Better Health For All

June was a busy month for the Policy team at FPH. We released our project’s second discussion paper, furthering our investigation into how NHS organisations are responding to or shaping the broader prevention agenda. Thank you to all FPH members and other partners who contributed!

We also released the results of our opinion polling of 310 NHS leaders about prevention – which we think provide a fascinating starting off point for understanding the journey that NHS organisations are on towards (hopefully) a more prevention-led service.

We also travelled to Edinburgh to meet with our Committee of the Faculty of Public Health in Scotland (CFPHS) members and others working in NHS Scotland organisations, NHS Health Scotland, and NHS National Services Scotland to discuss our findings from a Scottish perspective. We received a very warm welcome from the CFPHS Chair Julie Cavanagh and all of the attendees, ensuring the workshop was not only incredibly informative but also very enjoyable.

We covered a huge amount in a relatively short period of time, but here are our initial 5 takeaways from the event:

• The planned public health reforms are a huge opportunity to make a significant step-change towards a culture of health – Scotland’s public health reforms are striving to address three key issues: Scotland’s poor relative health, significant and persistent health inequalities, and the unsustainable pressure on health and social care services. The ambitious reform programme has already seen the development of public health priorities for Scotland and the development of a new public health body, Public Health Scotland (PHS), is currently underway. There is a commitment that PHS will be an NHS organisation, at least initially and the current NHS public health workforce will continue to be employed by the NHS, but with increased reach/relationships with local authorities and other community partners. CFPHS is broadly supportive of this approach, but recognises the need to maximise NHS contribution to public health while broadening the reach of the public health function. This is the space of the debate at the moment.
  

• Our opinion polling findings of NHS leaders about prevention only partially reflect the Scottish experience and mind-set – only 6% of NHS leaders who we polled were living and working in Scotland. We were curious to see if our overall results around prevention priorities, barriers to prevention delivery, prevention budgets, and the most pressing issues facing the health and wellbeing of local communities reflected the situation in Scotland. Workshop attendees told us the following main points:

1. NHS leaders overall who we polled were most likely to say that the NHS should be prioritising the following five approaches to prevention delivery: the systems approach, embedding prevention into routine practice, embedding prevention into clinical and/or patient pathways, reducing health inequalities, and addressing common risk factors. Attendees at our workshop similarly emphasised the need to prioritise the first four of those, but then prioritised ensuring the NHS is a good employer, e.g. by improving NHS staff health and wellbeing over addressing common risk factors.
2. We also asked NHS leaders to tell us (based on a long-list of potential tax and regulatory measures spanning alcohol, drugs, obesity and food, and tobacco) the policy or regulatory changes that they thought would most benefit the health of their local communities. NHS leaders overall were most likely to choose measures that impacted on the local food environment, with four out of their top five shirt-listed measures relating to that. Participants at our Edinburgh workshop, however, also chose some of the same measures relating to the local food environment, but they also short-listed a measure relating to drug and alcohol treatment. This, they told us, reflected the fact that in Scotland drugs, alcohol, and suicide are the three largest contributors to years of life lost to premature mortality.
3. They were most surprised (in a good way) that around half of all NHS leaders polled say that prevention is a core or large part of the work in their department. They were heartened by that result, but some wondered whether understandings of what ‘prevention’ approaches or activity actually constitutes is so variable as to render this finding misleading.

• FPH may need to revisit our definition and understanding of healthcare public health – Interestingly for FPH colleagues working across health services and in education and training, we heard the strong message that the FPH definition of health care public health (as one of the three domains of public health) was not necessarily applicable to the Scottish health system. Unlike in England, in Scotland there is no existing national framework for the delivery or governance of HCPH and the domain is experienced and described differently. Due to the structure of the public health and health system in Scotland, the majority of those working in specialist public health capability and capacity for HCPH are located within territorial NHS Board Public Health Directorates and are often working across all of the domains at once. This workforce is unlikely to find the FPH definition of HCPH useful for their work. They told us that we need to establish better the scope and vision for HCPH in Scotland and strengthen the HCPH role beyond clinical healthcare services. The Improving Services Commission in Scotland is exploring whether or not to describe the function as ‘Population Integrated Care’ instead.

• Colleagues in Scotland agree that better governance of prevention is absolutely critical to supporting a prevention led NHS – In our first workshop back in October 2018, stakeholders identified better governance of prevention as a key area that needed to be prioritised if the NHS was to sustainably pivot towards prevention. Scottish colleagues were very interested to learn from the Deputy Director of Healthcare Public Health at PHE East Midlands, Ben Anderson, about his team’s work addressing the prevention challenge and the governance gaps that they’re striving to fill at trust and CCG levels. Colleagues in Scotland spoke of similar challenges around ensuring strategic leadership for healthcare public health across the system (including the NHS, LA, HSCP, education, public sector, voluntary sector, SG policy makers), the need for better coordination and optimisation of data and intelligence, issues incentivising outcomes, and the need for better performance management of essential prevention activity.
  

• FPH needs to do more support learning across the nations and help our workforce tell a better story – Despite some clear differences and unique challenges, many of the barriers standing in the way of prevention within the NHS are shared, for example: a lack of funding, a lack of understanding of what prevention and more broadly health care public health actually constitutes and their impact, and a lack of data, and service fragmentation. But different places are overcoming these barriers successfully or identifying some of the missing pieces to help other places overcome them. Attendees at our Scotland workshop want to learn more from what colleagues elsewhere are doing. They would like FPH to host more events like our workshop, to bring colleagues working across the UK on similar issues together to learn from one another. There was also a really strong message for FPH ‘to support us to think differently as a workforce’ and ‘develop a more compelling narrative for what the public health workforce does.’ This will help them communicate the value of the public health approach more effectively.

These are just a few of our initial thoughts. But we’d love to know what you think of our papers, findings, and initial conclusions.

Please let us know by emailing policy@fph.org.uk Thank you so much and we look forward to hearing from you soon

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group.

and

Lisa Plotkin, FPH Senior Policy Officer