Better Health For All

Rachel Thomson is a third year specialty registrar from NHS Ayrshire & Arran in Scotland, currently on a six month attachment with the FPH Policy and Communications team. This is the first of several blogs that she’ll write during her placement which will provide a window into the work of the policy & comms team and inspire other registrars to follow her lead! In this first entry she talks about her first couple of months, what she’s going to be involved in, and how the reality has lived up to her expectations so far…

Today marks just over two months since my induction, which feels a bit mad as it seems to have gone by in the blink of an eye! Much of the initial bedding-in period was focused on tying down what exactly I’ll be doing while I’m working with FPH, and working out how that ties in with my learning needs. The team are based in Regents Park, so of course we’ve also spent plenty of time having outdoor lunches in the glorious sunshine…

Lunch on day one: Surely it can only go downhill from here!

I’ll be working mostly on the Public Health Funding campaign, with my particular focus being communications – hence the opportunity to supplement my day-to-day work with this regular blog spot. As the team is quite small and everyone is so encouraging, there’s been real opportunity for me to get stuck in straight away and to lead on several aspects of the main FPH comms plan, which is both scary and exciting!

The main thing I’ll be progressing on my own is the photo competition #PublicHealthLooksLike which I will have a hand in preparing, promoting and evaluating, allowing it to cover a wide range of Learning Outcomes (particularly those in key areas 3 and 4 which focus on action plans and influencing). It seems the perfect fit for me, because there’s so much crossover with my own personal love of photography and the arts in general. It’s early days so far, but I’m really looking forward to engaging with arts communities and public health professionals alike to try and generate a slew of entries that properly represent the breadth and diversity of public health; essentially, what drove us all to it in the first place. (Sales pitch over for now, I promise, but make sure you head over to the competition website to find out more and enter! There are some amazing prizes up for grabs, including £250 and a year’s free FPH membership.)

I’m only working for FPH three days a week and am doing most of that remotely from my home in Glasgow, which is an interesting new challenge for me. So far it seems to be working well – I’ve made the trip down to London for a couple of days twice already with no issues, and am spending the rest of the time either in my home office or touching base with my home board in sunny Ayrshire.

Shadow seems to have grasped the concept of work-life balance a little too well!

I’m finding it’s actually easier than I thought to get into the habit of sharing bits of work-in-progress with the team via email, and they are well set up to support registrars working remotely since that’s much of what they do. So far my main issue has been desk invasion…

Overall it’s still early days, but I’m extremely excited about the opportunities working on the Public Health Funding campaign could bring, both in terms of training and the real-life ‘win’ of feeling I’m contributing to something that could make a big difference to the health of the public.

I’m sure I’ll talk more about the campaign itself in future blogs, but the goals the policy team have set for themselves are ambitious and could have hugely positive impact on the way public health is funded in England if successful. I’m really looking forward to being a part of that, and updating you all on the journey as I go along.

When you know you’re really part of the group – joining the FPH policy team self-portrait wall!

Written by Rachel Thomson, specialty registrar and member of FPH’s Public Health Funding project group. You can follow her on Twitter @rachel_thomson. If you’re a Specialty Registrar, want to get comms experience that will help you achieve your learning outcomes and interested in joining our Project Scheme, click here for more info or email policy@fph.org.uk to find out how you can apply.

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Over the summer, FPH’s Brexit Project Group started work on the third of our Brexit policy ‘calls’ – to secure health focused post-Brexit trade agreements. We met with twenty key stakeholders from across the wider health community, legal experts, civil servants and the business community, including the Brexit Health Alliance, Cancer Research UK and Department for International Trade. We wanted to understand their priorities and aspirations for the public’s health as the Government develops the UK’s post-Brexit trade policy.

We’ve summarised those conversations into a short discussion paper that we hope will continue the discourse around the role the UK’s post-Brexit trade policy can play in delivering a healthier society.

What we’ve been hearing

Six key themes emerged from these conversations and here’s a snapshot of what they are:

1. A ‘seat at the table’: Stakeholders feel that a formalised and transparent engagement process is vital in providing trade negotiators with the specialist expertise they need. Public health needs to have a ‘seat at the table’ in shaping trade policy.
2. The right to health: We heard that respect for the right to health should form the bedrock of our future trade policy. The UK has an opportunity to show global leadership by embedding the right to health as an explicit objective of the UK’s post-Brexit trade agreements.
3. The right to regulate: Stakeholders view the development of an independent trade policy as an opportunity for the Government to reinforce the UK’s right to regulate in the public interest – for example, on environmental and food hygiene and safety standards and on medicines.
4. A commitment to ‘Do No Harm’: The Government has made an unequivocal “guarantee of equivalent or higher standards of health protection and health improvement when we have left the EU”. Stakeholders are keen to ensure the Government is true to its word.
5. A commitment to ‘Do Better’: The UK remains a world leader in public health. Stakeholders emphasised the opportunities provided by Brexit to move faster across a range of policies from minimum unit pricing to advertising health-harming food and drinks.
6. The NHS should be protected: Stakeholders welcome the Government’s signal that the NHS and public services will not be traded away. However, concern was raised that several aspects of traded healthcare should be ‘off-limits’.

How you can help us develop this vitally important piece of work?

• Please have a read of the discussion paper and share your thoughts on whether these themes cover the key priorities for health and trade and if so, why do you feel they are important? Is anything missing? Our discussion paper sets out a small number of further questions that we’re keen to explore with you too.
• If you’re interested in this topic and an expert in the field, attend our workshop on 17 October where we’ll be developing our thinking.
• Join our ‘healthy trade’ coalition of stakeholders and health organisations who are uniting in support of our forthcoming ‘healthy trade blueprint’.
• If you’re an FPH member and would like to help us shape our thinking, you can also join our Brexit ‘sounding board’ of members.

What are the next steps?

The workshop will help to inform our response to the Department of International Trade consultation at the end of October. Then, at the beginning of next year, FPH will be setting out a set of principles for ‘healthy’ trade agreements that we will encourage the Government’s trade negotiators to support as they agree future trade deals with the EU and the rest of the world.

Written by Rhosyn Harris, Specialty Registrar, FPH Brexit Project Group. You can follow Rhosyn on Twitter @RhosynHarris.

For further details on any of the above, please contact Mark Weiss, Senior Policy Officer at FPH, via email: markweiss@fph.org.uk.

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The public health community is accused of many things but insurrection is rarely one of them. In fact, insurrection sounds more like something out of Tudor England and the 1536 Pilgrimage of Grace. However, if the public health function were to adopt a rights-based approach to the delivery of health improvement then insurrection may indeed be just around the corner.

But what is a rights-based approach? Human rights are set out in the 1948 Universal Declaration of Human Rights and provide the world’s governments with a code of conduct. This declaration, most notably, covers civil and political rights – for example, the freedom of speech – but there is also a third element of social rights. The latter includes the right to education, an adequate standard of living, basic housing, food AND the highest attainable standard of health. All these rights are of equal standing. They are indivisible from each other, inter-dependent and inter-related. Upset one (eg remove housing) and others (eg health) is upset. Human rights are also backed by legal obligation and can therefore be both challenged and defended in a court of law.

Such rights can be delivered through a set of PANEL principles of Participation, Accountability, Non-discriminatory, Empowering, and Legally-supported. Rights-based services are always Available, Accessible, Acceptable and of high Quality (AAAQ). Social rights also carry the obligation to be realised progressively over time, although resources can be taken into account. It means that where evidence backs intervention and there is low or even no cost to the State, then the Government has a duty to implement the measures. That means a year on year, decade on decade, improvement. Think what that would do to help the population achieve the highest attainable level of health.

The idea of the right to health generating insurrection is not as far-fetched as it sounds. The demand for human rights to be observed and protected is often led by those who are deprived of such rights. Consider the resistance to apartheid as just one example of a movement to overturn injustice on a national scale. Although public health organisations are not human rights organisations per se, it is no stretch of the imagination to see that good public health is good human rights.

Public health organisations and professionals are in an excellent position to encourage the public both to want and to expect better levels of health. Reframing public health messages in terms of the right to health could create the potential for greater public demand and consequently increased political support. A rights-based public health policy might, for example, promote value-added nutrition labels on food and alcohol as information labels to satisfy consumers’ rights to know about the food and alcohol they purchase rather than as a mechanism for tackling obesity which raises objections as a barrier to trade.

The right to health should become a standard tool for the public health profession in its quest for a more equitable and healthier society. Used to its fullest extent it might even lead to the next “Pilgrimage of Grace” by a populace demanding the Government changes a course of action.

Written by Heather Lodge, UK Public Health Network Co-ordinator. The question of how the public health community can make use of the right to health will be on the table for discussion at Public Health England’s conference in September 2018. The session will be chaired by Paul Lincoln with John Coggon of Bristol University and Cath Denholm of NHS Health Scotland providing expert analysis and commentary.

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Jane Leaman provides her views on the importance of the recently published NICE public health guideline on preventing suicide in community and custodial settings

More than 6,000 people take their own life each year in the UK. The risk of suicide is particularly higher in UK prison populations compared to the general population. In order to tackle and significantly reduce death by suicide, there needs to be a clearer approach to prevention; the recently published NICE public health guidelines aims to do this.

The guideline looks at ways to reduce deaths by suicide and help people bereaved or affected by suicides, including families and emergency responders, who may as a result be at risk of harming themselves. The recommendations also suggest ways to identify and help people at risk, particularly in places where suicide is more likely, such as high-buildings or medical, veterinary or agricultural settings where human or animal drugs may be readily available. Tackling access to high risk places where suicide can occur means we can explore prevention which is very important to consider.

The best way to put these measures in place is to have a multi-agency approach that looks at what plans and training local services need to put in place. A 2015 report published by the All-Party Parliamentary Group on Suicide and Self-Harm Prevention identified 3 main elements essential to the successful local implementation of the national suicide prevention strategy:

1. Carrying out ‘suicide audits’ to collect data on suicides
2. Developing suicide prevention action plans
3. Establishing a multi-agency suicide prevention group

The guideline encourages local authorities to work with local organisations to set up and lead a local multi-agency partnership on suicide prevention. It also advises that there should be consideration of continuous and timely collection of data from police, coroners and other sources. This data will then inform services of suspected suicides and potential emerging suicide clusters and could also be used to identify people who need support after such events.

The guideline also includes evidence-based recommendations on suicide and self-harm in custodial settings. Government records of deaths in prison custody, specifically self-inflicted deaths, have risen steadily over time. The guideline recommends that custodial and detention settings should collect data on sentence type, offence, length and transition periods when gathering data in their institutions to identify trends.

The NICE team also made sure that the core members of the committee who developed the guideline were those who have specific lived experience of this topic or who work within the field such as within a custodial setting. Having such a broad range of views and expertise further strengthens the final recommendations.

A clear message from the guideline is that action needs to be taken at local level to really understand risk factors, demographic profile, and settings and places that could be contributing to suicide levels. Crucially, it makes services and organisations aware that suicide is preventable. By working together and identifying where and by what means suicide occurs, we can look at ways to prevent and support those who are at risk of suicide. As a result we might begin to see a decrease in the current figures for self-inflicted death, particularly in high risk environments such as custodial settings.

Written by Jane Leaman, core member of the public health advisory guideline committee for the National Institute for Health and Care Excellence (NICE) and a Public Health Consultant. NICE is developing a quality standard that supports this guideline and will be published later on this month.

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Dear FPH members and the wider public health community,

Organ Donation Week, taking place this week, is our opportunity every year to seek to encourage consideration and discussion of organ donation across the UK. As a consequence I am immensely grateful to be given this opportunity to reach out across your organisation and share a plea for help.

Every day in the UK 3 of our fellow citizens die because the organ for transplant they so desperately needed did not arrive in time. Look around your workplace and imagine that rate of attrition, 3 people every day passing away when there is no need, all that life and hope ended. That stark image is what drives us to encourage everyone to think about their own personal organ donation decision and just as importantly to have a conversation about that decision with their loved ones. We know over 80% of the UK population believe in Organ Donation and that where someone is on the Organ Donor Register and their loved ones know they want to be an organ donor that 92% of families support their donation decision. Where a family does not know the wishes of their loved one the number who agree to donation drops down to just under 50%.

So, my plea this Organ Donation Week is that if you want to be an organ donor you share that message, and if you believe in organ donation that you take the opportunity this special week offers to have a conversation about organ donation. Only by spreading the word can we offer hope to those waiting for an organ hoping for ‘the call’ before time runs out. Words Save Lives, that is our motto this Organ Donation Week and with your help we can make that a reality.

Thank you and best wishes

Anthony J. Clarkson

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