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Archive for the ‘local authorities’ Category

By Hannah Dorling, Helen Walters and Tara Lamont

How can alcohol licensing decisions impact upon alcohol-related crime and health issues? Does turning street lights out at midnight cause more accidents? How does a new bus service impact upon physical activity levels?

Front-line public health professionals need relevant evidence in formats that reach them and are digestible by them and those they work with. At this year’s FPH conference we are running a session on just this issue. The National Institute for Health Research (NIHR) spends £10m a year on its Public Health Research (PHR) programme and we are one of the main funders of public health research in the UK. We support research which may not be funded by others – from studies of impact of alcohol licensing to evaluation of urban motorways. NIHR also runs the Dissemination Centre whose specific role is to get research findings to the front line.

We want to fund research that evaluates public health interventions that happen outside the NHS – that will provide new knowledge on the benefits, costs, acceptability and wider impacts of interventions that impact on the health of the public and inequalities in health. We want this research to be multi-disciplinary and broad, covering a wide range of public health interventions. Funding comes from the Department of Health in all four UK countries. A key aim of the programme is to deliver information to allow practitioners and policy makers to improve services, rather than simply improving scientific knowledge. A challenge for the programme is finding the questions that most urgently need answering.

We also need to help decision-makers get hold of the evidence they need. Every day, about 75 new clinical trials and 11 new systematic reviews are published, many of which will be relevant to public health. The NIHR Dissemination Centre filters new knowledge and produces a wide range of publications. We want to know more about what kinds of evidence and formats work best for front line staff.

This is where we need you. This interactive conference session is aimed at front-line public health professionals (though academics are welcome!) who want to talk about how you use research in your daily work. Where do you find your research? What do you do with it? What would you like more of? Do you have challenges linking to the academic world? What questions would you like answered to help you in your work? Come along to our session and tell us what you think. We are keen to hear and to use your wisdom as we reflect on 10 years of public health research funding and make plans for the next 10 years.

In the meantime if you have an idea for research that needs doing please do contact us on phr@nihr.ac.uk or use the programme’s online mechanism for submitting suggestions.

Join the session at the FPH conference on Tuesday 20 June in Telford:
11:30 – 12:30: Public health need – filling the evidence gaps in local government
Location: Wenlock Suite 1&2
Presenters: Helen Walters, Consultant in Public Health Medicine / Consultant Advisor, NIHR NETSCC, University of Southampton
Tara Lamont, Deputy Director of the NIHR Dissemination Centre
Closing comments: John Middleton, President of the Faculty of Public Health

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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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by Daria Kuznetsova, researcher,  New Local Government Network (NLGN)

Local government is once again a major player in the health arena. With a new public health duty and a leading role to play in the new Health and Wellbeing Boards (HWBs), councils have an opportunity to generate much greater efficiency and effectiveness.

Moreover, as this is the first time clinicians, politicians and local government officers have come together, there is a once in a lifetime opportunity to rethink and redefine preventative health interventions to radically improve the health outcomes of the local population. In a recent research report, we began to map out how local government could take up the role of the ‘health improving council’ implied by the recent reforms.

The new arrangements will certainly create opportunities, and there are reasons for optimism: among those involved in the agenda, our research reveals a relatively high degree of confidence (3.85 out of 5) in HWBs. However, it is already evident that creating stronger relationships across an increasingly complex health and social care sector will not be without its challenges. Sixty six per cent of survey respondents said that organisational differences were the most significant factor which might limit the effectiveness of their HWB.

Organisational divisions and territorialism in decision-making and budget-setting will be particularly problematic, particularly where hard choices have to be made to divert limited resources from existing services to new priorities. To encourage honesty in these ‘difficult conversations’,  we recommend HWBs design ‘prenuptial agreements’ illustrating the commitment and contribution each board member is prepared to make to the board.

The effectiveness of HWBs will depend on their ability to engage with a wide variety of external stakeholders, which they can influence only indirectly. However as local government only has soft powers at their disposal, there is a danger of public health not being prioritised by other local agencies.

We propose legislating a “duty to cooperate” with HWBs, similar to that in the Localism Act 2011, for public bodies. We further propose the HWB chair should have a ‘call in’ power to local authority departments commissioning services (for example in relation to the use of CIL) to ensure local authority delivery takes the Joint Health and Wellbeing Strategy into account.

At the heart of the changes lies an opportunity for a new era of public involvement in health services and prevention. By engaging residents, particularly ‘hard to reach’ groups, HWBs will be able to design interventions that meet immediate needs but also reduce demand in the long term. To ensure public engagement is prioritised, we recommend that HWBS should publish an explicit strategy for public involvement in their work.

Our research found that budget pooling is seen as the most effective tool available to ensure effectiveness of HWBs.  However 94 per cent of respondents felt that central government has provided insufficient incentives for integrated working. If local authorities are to succeed in reducing demand for acute services, they will need to shift resources to prioritise preventative measures. We suggest government should create “Health and Wellbeing Deals” whereby HWBs bring forward plans for pooling in exchange for the removal of regulatory or legal barriers to pooling as well as potential top-up funding for pooled budgets from central government.

The reforms in public health offer a real opportunity to reshape public services and drive preventative healthcare into everything local authorities do. However without tougher power for HWBs, they risk becoming a talking shop. We therefore strongly urge the government to legislate for a small number of hard, statutory powers which could turbo charge the new boards and ensure the emergence of a new generation of health improving councils.

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