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Archive for the ‘PH Spending’ Category

By John Middleton, FPH President

John Middleton 2 web

I wanted to let you all know about the progress we’ve been making with our two flagship influencing projects and to ask you, our FPH members, for help.

You may recall that in June last year I let you know that we had decided to focus the efforts of our small, but perfectly formed, Policy and Campaigns Team on two vital public health priorities – Brexit and Public Health Funding.

This followed a significant policy consultation and prioritisation process with our members through the first half of 2017.

Before I tell you where we’ve got to with these two campaigns it might be helpful to remind you that these two issues aren’t the only two policy areas FPH is working on. We also have five policy committees and 30 (and growing) Special Interest Groups all developing and shaping policy and making the case for a very broad range of public health issues.

In terms of the Brexit and Public Health Funding projects, since June last year we’ve done a number of things in order to be ready to start campaigning at the beginning of 2018.

We’ve talked with a range of different public health stakeholders – including the Public Health Minister, Steve Brine MP – to find out where they thought we should focus our efforts within these two large policy areas. Through this consultation process we drew up ‘long lists’ of possible policy asks.

We’ve also created two campaign project groups, made up of staff and – for the first time – specialty registrars on placement at FPH. As well as giving us more capacity to deliver both campaigns, we’re keen that these projects provide an opportunity for our public health trainees to learn about, and play a vital part in, campaigning for policy change at a national level.

We’ve also created two Advisory Boards of senior FPH members – one for each campaign – to ensure we’re able to draw from the vast expertise we have on both these issues. I won’t embarrass the Board members by highlighting particular people but trust me when I say that both Boards are packed with very senior, experienced FPH folk.

The Advisory Boards met in November and December and shortlisted three policy asks for each campaign. I’m very pleased to announce they are:

For Brexit:

1. We are calling on the UK Government to introduce a ‘do no harm’ clause into the EU Withdrawal Bill – with the effect that the Government commits to ensure that the Bill’s powers are not used to reverse or amend regulations critical to the health of the population.

2. We are calling on the UK Government to ensure the UK’s future relationship with the European Centre for Disease Prevention and Control – we think it is vital that we can continue to work in close partnership with our European partners to tackle serious cross-border threats to health security, e.g. blood borne viruses, pandemic influenza, viral haemorrhagic fevers, and chemical and radiation incidents. In so doing, we will provide a model for the UK as it considers how to continue to play a significant role in other EU public health agencies.

3. We will be calling on the UK Government to ensure that the impact on the public’s health is a vital determinant in our post-Brexit trade agreements – we will develop with the public health community a set of evidence-based public health principles for negotiating ‘healthy’ trade agreements. We will call on the UK Government to adopt these principles as it negotiates our future trading arrangements.

For the Public Health Funding campaign:

1. We are calling on the UK Government to invest in a public health ‘transformation and innovation fund’ to support the upgrading of prevention and population health services in local authorities – FPH members are telling us that they have gone to heroic lengths to deliver more with less and less but they cannot make the ‘radical upgrade’ in prevention services asked of them without additional dedicated funding. This is needed to enable their teams to make the step change in the types of services they provide and how they provide them. We think this fund will need to be in the region of an extra £1bn per year but the exact figure will be determined during the policy development phase.

2. We are calling on national governments to conduct a review into NHS spending on public health and prevention – our aim is to ensure that the approximately £2 billion spent in England annually on prevention and public health services ‘in the NHS’ is spent appropriately and as effectively as possible. We’ll also be looking at what an increased funding settlement for prevention in the NHS might look like in order to help deliver the radical upgrade. As part of this we will be encouraging STPs to focus more on the prevention agenda.

3. We are calling on Public Health England, and other relevant national bodies, to develop an improved ‘dashboard’ for public health services – we want to ensure updated dashboards include what our members think are the key public health performance metrics and indicators. We hope this dashboard will enable the public health community to agree what a ‘good’ public health service looks like, where it is occurring, and to further encourage the sharing of best practice between different areas and sector-led improvement.

Over December and January both campaign project groups have been pulling together their campaign plans for the first year of what will be three-year long campaigns.

These plans have now been signed-off by our Advisory Boards and, as a consequence, I’m delighted to say that at the end of January the Brexit campaign took its first steps and started to make the case to Peers in the House of Lords for our ‘do no harm’ amendment.

It’s been incredibly exciting to be so closely involved in the journey FPH has been on over the past year to get us to this stage and there’s an awful lot of campaigning activity to follow in 2018 and beyond.

And that’s where you come in!

We’re looking to create informal networks of FPH members who are particularly interested in Brexit or Public Health Funding (or both) who we can involve in each campaign on a regular basis.

The kinds of things we’d be looking for you to help with are:

  • Asking for your views as we’re developing our policy thinking – i.e. acting as an informal sounding board as we’re testing our draft ideas and thinking, so that we can be confident that what we end up saying in public and to governments is closely informed by what our members think.
  • Helping us decide which campaign messaging works best – eg. which messages do you think are most inspiring? which messages are likely to play best with local and national decision-makers? which hashtag do you like most? We want to know what you think.
  • Championing our campaigns on social media – eg. retweeting and commenting positively about tweets FPH sends out and saying supportive things about our campaigns on other social media.
  • Speaking up at conferences and events you’re attending – to highlight the importance of these issues and our specific asks.
  • Responding to questionnaires and surveys we will be doing throughout the campaign.
  • Introducing us to your networks – if you play Canasta with Philip Hammond, table tennis with Jeremy Hunt, or go paint-balling with Jeremy Corbyn then please do let us know.

If you’d like to find out more, then please email our Policy and Campaigns Team via policy@fph.org.uk and tell us which campaign you’d like to get involved in.

Thank you so much in advance for your help and watch this space for future updates on both campaigns. We’ll be updating you very soon on our Brexit activities so far in the Lords.

 

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By Professor Aileen Clarke, President of the Society for Social Medicine

A highlight of this year’s UK Faculty of Public Health Conference in Telford is going to be the Society for Social Medicine’s (SSM’s) ‘Research in Action’ session.

The SSM will be hosting this research feast at the always fantastic and hugely enjoyable FPH conference. Last year this session had standing-room only and this year it will be bigger and better than ever – and hopefully will have more chairs!

In our ‘Research in Action’ session, we will be presenting the top-scoring abstracts from SSM’s own annual scientific conference with a variety of public health topics. Last year they ranged from obesity, to housing and health and active commuting. This year we’re including public health advocacy, youth mentoring and immunisation uptake.

You can also expect the presentations to cover a range of research methodologies from epidemiology, cost-effectiveness modelling, systematic reviews and mixed methods to qualitative research.

SSM’s purpose is “advancing knowledge for population health” and in this case we are hoping to advance knowledge by showcasing exemplar public health research. Our session at the FPH conference is an exciting opportunity to promote linkages and future collaborations between public health researchers and practitioners.

I hope I have been able to sell our session to you. Please do come along and get involved.

Please find more information about the FPH conference at Telford on 20-21 June here.

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By Dr Nadeem Hasan

The importance of effective advocacy to achieving public health goals cannot be overstated.
Every day policies and regulations that affect health outcomes for better or worse are put on the agenda and kept off the agenda; discussed and debated; approved and rejected.

Many, if not most of these relate primarily to non-health sectors, such as food and beverages, energy and infrastructure, and alcohol and tobacco. But their impact on health outcomes is very real: all the stop-smoking programmes in the world can’t match the impact of the ban on advertising and smoking in public places on smoking prevalence; and there’s no amount of spending on childhood obesity programmes that can make up for the regulatory vacuum in this area.

Looking more broadly, policy decisions that affect income inequality, carbon emissions, and military action all have serious consequences for health across the world.

If we’re serious about prevention, we need to be serious about advocacy.
Where profits can be affected (almost everywhere), industry lobbyists seek to influence the regulatory environment in their favour. And they are very good at it. In principle, this is quite right – those affected by policy and regulatory shifts should indeed be able to make representations and provide additional evidence to support the decision-making process – and this includes relevant industry actors.
Representing the interests of everybody else is where advocacy organisations come in – acting as sort of ‘civil society lobbyists’ to balance out the discussion – advocating on behalf of the health, wellbeing, and broader concerns of the general population. Notably, this isn’t always an ‘us vs. them’ relationship: health insurance companies are routinely allies on advocating for lower drug prices; and renewable energy companies are more than happy to work with advocacy organisations on climate change regulation.

Put this way, it might sound like a fair playing field, with decision-makers receiving submissions from a range of groups and making balanced decisions to maximise the benefits to all parties. The reality of course is quite different, and much, much messier.
In 2014, there were an estimated 30,000 industry lobbyists in Brussels alone, falling just short of the 31,000 employees for the whole European Commission.

Civil society pockets are not deep enough to come close to matching this (or the salaries of lobbyists), and civil society advocacy and pressure groups are few and far between. Transparency falls short of the ideal, and the revolving door between policy-making and industry remains alive and well. Most recently the former President of the European Commission José Manuel Barroso was appointed Chairman of Goldman Sachs International, a move that has been widely criticised.
Advocacy organisations, then, have a difficult task – but one where even small successes can have far-reaching benefits for public health.
The European Public Health Alliance (EPHA), based in Brussels, is one such advocacy organisation. They bring together a range of health-related NGOs to advocate for better public health in Europe, working across five campaign areas: antimicrobial resistance; food, drink and agriculture; healthy economic policy; universal access and affordable medicines; and trade for health (and specifically the EU-US free trade agreement – TTIP – and the EU-Canada free trade agreement – CETA). Earlier this year, they hosted myself and another registrar in a pilot placement to understand health advocacy at the European level and to develop skills in this area.
So how to sum up the placement?
Invaluable. EPHA track the policy process for each one of their campaign areas and engage at every possible point. They attend every meeting at the European Parliament and the European Commission on these areas and make oral contributions at every opportunity; they submit comprehensive written responses to every relevant consultation; they engage on a daily basis with journalists to publicise their positions and build public support; they engage like-minded actors in the public, private, and not-for-profit sectors on a case-by-case basis to coordinate action; and they do all of this with just a handful of relatively young staff and interns.

They were very welcoming in bringing us into the whole process, allowing me to engage in every one of these steps – from writing position papers and consultation responses to making oral contributions at the European Commission and Parliament on their behalf.
Notably, EPHA also position themselves as an advocacy agency that actors from across the spectrum can engage with – in contrast to, for example, much more vocal organisations such as Greenpeace.

By way of example, the area that I was working on was TTIP. Whilst there are a raft of advocacy organisations across Europe (and the USA) that reject TTIP outright, EPHA’s

approach is to work through the whole agreement and advocate for the protection of public health on a section-by-section basis without rejecting the whole deal. With the European Commission politically committed to getting a deal, this makes EPHA one of the few organisations they can meaningfully engage with on this issue (though recent developments have called into question the likelihood of getting a deal in the near future).

This isn’t to say that their approach is ‘superior’ – every actor plays a particular role, with the more intransigent organisations key in shifting public opinion and providing the space for actors such as EPHA to engage in more balanced discussions. This means that they are invited to closed-door sessions with only a handful of actors, and have much more influence on the process than they otherwise would.
One of the challenges from a ‘public health professional’ perspective was that effective advocacy sometimes involves taking – shall we say – a less balanced view than we would normally as technical experts. From an ethical perspective, this raises a number of questions around whether the ends justify the means. I witnessed first-hand industry lobbyists making quite outrageous claims, including a rather undignified moment where I coughed up half my glass of water in a large auditorium at the European Commission when it was submitted that ‘alcohol is in no way an unhealthy commodity’ .

In a world where climate change denial is alive and well despite the most overwhelming evidence to the contrary, the ‘best’ approach to making our points is perhaps not so easy to discern.
And what of the relevance to the UK, particularly as we now start closing our doors to the EU in a bid to be a more open, global-facing country?
Whether or not the UK is a member, the EU remains a powerful actor that can influence policies related to public health both for its own citizens (which will still number ~450m after the UK leaves), and globally. As a close neighbour, EU regulations will have a strong bearing on public health in the UK too, and so engaging in advocacy at this level will continue to be an effective approach to improving UK public health.

This is true for everything from environmental regulations and air pollution, to pharmaceutical regulations and drug pricing and safety.
Within the UK, whilst it’s true that our policy-making process is not as amenable to advocacy as at the EU level (or remotely as civilised), effective advocacy still has huge potential to improve public health. We have not done well recently, with a watered-down childhood obesity strategy, no resistance to an unfunded ‘7-day’ NHS (that differs from the 7-day NHS that has existed since 1948 in some undefined way), and year-on-year increases in the use of food banks without any policy response (to name just three areas).

At the local level, there are a cornucopia of opportunities for advocacy to improve health, from influencing urban planning (fast food outlets close to schools, street design, cycling lanes) to advocacy around shifting public perceptions e.g. from opposing to welcoming refugees into local communities.
In this context, strengthening the advocacy skills of the UK public health workforce through engaging with and learning from experienced actors such as EPHA should be pursued with vigour – we can ill afford the alternative.

Dr Nadeem Hasan is a Specialty Registrar in Public Health

 

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by Paul Southon

  • Public Health Development Manager
  • UK Healthy Cities Network Local Coordinator

Welfare reform is a reality. Reviews of the likely health impacts suggest that they will be significant, are starting now and will last for a generation. (1) (2)

Work to quantify the financial implications for local areas shows that the financial impact will be disproportionately felt by the areas with the largest health inequalities. (3) There is also evidence that the impacts on already disadvantaged sections of communities – such as disabled people, black and minority ethnic groups and women – will be disproportionate. (4) (5)

All of this is happening at a time of major reductions in budgets and staffing across the public sector which limits the local ability to respond. This has been described as a perfect storm for local government. It will also have significant impacts across health services.

Over the longer term there is likely to be an increase in mental health problems, non-communicable diseases and related disabilities which will be felt across the health and social care system. Increasing poverty, especially child poverty, will have long term and generational impacts on child development, health outcomes and life expectancy.

GPs are reporting an increase in people with mental health problems. They are also reporting increasing numbers of requests for support with appeals against Work Capability Assessment decisions and the changes to disability benefits.

Currently the most visible part of the welfare reforms is the spare room subsidy or ‘bedroom tax’. Families on housing benefit who are defined as having extra bedrooms suffer a financial penalty. There is a severe shortage of available smaller properties for these families to move into. Their options are to move into the private rented sector, which may be more expensive, or stay where they are with a reduced income. Families are also moving to areas with lower rents, losing their social and support networks.

Councils are already reporting increases in rent arrears.(6)It is likely that this will lead to increased stress and family tensions, which could be exacerbated by the loss of social and support networks. A concern is that these families will resort to using alternative lenders, such as pay day loans, to cover shortfalls. One payday loan company has recently increased its typical APR to 5,835%.

For families experiencing poverty food becomes a major problem, both in access to enough food and in the quality of the food available. The rapid rise in food banks is testament to the difficulty families have in buying food. (7)

They also have to rely on the cheapest food which is often poor in nutrition and high in fats, including trans-fats. With the current food environment eating healthily is not a cheap option.

So, welfare reform is a reality. The evidence suggests that it is likely to have a major negative impact on public health and inequalities. It is now time to ask the key question: What can local areas do about it and what is the role of public health?

Much of the focus in councils has been on setting up the local systems to manage what were previously national benefit systems, the social and crisis fund payments and council tax benefits. Now these are operational the wider impacts of the reforms are being considered.

Many councils are mapping the local impact of welfare reforms to better understand the local challenges. (8) However, the scope to tackle these challenges at a local level is limited.

One of the stated aims of the welfare reforms is to encourage people into work. This is a laudable aim. Supporting someone into good quality work is a major public health win. The main way to reduce the numbers of people reliant on benefits will be to increase local employment.

However, increasing local employment is challenging in the areas where welfare reform will have the largest impact. Many of these areas have poor levels of educational attainment. Much of the available employment is low paid and insecure. A recent report estimates the local financial impact.

For example, Sandwell will lose around £119 million from the economy each year resulting in less money spent within the local economy, affecting local business and resulting in fewer local jobs.

With the limited scope for minimising the impacts of welfare reform at a local level it is essential that the most is made of local resources. This will need joined up working across councils, health, voluntary and community sectors and local businesses.

Public health has a role in raising awareness of the changes and the health impacts across all parts of the council and partners. It can also support the mapping and analysis of local impact, helping identify the local priorities for action and ensuring local plans are evidence based and monitored effectively.

Welfare reform is here, it comes with a real risk of significant negative impacts on health and inequalities at both local and national levels. Public health in councils needs to recognise this and ensure that it is fully involved in local efforts to minimise these impacts. At a regional and national level public health must lobby for changes to policy to protect population health and the disproportionate effects on the most vulnerable.

(1)Institute of Health Equity (2012). The impact of the economic downturn and policy changes on health inequalities in London.

(3) Beatty C, Fothergill S. Hitting the poorest places hardest: the local and regional impact of welfare reform. Centre for Regional Economic and Social Research. 2013

(4) Oxfam GB. (2010) A gender perspective on 21st century welfare reform.

(5) Welsh Government. (2013) Analysing the impact of the UK Government’s welfare reforms in Wales – Stage 3 analysis.

(6) Inside Housing (2013) Rent arrears up in wake of bedroom tax.

(7) Trussel Trust (2013) Increasing numbers turning to food banks since April’s welfare reforms.

(8) Sandwell Trends: Welfare Reform Topic Page (2013).

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By Alan Maryon-Davis, honorary professor of public health at Kings College London and past president of the Faculty of Public Health

WE love our NHS, despite its failings. We trust it, we depend on it and we cherish its fundamental principles of fairness and universality – free to all at the point of use.

Born out of Beveridge, midwifed by Bevan, the safe arrival of the infant NHS in the aftermath of war was nothing less than a revolution – the sort of massive change that could never happen today. It was huge – so big it dwarfed outer space.

Now, as we all know, the NHS is under threat – weighed down by the ageing population and high-tech hypertrophy, harried by small-state politicians, encircled by drooling marketeers  and asset-strippers.

The NHS is accused of being too monolithic, lumbering and unsustainable. The Government’s response has been to claw back millions of pounds and fire an explosive harpoon into its belly. The 2012 Act has torn into the flesh of the NHS, damaged many of its vital organs and put it on the critical list.

But it’s not dead yet. They have underestimated the power of the people. The NHS is healthcare of the people, by the people, for the people, all for one and one for all. This is why so many of us feel so passionate about it – and why we delighted in seeing it celebrated in the Olympics opening ceremony.

I believe the NHS at 65 is still, fundamentally, in good shape – in spite of all the ‘efficiency savings’, all the sniping and Cassandras, all the barbs, rug-pulling and clattering of bedpans in the corridors of Whitehall. The NHS can be nursed back to full health and vigour. Of course this requires political will – but political will is driven by the power of the people. And people power can be shaped and energised by the advocacy of those of us who feel strongly about defending the NHS and its fundamental principles.

We must seize this 65th birthday celebration to let everyone know that we will fight to make sure the NHS – the real NHS, not just the logo – is here to stay.

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by John Middleton, Vice-President of the Faculty of Public Health

The results of our latest member survey show despair, uncertainty and distress about the NHS reforms. We share members’ anger and frustration, reflected in feedback from local boards and committees. The results articulate the possibility of a wholesale departure from the specialty and major risks to the protection and improvement of the public’s health and the services they receive.

Wordcloud: Adjusted responses (phrases/themed/categorized), first 200 responses (max 50 phrases)

Credit: Andrew Hood, using wordle.net

Wordcloud: Adjusted responses (phrases/themed/categorised), from the first 200 responses in the survey (maximum 50 phrases)

As peers continue to debate the reforms, attitudes of public health professionals, and FPH’s leadership, are hardening. Faced with a government which does not seem to value professionalism or standards, it is essential that we continue to fight for the standards, accreditation and regulation of public health. No-one else will – and our partners in the public health national lobby agree with our stance.

Members have broadly supported this direction of travel – until now.  The ignorance and disregard in high places of what public health is and has done over 40 years in the NHS is alarming. FPH continues to hold a strong expectation for:
•    An independent and robust Public Health England;
•    A coherent career and training structure for public health professionals;
•    Protection of terms and conditions of staff;
•    Directors of public health reporting to chief executives of councils,
•    Clarity in the size and applications of the ring fenced budget and
•    Professional regulation for all public health specialists.

These issues were met with welcome support in the House of Lords committee stage.  However, a substantial cadre of our members believe that the public health community must campaign more explicitly against the likely negative health impacts if the reforms go through unchecked.

The Secretary of State has had a duty to ‘provide and secure’ the NHS since it began.   NHS planning has historically relied on regulations and guidance, not legislation.  This enables the NHS to move forward if the Secretary of State is in charge. If not, every line of the Health Bill becomes crucial.

Hard-pressed local authorities will only do what they must by law CCGs also will only do what they are required to do in law. The health system becomes a giant free-for-all; everyone doing the least possible, or the most lucrative and pocketing taxpayers’ cash. Some services may be deemed ‘bad business decisions’ and not be provided.

Where will these be without the Secretary of State’s duty to secure? This is a health insurance versus public health model. It calls into question the ideal of public service with which most of our members entered the NHS. Everyone in public health and health service users should be concerned about that.

As part of this debate, we have invited a range of organisations to contribute to this blog.  It remains open for members’ comments and more formal critiques. We look forward to your contributions here and through your local board members and FLACS.

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By Mark Weiss, FPH Policy Officer

As the Health and Social Care Bill makes its journey through the Committee Stage at the House of Lords, FPH continues to actively engage with members, key stakeholders, parliamentarians, as well as through its representation on strategic working groups and supported by its wider media work.

Committed to ensuring the Bill will provide the structures and safeguards necessary to protect and improve the health and wellbeing of the people of England, FPH is working hard to ensure a strong and viable public health workforce is maintained and strengthened for the future; and a rigorous framework for the statutory registration and regulation of all public health specialists to protect the public is established. 

As we continue to press hard for amendments to the Bill, at the forefront of our minds the risks to the public posed by the Bill – E.Coli, SARS, pandemic flu, Buncefield, heatwaves, flooding, immunisation and screening – loom large. To meet this challenge, with Lord Patel taking a lead on FPH’s amendments, we maintain a focus on statutory regulation; the role, qualifications and accountability of directors of public health; the organisation independent of Public Health England; public health expertise in the new NHS Commissioning Board; employment conditions for public health professionals at parity with the NHS.

Over the past few months, FPH has developed and implemented a firm lobbying strategy. We have written to all MPs and peers taking part in the Health Bill readings in both the House of Commons and Lords, setting out a clear case for our amendments to the Bill. We have the support of a broad range of peers from across all political parties – and have regular meetings with peers to discuss the possible impacts of the Bill in the context of public health.

We are also working with other health and public health organisations through our chairing of the PHMCC task group, and actively engaging with local government colleagues – including producing a joint statement with the Local Government Group. We also have representatives on key strategic groups, including the Public Health England Group (feeding into the development of the PHE Outcomes Framework) and the Workforce Advisory Group and have taken an active involvement in the NHS Future Forum Process with a submission recently sent in for the Second stage. FPH also maintains close working relationships with other faculties, Royal Colleges and stakeholders to share information and horizon-scan.

Informing our position, three member surveys have been conducted to ensure that we are engaging our members in a full and meaningful dialogue. At present we are in the process of analysing the results of our latest survey of members’ views of the Health Bill, with a full analysis to follow shortly. In addition, FPH works closely with its Local Board Members to encourage their active engagement with local MPs and relevant stakeholders.

Our lobbying work around the Bill has been supported by our wider media work, delivering news articles including a recent response to the Health Select Committee 12th Report on Public Health appearing in the Guardian (a copy at this link); and letter to the Times outlining our key concerns with the Bill. In turn our monthly bulletin continues to keep all of our 3,500 members abreast of the latest developments.

For all the latest news on our work on the reforms visit www.fph.org.uk

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