Better Health For All

The Faculty of Public Health has long recognised gambling as a public health issue. This has led to the creation of a new FPH position statement.

So what was my involvement?

I initiated a conversation with the FPH following a placement at the Welsh Government with Dr Frank Atherton which included producing a chapter for the Chief Medical Officers (CMO) Annual report on gambling as a public health issue.

My first step was to see if a position statement would be both helpful and welcomed by the FPH. Once the principle of the FPH having a position statement on this topic was agreed, I worked up a draft statement with a range of Consultants in Public Health from across the UK who have an interest in this field. This was shared with the membership of the Health Improvement Committee (HIC).

The HIC members referred me to further academic papers that had new themes to explore. Once I had incorporated these into the statement it was shared again with the HIC membership. After a few further comments the paper went to the Policy Committee and they suggested some minor amendments to tighten up the text. This led to the adoption of the Position Statement by the FPH.

The position statement sets out the main issues in relation to public health and then goes on to suggest action that might be taken to tackle this emerging issue in the UK. It should prove helpful when advocating for action, and it will ensure that the FPH’s position is clear and can be justified. The position statement can be found here.

What’s the thinking behind having a position statement?

I hope that it will be a helpful resource to others who may come to this topic with little experience of the issues and help raise awareness of the following:

• Gambling has the potential to cause harm to both individuals and to wider society
• It is an issue that cannot be tackled by interventions aimed solely at individuals
• The harm caused by gambling is unequal in distribution, with those who are economically inactive and living in deprived areas suffering the most harm.

It also sets out a number of actions that could be implemented in the UK to tackle the harm from gambling, for example advocating for the assessment of the totality of any advertising reaching children and young people including television advertising, online advertising, sponsorship and other forms to assess the total impact on children and young people, and use of legislation to tighten regulation of the gambling industry and the sponsorship, marketing, promotion and offers, especially online marketing which is currently reaching children and young people.

For a longer read on gambling as a public health issue see the CMOs latest annual report for wales here. a summary of the work undertaken is also due to be published in the Journal of Public Health soon- so keep a look out!

Written by Claire Beynon, Specialty Registrar in Public Health, Wales.

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#futureofpublichealth: this is the fourth in a series of blogs that aims to champion the prevention delivered in NHS settings as part of the NHS at 70 celebrations and FPH’s public health funding campaign

From a public health perspective, maternity services are in a privileged position. Unlike many other ‘medical’ specialities, we are dealing largely with healthy individuals rather than treating a population with ongoing health issues. In addition we deal with people who are generally more motivated to make positive behavioural changes. As a discipline we are well placed to make a big impact in the public health agenda as we advise all women and sometimes their families, on many health prevention and protection issues.

We routinely speak to all women about a wide range of subjects including the generic prevention topics discussed widely in the NHS, such as alcohol consumption, active and passive smoking, diet, weight management, mental health and wellbeing and some more of the specific prevention such as, contraception, vaccinations, breastfeeding, sexual health and antenatal screening tests. A huge part of what we do is about promoting health and wellbeing of pregnant women and their babies and taking measures to improve health outcomes. So as a specialist midwife in public health, what do I see as the public health opportunities within maternity services and what challenges do we face?

There are currently numerous opportunities within midwifery to make a real difference to health outcomes. Realisation that prevention is cost effective has led to a surge of public health initiatives and reports. Both profession specific reports such as Saving Babies Lives and the Maternity Services Better Births review and generic plans including The NHS Sustainability and Transformation Partnership, The Tobacco Control Plan for England and PHE Better Outcomes by 2020 provide an exciting outline of expected health improvements, where maternity services can make a valid contribution.

The first challenge is how do we prioritise? With so much that can be achieved there is a limit to the number of changes that can be realistically introduced at any one time. Ideally we need to concentrate on those areas which can have the biggest impact, such as smoking but without losing sight of and neglecting established activities.

Secondly there is the challenge of integrating the actions of all agencies to avoid fragmentation of campaigns, thus enabling the biggest possible positive impact on public health. Historically promotion and support of breast feeding was laid firmly at the feet of maternity services but excluded those involved in care before or after birth. More recently there has been increased focus on the role of primary care in supporting infant feeding. Surely it would have been better if we had all moved forward with this together at the same time.

Currently there is some fantastic work within primary care, addressing parental interactions with their baby and the importance this has on strong parental-child attachment and emotional and social development of the infant. It is recognised that sensitive, responsive caregiving in the first few years of life is important in building the foundations of social and emotional wellbeing. As parent-child bonding begins during pregnancy, the impact would be greater if midwives and those within primary care worked together in developing this, so that we were all singing from the same chorus sheet, before and following birth. I hope to introduce this work into our maternity service, so that we have a collaborative approach locally.

Through networking I have discovered commissioned services and initiatives, previously unknown to maternity workers, which meet a real need within our care. This raises the question of why we were unaware of these funded services. Likewise I have joined a regional public health network and despite having 700 members, I am their first midwife representative. This both excites and saddens me. When healthy outcomes start with pregnancy and birth, why are midwives not more involved in the big picture? We need to find an effective strategy to ensure all relevant groups are identified and involved in the planning of the local health promotion and prevention strategy and that any services are appropriately advertised.

Finally there is the issue of financial resources. Prevention is cost effective but requires initial investment before the savings can be achieved. When the NHS is spending so much on diagnostics and treatment, it is financially difficult to invest money in preventing disease but I think that unless the NHS plays its part in prevention, the high cost of treatment is never going to be reduced. Ideally there should be availability and time for training, of all health care workers so that they have a confident approach in supporting people to make healthy choices. CQUINs are certainly a good incentive for focussing the NHS on prevention however maternity services are not always included in these, despite the relevance to our service users.

There also needs to be adequate resources to meet the need. There is little value in identifying someone who wants quit smoking if there is no local service to support them. Likewise NHS professionals can be frustrated when they identify someone with mental health issues that could be assisted with short term interventions but the waiting list is so long that the problem escalates before help can be given. It is vital that any financial resources for public health are invested wisely and that spending is considered and planned, involving service providers and users, ensuring communication and collaboration with all relevant parties.

With public health finally establishing itself as an integral part of both NHS and maternity care, I firmly believe maternity services have an integral part to play in making a positive impact on health before, during and beyond pregnancy, improving the health of the next generation. We need to ensure we are included and contribute to wider public health strategies. Ideally maternity services should work with policy makers, primary care and educational institutions, to help make a positive impact on health before pregnancy, especially in regards to obesity, smoking and alcohol, as well as use our service to help people make life long positive behaviour changes, to ensure a healthier future generation. The challenges are many but we need to embrace the public health opportunities presented to us.

Written by Lynne Walker, Specialist Midwife: Public Health. You can contact Lynne via email: Lynne.walker@lthtr.nhs.uk.

Note from FPH: As we celebrate the NHS at 70, many in the health community are taking this moment to ask some big questions about the kind of future we envision for our health system and the level of funding support necessary to realise it. We believe that public health and prevention must be central in this national debate about the future of NHS funding and we’d like your support to help us make that case. If you’re an FPH member or work in the NHS delivering prevention, please consider joining our ‘sounding board’ of members and clinicians who are helping us develop policy on this issue. For more info, please email policy@fph.org.uk.

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They say you can’t teach old dogs new tricks, but I have to disagree. I have been going for interviews for many different roles across my career, and have been lucky to be successful in a few of them! Over the years, being interviewed and also being a recruiter of others has shown me the good, the bad and ugly when it comes to interview styles and techniques.

Being in my first consultant post I was keen to complete the FPH effective interview skills workshop to prepare myself future consultant interviews. I was lucky to get a place on the programme as places are limited – this was one of the attractions of the course – that the group was small.

In November 2017, I made the journey to London to spend the day with 8 other delegates and left feeling that I was walking away with new knowledge and skills to help me in future interviews. There is the expectation that you undertake some pre-course homework before attending and would encourage those planning to attend not to skip this as the more you put into the course the more you get out (don’t leave it to complete on the train journey like I did!). The group was a mix of delegates including registrars in the middle of their training, registrars at the end of their training, some seasoned consultants and new consultants like me.

The course gives you the opportunity to learn not only from very experienced HR consultants and FPH advisors but also gives you the opportunity to learn from each other as there was a wealth of interview experience in the room. Hearing these stories allowed you to develop and hone your own interview style from hearing what has worked (or didn’t) from others.

The morning consisted of learning about the public health consultant interview process and started to build skills though small group workshop activities. The afternoon allowed you to undergo a mock interview with your fellow delegates, chaired by faculty advisors and other senior public health professionals. This gave delegates the opportunity to practice an interview presentation and also to practice some interview questions and receive constructive critique.

I have not taken the opportunity to use these skills at interview yet, I’m very happy where I currently am, however I will very much bring out these skills when the time comes. The handbook provided for the course will service as a great guide into the preparation for future consultant interviews. I would say this course is a must for those looking for their first role in consultancy and for those experienced consultants looking to bush up their interview skills to pursue new challenges.

Written by Steve Maddern, who is acting public health consultant at Wiltshire Council. He is registered with the UK Public Health Register and is a member of the Faculty of Public Health. You can follow Steve on Twitter @stevomadds.

To book your spot on FPH’s Interview Skills course, which is taking place in London on 13 November, click here.

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#futureofpublichealth: this is the third in a series of blogs that aims to champion the prevention delivered in NHS settings as part of the NHS at 70 celebrations and FPH’s public health funding campaign

I’m really pleased to have the opportunity to write a blog for FPH about prevention in the NHS as I recognise just how important prevention and public health are, especially in an NHS setting. I work as a Health Improvement Manager at Barts Health NHS Trust in East London and see first-hand the impact preventable causes of ill-health and death cause. We are extremely lucky at Barts to have an in-house public health team and lots of clinicians across each of the five hospital sites who also recognise the importance of prevention and champion this amongst colleagues and patients alike. But prevention and public health should be championed by everyone! Smoking is the leading cause of preventable ill health and death in the UK, followed by obesity and then alcohol. It is estimated that smoking costs the NHS in England approximately £2 billion a year for treating smoking related diseases and every £1 spent on smoking cessation saves £10 in future healthcare costs.

As a result, this week has involved promoting prevention across the Trust, for example by talking to nursing leaders on wards to try and persuade them that taking time in incredibly hectic circumstances on acute wards to ensure patients are asked about lifestyle issues is extremely worthwhile. I’ve also been talking to midwives about smoking in pregnancy and how they can help their patients give up smoking using CO monitors as a motivational tool and pharmacotherapy to help with nicotine addiction. A session on smoking and alcohol prevention was delivered to new nurses, midwives and physiotherapists during their Preceptorship programme, and next week we will be talking to new junior doctors during their shadowing week before they start their first year at the Trust.

There is a huge opportunity for clinicians to integrate prevention into their work by talking to patients about lifestyle issues and by giving advice and support. As a result we hope to reduce health inequalities and see improved outcomes for our patients and local population. We cannot do this alone and working in partnership with local specialist services, commissioners and Local Authorities is of paramount importance. Prevention should be integrated across NHS settings so conversations about healthy lifestyles happen but also make an impact and have a positive outcome. These conversations should be part of routine good clinical care in an NHS setting.

In East London smoking rates and hospital admissions that relate to alcohol are generally higher when compared to national benchmarks. Smoking is the single biggest cause of health inequalities in England and the impact of smoking and alcohol affects different groups of people disproportionally. I am pleased that the Trust I work in is taking part in ‘Preventing ill health from risky behaviours,’ a national incentive for Acute Trusts with a focus on tobacco and alcohol use. Hospital initiated smoking cessation interventions are effective as demonstrated through the Ottawa model and smokers are up to 4 times more likely to quit successfully using pharmacotherapy and specialist smoking cessation services.

NHS settings are also opportune places to talk to people about alcohol use. New alcohol guidelines were published by the Chief Medical Officers in 2016; to keep health risks from alcohol at a low level it is safest not to drink more than 14 units a week on a regular basis. At Barts Health NHS Trust we are aiming to raise awareness of alcohol risk and target people who are drinking at increasing risk, higher risk or binge drinking, and who may not realise they are putting their health at risk. We know prevention is far better than cure and being in hospital acts as an ideal opportunity for a teachable moment when our patients are more likely to listen to their healthcare provider’s advice, regardless of the admitting diagnosis.

I have mainly talked about prevention with a focus on patients but staff health and wellbeing is equally as important. The NHS has vast numbers of employees often working in stressful environments and doing long shifts at unsociable times. At Barts Health NHS Trust there are lots of initiatives taking place across the Trust to help employees stay healthy, including physical activity classes, healthy eating options, active travel, stop smoking support, MOT checks, mental health first aiders and mindfulness, just to name a few!

As mentioned previously, prevention and public health should be everyone’s responsibility, but NHS settings are a great place to start. Prevention should be part of good routine clinical care.

Written by Katie Gallagher, Health Improvement Manager at Barts Health NHS Trust. You can follow Katie on Twitter @gallagherkatie9.

Note from FPH: As we celebrate the NHS at 70, many in the health community are taking this moment to ask some big questions about the kind of future we envision for our health system and the level of funding support necessary to realise it. We believe that public health and prevention must be central in this national debate about the future of NHS funding and we’d like your support to help us make that case. If you’re an FPH member or work in the NHS delivering prevention, please consider joining our ‘sounding board’ of members and clinicians who are helping us develop policy on this issue. For more info, please email policy@fph.org.uk.

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