries, there are an increasing number of requests to FPH from wealthier countries wishing to build stronger public health systems and adopt competency based training. A recent funded mission to Kuwait has created opportunities for potential future collaboration, where we hope to draw on a number of FPH members who have expressed interest in supporting training and public health capacity development. These funded opportunities both allow FPH to support our partners to develop their public health capacity and also generated the necessary income to enable FPH members to work internationally, helping to cross-subsidise work in the poorest countries.

At a time when it seems even more important that the UK remains actively committed and engaged internationally, the work of the Global Health Committee provides a real opportunity to productively engage in support of our colleagues in other countries as we collectively strive to achieve the Sustainable Development Goals (SDGs). In June FPH will organise a global session for the Association of Schools of Public Health in the European Region (ASPHER), where we hope to promote a coming together of a number of international networks committed to strengthening public health training and capacity globally, linking this to support of stronger national public health agency development. There is a significant opportunity and appetite for the international public health community to come together to tackle common concerns linked to poverty reduction, inequality, to global threats such as climate change, and to tackle global challenges such as violence.

Collaboration with other Royal Colleges remains an important objective, and strengthening relationships across the UK health system in support of global public health a priority. We are actively seeking committed members to join one of a number of causes that have global dimension, where there is a real opportunity to shape the future work and growing global profile of the Faculty of Public Health. These are opportunities we encourage all interested members to engage in, with a growing international membership to serve and an expansion in our practitioner members, who can help us champion multi-disciplinary public health globally.

To find out more about FPH Special Interest Groups specialising in global public health, click here.

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By Stevie Benton, Communications Manager at ASH (Action on Smoking and Health)

As smoking prevalence continues to fall, NHS and public health organisations are taking things to the next level with the NHS Smokefree Pledge. 

Co-ordinated by the Smokefree Action Coalition, the NHS Smokefree Pledge is a commitment to help smokers in their care to quit for good and to create smoke-free environments that support them to do so. By signing the Pledge, organisations agree that they will take a number of actions to reduce smoking prevalence and help smokers quit. The commitments in the pledge include:

  • Treat tobacco dependency among patients and staff who smoke, as set out in the Tobacco Control Plan for England
  • Ensure that smokers within the NHS have access to the medication they need to quit in line with NICE guidance in secondary care
  • Create environments that support quitting through implementing smoke-free policies as recommended by NICE

Smoking remains the single greatest cause of premature death and disease in our communities. Around 79,000 people die because of smoking in England every year and for every death, another 20 smokers suffer from smoking-related diseases. Smoking imposes a huge burden on the NHS. Stopping smoking is the single most effective action a smoker can take to improve their health.

Signing the pledge is simple and a visible commitment to a smoke-free NHS. This No Smoking Day, if you’re a director of public health, why not take that crucial first step and encourage your Trust to sign up?

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John Middleton 2 webBy Professor John Middleton

Last month I let you know about the progress we’ve made in our Public Health Funding campaign. A new FPH project group – made up of staff and registrars – will be focussing its efforts on making the case for greater investment in public health services in local government and moving the dial towards prevention in the health and care system.

I’m blogging today to let you know about the Government’s recent response to the House of Lords Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care and what it means for our new campaign.

In their response, the Government dismissed recommendations to reverse past cuts and cancel future ones to the public health grant and to extend the ring-fence for the next decade.

The Government’s argument rested on four central planks.

Firstly, the Government argued that ‘public health is about far more than the services funded through the grant’. With the transfer of public health to local government, prevention interventions are now delivered by many other local services, such as housing, which are not necessarily funded by the grant. These types of joined-up services are exactly what public health reform has sought to achieve.

Secondly, the Government argued that public health teams are now ‘demonstrating real innovation’ to achieve more with less. Now that local authorities have the autonomy to redesign services in a holistic and place-based way, councils are achieving better value for money while still producing good outcomes. These innovations are very welcome.

Thirdly, the Government argued that despite a challenging period for public finances overall, local authorities will still receive more than £16 billion for public health over the 2015 spending review period. This is not an insubstantial amount.

Lastly, the Government argued that any conversation about public health funding must include the role of the NHS. Local authority public health spend is bolstered by ‘well over £1 billion a year’ that the NHS spends on key public health functions, alongside the commitments to prevention outlined in the Five Year Forward View. Prevention is a core priority for the whole health system.

So what does the Government’s response mean for our campaign?

Firstly, we think the public health community needs to be able to respond to the Government’s key arguments if we are to make an effective case for greater investment in public health. We’re pleased that the focus of our campaign is seeking to address these points.

We are calling for increases to public health spending, but we’re not simply asking for greater investment in current services for ‘business as usual.’ We agree with the Government’s point that public health teams achieve great results when they are able to innovate. While recent reforms have provided local authorities with the autonomy and the responsibility to innovate, they have so far not provided proper funding in order to enable this to happen in a systematic or equitable way.

That’s why we’re calling for investment in an ‘Innovation and Transformation Fund’ to enable local authority teams to transform services to match the needs of their fast changing local populations. This investment is needed now in the short-term to allow public health teams to respond to the challenges of the future. We believe that investment in public health innovation needs to be placed centre stage during the next spending review period if public health reforms are to be viable for the long-term.

We know that the £16 billion allocated to local authorities for public health over the 2015 spending review period is no small figure when placed within the context of overall central Government funding for councils. We would contend, however, that when compared to the over half a trillion in funding allocated for NHS treatment and care over the same period, £16 billion for public health is a modest investment.

This is why our campaign will also be driving forward a programme of work around prevention activity within the NHS. The Government is right to point out that local authorities are not alone in providing prevention interventions. Around 40% of all accounted-for public health spending originates from the NHS, on Section 7A services like immunisations as well as other initiatives like the national diabetes prevention programme. The NHS itself, with its long reach into every community, is also a wider determinant of health.

But we believe that to deliver the ‘radical upgrade’ the NHS needs to make better use of its existing preventative spend and also explore further opportunities for targeted increases in investment. In order to achieve this, we first need to know what the health system actually spends on prevention. While most estimates of public health spend place it at between 4-5% of total government spending on health, according to PHE’s Chief Economist, ‘we do not actually know what the whole health and social care system currently spends on prevention’.

That’s why our campaign is calling on the Government to conduct a review into NHS spending on public health and prevention. We need to know where we are now before we’re able to move forward and ensure that the NHS and local authorities are truly providing the kind of joined-up care envisioned in Sustainability and Transformation Partnerships.

Finally, we believe we’ll have the best chance of securing increases in public health investment if we’re able to tell our story in a compelling way to policy-makers and the public. We’re proud of the work our members do every day in their communities to protect and improve the health of the public. We have a good record, as demonstrated by major successes in our screening, immunisation, and smoking cessation programmes.

And that’s why we’re supporting PHE’s work on their new public health dashboard. This dashboard will enable a lay audience to understand and see the incredible range of services that public health teams provide and allow us access to up-to-date evidence that we can use to support our calls for greater investment in services.

In my last blog I asked for your help in marshalling our arguments, developing our policy thinking, and spreading the word to your networks. I’d like to say a big thank you to members and partners across the public health community who have already been in touch to say they would like to be involved in the campaign.

The strategic case for investment in prevention and investing in better outcomes has lessons which can apply in all four nations of the UK and indeed anywhere in the world. We will build on our four nations work as this campaign takes shape.

If you’d like to contribute to our campaign and help shape our thinking then please contact policy@fph.org.uk.

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By Wendy Nicholson, National Lead Nurse – Children, young people & Families & Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and photo_wn_5Midwifery.

Clearly, nursing is a diverse and far-ranging profession. The traditional stereotype of nursing and nurses is changing and the drive to provide care closer to home and really get serious about prevention has quite rightly put public health nursing in the spotlight.

When I pulled on my crisp new student nurse uniform in the early 1980s I could never have imagined I would find myself working in public health, as the focus and direction of travel for most nurses was gaining experience in hospitals before venturing into the ‘community!’ Like my peers and other nursing colleagues, I recognised that many of those hospital admissions were avoidable and many of the A&E visits could have been prevented.

Shifting the balance to upstream prevention and public health was certainly not a new phenomenon. Probably the most well-known nurse, Florence Nightingale, was a pioneer for prevention and indeed the use of evidence to underpin practice.

So much of Florence Nightingale’s legacy reinstates today with public health nurses and we know that there are many public health challenges, particularly for children and young people. We know giving children the best start in life and building resilience across the life course can improve outcomes – and this is where my passion lies.

For myself, moving to public health and focusing on prevention was a huge shift, I had my PICU mapped out. The catalyst for change was a small child who sadly will never know the difference she made to my nursing career. She arrived in A&E after being hit by a car. Her injuries were severe and she died soon after arrival. Like so many unintentional injuries her death was preventable and this made me re-think my career choices.

Public health nursing and the prevention agenda is vast. I have been fortunate to lead the development of new projects such as Sure Start and Teenage Pregnancy Prevention. Both have been challenging, but working with communities to support behaviour change and cultural norms was indeed rewarding!

Today, I find myself working for Public Health England as the National Lead Nurse for Children, Young People and Families and a Deputy Head of World Health Organisation Collaborating Centre for Public Health Nursing and Midwifery, working within the Nursing, Midwifery and Early Years directorate. This is an incredible role, and provides an opportunity to advocate for public health nurses who make a huge difference to individuals, community and population health.

Being a WHO Collaborating Centre for Public Health Nursing and Midwifery is an amazing opportunity to contribute to the global Sustainable Development Goals and to influence globally – ensuring prevention is a clear focus with public health nursing driving improvements.

It is quite apt that today I am with 400 nurse leaders at the Chief Nursing Officer summit in Liverpool – this city which is steeped in the history of public health. On International Women’s Day, we should take the time to reflect on great leaders such as Florence Nightingale. She was so much more than ‘the lady with the lamp’ – clearly a visionary for public health, nurses and prevention.

Let us never consider ourselves finished nurses….we must be learning all of our lives.
Florence Nightingale

Read more about All Our Health here

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