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This is the first in a two-part blog that lays out our thoughts on the recently-published #NHSLongTermPlan, and where the NHS could focus its prevention efforts. The second part can be read here.


Gus headshotI thought it might be interesting to assess the recently-published NHS Long Term Plan against the shortlist of prevention priorities FPH set out in our December Prevention in the NHS discussion paper.

First some quick background. In October last year, FPH invited more than 40 senior NHS and public health leaders to a policy workshop to discuss where they thought the NHS should focus its prevention efforts.

One of the most challenging things we did was to co-create a ‘long list’ of prevention priorities. We then encouraged workshop attendees to vote for eight of these priorities – eight and eight only.

From a longlist of around 30 ideas, the group collectively identified 11 key priorities.

While the process had its flaws, the shortlist of priorities produced from this ‘hive mind’ of senior experts was fascinating:

1. A systems approach to prevention
2. Better governance for prevention
3. Realising the potential of the community
4. Tackling inequalities
5. Tackling multi-morbidities
6. NHS staff health and wellbeing
7. Mental health and wellbeing
8. Smoking
9. Alcohol
10. Early years
11. Health promotion

We set out this shortlist in a discussion paper published before Christmas. It is the first of three we’ll be writing as part of our ‘The Role of the NHS in Prevention’ project, which is being supported by the Health Foundation.

So to the assessment of how well the NHS Long Term Plan measures up against the first five of 11 priorities. (The remaining six priorities will be discussed in tomorrow’s blog.) Like many assessments in blogs it is subjective (sorry) so please do let me know your own thoughts via policy@fph.org.uk.

1. A systems approach to prevention

The NHS Long Term Plan says that its renewed NHS prevention programme has been shaped by the Global Burden of Disease study of the various risk factors that cause premature deaths in England. These risks are smoking, poor diet, high blood pressure, obesity, and alcohol and drug use, with air pollution and lack of exercise also seen as important.

The specificity of the focus for the NHS prevention push is in many ways very welcome. A lack of prioritisation can sometimes prevent non-public health decision-makers from ‘buying-in’ to a prevention agenda. But the biggest message we heard from our workshop experts was that a collection of individual interventions alone will not achieve the change we need to deliver at a population level. This, they argued, requires a systems approach.

FPH’s view is that it isn’t an ‘either or’. We do need to prioritise – and then implement well – prevention interventions that we already know are impactful, cost-effective, and deliverable. If that is the work of, say, the first five years of the ten year plan, it is up to public health leaders to start to explain simply and compellingly what a ‘systems approach’ is now and how it can be adopted by an organisation as complex as the NHS. This could then be the work of years’ six to 10 of the Plan. In return, the NHS needs to be willing to think even more innovatively about how to create a truly prevention-focused NHS.

Verdict: the initial prevention focus on specific individual interventions is understandable and welcome. But there’s significantly more for the public health community and NHS to do in partnership during the second half of the Plan if the aim is to transform the NHS’ approach to prevention.

2. Better governance for prevention

The NHS is full of people passionate about keeping local and national populations healthy and happy. It’s just that this passion for prevention doesn’t necessarily translate sufficiently into how NHS ‘success’ is really measured and how NHS leaders are really rewarded. The Plan talks about an increasing focus by local NHS organisations on population health and on contributing to the government’s ambition of ‘five years of extra healthy life expectancy by 2035’ but there’s not much additional detail.

Importantly, it is not clear how the NHS Long Term Plan and the DHSC’s ‘Prevention is Better than cure’ Vision complement and support each other. As Rachel Chapman and FPH President, John Middleton, argue in their assessment of the Plan, the NHS needs expanded capacity in population health management and public health skills, specialist public health expertise in all NHS institutions, and a ‘dashboard’ for assessing progress against clearly defined prevention milestones and goals.

Verdict: more to do. A good indicator of the NHS’s commitment to population health will be its willingness to take shared responsibility for the outcomes set out in the forthcoming Prevention Green Paper.

3. Realising the potential of the community

The Plan commits to doubling the number of NHS volunteers over the next three years and to scaling-up successful volunteering programmes across the country. The NHS will also continue to work with local charities, social enterprises and community interest companies providing services and support to vulnerable and at-risk groups. There is also a commitment to significantly increase the number of people benefiting from ‘social prescribing’. While all this is welcome, it is difficult not to feel that there remains an untapped opportunity to harness community resources more effectively to improve the population’s health and wellbeing.

Verdict: more to do but the emerging thinking around the NHS as an ‘anchor institution’ shows promise.

4. Tackling inequalities

The Plan makes clear the NHS’s commitment to reducing health inequalities. This is hugely significant, especially as FPH’s recent evidence review found that some NHS prevention programmes can reinforce health inequalities. This new commitment is backed by action. The NHS commits to set out specific, measurable goals for narrowing inequalities and to developing a ‘menu’ of evidence-based interventions to help deliver these goals. The Plan also promises better assessments of local health inequalities, a commitment to reducing inequalities as a pre-condition of new funding, to invest more in areas with high health inequalities, and new action targeted at those who are traditionally left-behind such as homeless people, people with severe mental illness, people with a learning disability and young carers. Expanding key programmes like the Diabetes Prevention Programme are also recognised as an important vehicle for tackling health inequalities given the high prevalence of type 2 diabetes in certain Black, Asian and Minority Ethnic groups.

Verdict: well done NHS! But implementation and monitoring of progress will be key.

5. Tackling multi-morbidities

The plan says it ‘goes further’ on multi-morbidities than the agenda set out in the Five Year Forward View. But it is difficult not to feel that this was an opportunity missed to signal more clearly that this is a key NHS priority for the next 10 years. The Health Foundation argues that the lack of an explicit national strategy to address one of the biggest challenges facing the health services is one of the most significant gaps in the Plan. Of course a month is a long time in healthcare and since the Plan was published NHS England has now published Universal Personalised Care Early feedback from stakeholders suggests it goes some of the way to answering the multi-morbidity criticism.

Verdict: perhaps not as bad as initially appeared.

Click here to read the second part of my blog and in the meantime, share your thoughts via email: policy@fph.org.uk.

Written by Gus Baldwin, Director of Policy and Communications, FPH. You can follow Gus on Twitter @Gus_Baldwin.

Each year, members of FPH are required to submit a CPD (continuing professional development) return to confirm that they have undertaken CPD activities related to their professional competence and PDP during the previous CPD year. This could be activities like attending a course to learn more about the field of public health relevant to their job role, teaching, audit, reading articles or perhaps getting involved with one of FPH’s many special interest groups.

The CPD requirements of the GMC, and in line with the UKPHR, expect registrants to:

reflect on what you have learnt from your CPD activities and record whether your CPD has had any impact (or is expected to have any impact) on your performance and practice. This will help you assess whether your learning is adding value to the care of your patients/residents and improving the services in which you work.

This is confirmed by the Academy of Medical Royal Colleges and has been adopted and approved by FPH for all our members.

Once the returns have been submitted, around 20% of FPH members are selected to be audited to make sure their reflective notes meet the required standard (in 2019 this is reducing to around 10%).

We are pleased to report that the CPD audit for the year 2017/18 is now complete so we are writing this blog to share feedback with our members. We also want to give advice that will help members submit a successful return in future years.

How many FPH members submitted satisfactory returns?

We are delighted to report that 92% of audit submissions were found to be satisfactory, which is 2% higher than last year. We were also pleased to see that more FPH members are making use of the PDP (personal development plan) element of the online CPD diary. This is something we’ll be encouraging more of our members to do because it helps to explicitly demonstrate the link between CPD and their PDP.

Was there a common reason why CPD returns were unsatisfactory? 

The most common reason CPD returns were assessed as unsatisfactory was because reflective notes were not of a good enough standard.

How do we determine if a reflective note is satisfactory or not?  

FPH’s online CPD diary provides a framework of four questions to help guide members when reflecting on their CPD activities. They are:

  1. Why did I choose this activity for my CPD?
  2. What did I learn from this activity or event?
  3. How am I going to apply this learning in my work?
  4. What am I going to do in future to further develop this learning and/or meet any gaps in my knowledge, skills or understanding?

FPH members should reflect on their new learning by answering each of these four questions in the boxes provided.  On page 34 of the Faculty’s current CPD policy (and page 27 of the new policy), there is a very useful table which provides a summary of the characteristics of a good answer to these four questions, so you know what to include.

A satisfactory reflective note is one in which the responses to at least three of these elements are assessed to be either borderline or good.

Lastly, a common observation during the audit was that some of the reflective notes read more like ‘descriptive notes of a learning activity’ as they did not contain any genuine reflection. Reflecting on an activity (what I have learned and what I need to do as a result) is different from reporting on an activity (who did or said what).

You can find examples and tips on writing good reflective notes by clicking here.

We hope that you find this advice helpful and it’s useful when you use your online CPD diary. If you have any questions, please contact your local Regional CPD Adviser.  Contact details can be found here or to download the new CPD Policy, click here.

Written by FPH’s Continuing Professional Development (CPD) Committee.

The end of 2018 marked the 70th anniversary of the Universal Declaration of Human Rights, the 40th anniversary of the Alma Ata Declaration on primary health care for all, the 23rd anniversary of the Beijing conference on gender and human rights, and the 45th anniversary of the first mobile phone call ever made. The common thread connecting these historical milestones becomes evident against the backdrop of the digital health technologies increasingly being used to strengthen the right to better quality primary health care, especially for women and girls.

Arguably, digital networks and mobile technology have permeated nearly every aspect of people’s lives across the globe. And many digital innovations have been introduced to improve how health services are planned, delivered and received, and even save lives.  

A recently published supplement, Advancing health equity and gender equality: Digital health in the Global Southdocuments evidence from seven countries from the Global South about what has worked and what hasn’t in terms of the use of digital technology to reduce health and gender inequalities. The authors from Bangladesh, Burkina Faso, Ethiopia, Kenya, Lebanon, Peru and Vietnam used results from five years of research funded by the International Development Research Centre (IDRC) to explore these important questions. The projects focused on access to health services by historically neglected communities who are served by an over-extended and under-resourced health workforce. The answers are, therefore, very helpful to support efforts by the global health community to reach the Sustainable Development Goals (SDGs) by leaving no one behind.  

In Vietnam, for example, a customized Health intervention for ethnic minority women in a mountainous region witnessed improvements in antenatal and postnatal behaviours. The customized text messages and personal follow-up increased women’s confidence to ask questions about their health. The intervention showed that changes in health behaviours and gender norms can help address decades of social exclusion that have been leading to lower health outcomes. Researchers in Peru, for their part, found that providing pregnant indigenous women with access to their health records strengthened their power, ownership and agency. And in Ethiopia, careful analysis allowed researchers to identify the potential negative impacts of a Health intervention on an already overstretched cadre of all female healthcare workers working in rural areas.  

The cohort of seven projects included some cross-cutting analyses that were integrated from the outset. Areas such as health equity, gender analysis, research quality, knowledge translation and cross-grant learning were monitored and supported to improve the potential impact of the results in different communities.  

The overall messages from the supplement are that digital health interventions at primary and secondary health care levels can positively influence health equity, help tackle existing gender inequalities, and create opportunities for new forms of positive power dynamics. But for that to happen, interventions need—at the outset—to be thoughtfully designed and implemented. Questions about inclusion, equity, rights, identity, access, agency and citizenship need to be integrated in the research questions and methodology in order to generate a solid knowledge base about how this could work in different geographic contexts, different populations and for different health challenges.  

The research also showed that digital health should not be based on a top down design. Findings from Burkina Faso and Lebanon pointed out that the chances of success and positive outcomes are commensurate when digital health interventions are based on community engagement, and user-centred models.  

The onus of building the evidence of what works, how, and for whom is on the research community. As digital health in low- and middle-income continues to grow in magnitude, scope and investment, the collection of articles presented in this new supplement also offers insight into areas that would benefit from more research. These include:

  1. providing adequate support and incentives to health workers (many of them women) to improve their work through digital health tools
  2. examining how using digital health to access and share information can influence agency, decision-making, intra-household dialogue and other types of power dynamics that are central to health and well-being for individuals and their families
  3. ensuring that health data are reliably collected and systems can securely share and analyze them to maximize use by community members and by decision-makers, including for reporting on the SDGs.  

If the global health community is to achieve the global goal of ensuring healthy lives and promoting wellbeing for all at all ages, bodies of research like the one presented in this supplement are critical. Research agendas need to evolve with the times and continue to build evidence on how digital health interventions influence health equity and gender equality wherever they are used. The most dazzling technology will always fall short unless it is applied using a people-centred and rights-based approach to public health.   

Written by Chaitali Sinha, Anne-Marie Schryer-Roy and Montasser Kamal. Chaitali and Anne-Marie are guest editors of the Journal of Public Health supplement, Advancing health equity and gender equality: Digital health in the Global South. Montasser is a Program Leader at the International Development Research Centre, Canada.

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It’s been a little over a month since we published our first discussion paper on prevention in the NHS. If you’re one of the many people who have responded to our request for feedback – thank you! We’re very grateful to all of our members and others who have taken the time to answer the questions we pose in the paper and send us their general reflections and thoughts.  

While the feedback has touched on a variety of topics, a good portion of it has focused on what is helping NHS staff and organisations do more prevention or what is getting in their way. It’s pretty clear from the combined feedback that our work needs to not only look at the ‘what’ of delivery, but – and perhaps more importantly – it needs to examine the ‘how’ of delivery.  

Our evidence review into prevention in the NHS identified 15 enablers and over 30 barriers to delivering prevention regardless of the sector in which programmes were implemented or the exact type of programme. Below we pull out some of the key ones that FPH members have told us helps or hinders their work.  

Enablers of good prevention delivery 

  1. Good partnership working – We received a lot of feedback about the importance of partnership working to deliver effective prevention and the role that the NHS can play as a partner to others in the community, voluntary, commercial, or statutory sectors and that more should be done to facilitate this type of working. Several people highlighted that within Scotland, the advent of Health and Social Care Partnerships has moved many prevention programmes to a shared responsibility and suggested there was learning from those partnership successes that needed to be explored further.  
  2. Using a targeted approach – Having a systematic and individually tailored process for prevention works much better than impersonal messages. Targeting sub-groups with specific needs and ensuring that the initial approach is made by a familiar face can also help. This can be something as simple as ensuring prevention advice is delivered by someone with an established relationship with the patient. Tools like the Heart Age Test where advice is more personalised also seem to work better than generic healthy living campaigns. 
  3. Contentaccess, and location – Making prevention accessible in terms of location, the use of non-technical language, and the use of technology improves uptake and delivery. We heard it’s important to ‘go where people are’ and always seek to address the individual holistically. This is especially important to bear in mind as a lot of prevention programmes exacerbate health inequalities because they are inaccessible to more disadvantaged groups. For example, we heard about Drug and Alcohol Services providing seasonal influenza vaccinations to heroin-dependent service users as part of their routine services – this proved successful in vaccinating a group of people who were considered hard to reach with traditional influenza vaccination programmes.  

Barriers to good prevention delivery 

  1. Lack of clarity about who is responsible for prevention – This is a key piece of feedback we’ve heard throughout this project: ‘If prevention is everybody’s business it’s often usually nobody’s job.’ This lack of clarity can often mean that prevention is not integrated fully into core services. This is exacerbated we heard by a lack of clarity around governance for prevention.  
  2. A lack of funding – We heard that although funding is not the silver bullet for prevention delivery challenges, many agreed that current remuneration models and a lack of financial resources allocated to prevention were significant barriers to doing more prevention.   
  3. Complexity and co-morbidity – Around 25% of us have two or more long-term conditions. This has been flagged as a key implementation issue when it comes to prevention programmes. We’ve been challenged to consider which condition the health and public health system should look to address first in order to ‘unlock’ the most improvements for people with co-morbidities.

We’d love to hear from you 

If you recognise some of these challenges or have examples of some of the enablers in action that you’d be willing to share, please email us at policy@fph.org.uk. Thank you for your feedback so far, it has really helped to shape and progress this work and as always please stay tuned to this blog for further updates.  

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

practDr-Justin-Varney-2-250x250February is Lesbian, Gay, Bisexual and Trans History Month, an annual opportunity to celebrate the contribution of LGBT+ people in history and reflect on how society can become more inclusive of diverse sexual orientations and gender identities. For public health professionals it is a reminder to reflect on how well we service this community in our daily professional practice.

In the last five years we have seen rapid evolution in the language surrounding gender and sexual identity, alongside this a more nuanced understanding from the media and the public of the diversity within the LGBT community.

Sadly the evidence suggests we still have a way to go in terms of community acceptance and inclusion.  The UK Government National LGBT Survey 2017, an online survey which gathered responses from over 108,000 LGBT+ people living in the UK, found that:

  • more than two thirds of LGBT+ respondents said they avoid holding hands with a same-sex partner for fear of a negative reaction from others.
  • 23% had experienced a negative or mixed reaction from others in the workplace due to being LGBT+ or being thought to be LGBT+.
  • At least two in five respondents had experienced an incident because they were LGBT+, such as verbal harassment or physical violence, in the 12 months preceding the survey. However, more than nine in ten of the most serious incidents went unreported, often because respondents thought ‘it happens all the time’.
  • 2% of respondents had undergone conversion or reparative therapy in an attempt to ‘cure’ them of being LGBT+, and a further 5% had been offered it.

For public health colleagues these findings shouldn’t come as a surprise. For over two decades the body of evidence, demonstrating significant and persistent health inequalities across physical and mental health affecting LGBT+ people in the UK as well as internationally, has grown in breadth and depth.

Public Health England has consolidated some of the evidence into reports on improving the health of gay and bisexual men, and the health of lesbian and bisexual women, in addition to the reporting of sexual health  and HIV affecting men who have sex with men and a specific guide on screening for trans and non-binary individuals.

There have also been an increasing number of local authorities doing specific LGBT needs assessments, including StockportDevon, Reading,  Manchester, Brighton & Hove, which provides a great foundation for action.

The National LGBT Companion Document to the Public Health Outcomes Framework (2013) set out four key recommendations for action which remain relevant today for public health professionals, further strengthened by the growing evidence base:

Recognition

This is more than just specific LGBT needs assessments, it is about recognition of LGBT people in all needs assessments and annual DPH reports, in the same way we routinely consider gender, ethnicity and age.

There are also many areas where intersectionality between different minority identities such as sexual orientation and ethnicity create compounded inequalities, as well as creating opportunities for bridging and collaborative solutions across communities.

It is also important to recognise that LGBT represents four different groups of individuals who share some inequalities but also who experience specific and different levels of inequality.

Engagement

Working with communities is at the core of public health practice, we are professionals for whom engagement is a core skill, yet we don’t always think about specific and targeted engagement with the diversity of the LGBT community.  Being conscious and aware of this may help approach engagement differently, and LGBT history month provides a great way to become more aware of local groups, networks and community organisations who can help you strengthen your conversations with local LGBT people.

Monitoring

Evidence and data are at the core of public health practice, especially when it comes to focusing resources where they are most needed. With the ONSNHS and local government integrating sexual orientation data collection into routine datasets there is now a stronger body of data to draw upon for the local and national picture. However data is only useful if it’s analysed and it’s incumbent on us as public health practitioners, and commissioners, to ask for this data to look at what is happening to our local LGBT communities.

Service Provision

Finally where public health professionals are engaged in commissioning or providing services it is important to think about how service provision is meeting the needs of LGBT individuals and communities. There is lots of support now available to providers to support them to provide more inclusive and culturally competent services for LGBT people, such as the Pride in Practice Programme and resources from NHS Employers. The concept of progressive universalism can work for LGBT people but only if universal services are culturally competent to meet their needs, and that requires explicit commissioning and monitoring of service use to ensure that LGBT communities are not being left behind.

Across public health we have a duty to address health inequalities and we can only do that effectively if we talk about, and think about, the needs of minority communities and take specific action to address them. LGBT history month is just one month, but it can provide an important prompt for reflection on whether you are doing enough in your daily practice to close the gaps in LGBT health. 

Written by Dr Justin Varney, Fellow of the Faculty of Public Health, HonFOM, and Interim Strategy and Policy Lead, Business in the Community and National Strategic Advisor at Public Health England.

Jonathan Shepherd

All the medical Royal Colleges and the independent, standard setting institutions which are the homes of engineering, architecture and other major professions, award prestigious, often eponymous, honorary appointments. By this means, national institutions celebrate and incentivise the public good which their professions deliver. In this tradition, the Faculty of Public Health (FPH) has developed its new Bazalgette Professorship scheme.

Nowhere, perhaps, is such an incentive needed more, especially for academics and their teams. The disconnect between academic public health and public health practice is clear; this has happened gradually but its effects are profound. Among the most important of these are that public health research is less focused than previously on solving the problems encountered in public health practice and that, as a result, trainees in public health are rarely attracted by the research products of, and potential career advancing opportunities in, academic departments.

A cause of this problem is the geographical distance between places where public health trainees and academics work, exacerbated by the absorption of public health into local authorities. This is in sharp contrast to academics and trainees in other branches of healthcare. In primary care, emergency medicine, dentistry and orthopaedics, for example, trainees are co-located with academic departments based in the practices and hospitals where academics practice their art and craft. This co-location and integration of training, research and practice, led by academics whose research is prompted and sustained by the everyday challenges of practice, is a model from which public health has largely withdrawn.

The march of evidence informed practice was largely prompted, and certainly accelerated, by practitioners deeply worried about the effectiveness of treatments available for their own patients; practitioners who have learnt trials skills, and then championed evidence informed change for the better. Separate practice from research though, as has happened in public health, and this motivation dissipates, and the precious evidence ecosystem in medicine, in which evidence generation, synthesis and mobilization are joined, fractures. Crucially, John Snow identified a source of cholera in Victorian London and took the handle off the Broad Street pump.

This disconnect is having negative effects in other ways too. For example, public health academics, because they have become separated from public health practice, are less able to demonstrate the significant contributions to the delivery and development of services which are necessary to compete successfully for clinical excellence awards.

As another example, although alcohol misuse is a major public health problem, medical presence on the Home Office health and enforcement alcohol forum (formerly the alcohol strategy group) comprises three liver doctors, a psychiatrist and a maxillofacial surgeon – practitioner academics all – but no public health academic. This may reflect Home Office blinkers but might it also reflect concentration of alcohol research relevant to practice and policy, and also real concern about the life destroying impact of alcohol misuse, not in public health but in these other disciplines? Surprisingly to clinical academics in other specialties, there has been little academic public health interest in putting NIHR funded findings about alcohol licensing into local action.

From this perspective, solutions suggest themselves. Strategically, public health academic departments need a physical presence in local authorities; professors of public health need to be co-located with public health practitioners and policy makers so that problems can be solved, hypotheses formulated and tested, and evidence applied together. Crucially, this would also benefit trainees, their supervisors and their research teams and make their endeavours more relevant, impactful and valued by local authority chief executives. But achieving this co-location, and evidence co-production and implementation is a major challenge. Other solutions are also needed. This is why the concept of an FPH professorship scheme came about.

The new Bazalgette professorships commemorate and seek to maintain the tradition of Sir Joseph Bazalgette, chief engineer to London’s metropolitan board of works in the mid-19th century who, through implementing his design for an efficient sewage system, did much to eradicate cholera across the city. Importantly, throughout this work, Bazalgette continued to train young civil engineers and provide independent advice to other British towns and cities – as well as places as far apart as Budapest and Port Louis, Mauritius. Recipients of this FPH honour will be scholars who, especially as team leaders, have translated their research to the benefit of UK population health.

FPH will appoint no more than one Bazalgette professor in any calendar year during which the holder will hold the honorary title of professor. Appointees will be fellows of FPH in good standing who have made a major contribution or contributions to public health by translating their own research. Since research translation involves collaboration, appointees will have built and sustained translation teams. These teams might include, but would not be limited to, NHS, civil service or local authority colleagues.

Two comments galvanised my thinking on this: the assumption expressed at FPH by a distinguished professor of public health that academics and practitioners are entirely separate groups, and the spontaneous reaction of a senior public health academic in my own medical school to the question why academics don’t consider themselves practitioners, “Well, we’ve tackled cholera haven’t we?”

Written by Jonathan Shepherd, professor of oral and maxillofacial surgery at Cardiff University. Jonathan generated the idea of the Bazalgette Professorship and secured funding from the Alliance for Useful Evidence to fund it, for which FPH is most grateful. Jonathan is a fellow of the Royal College of Surgeons of England and the Academy of Medical Sciences, and an honorary fellow of FPH and the Royal College of Psychiatrists. He is a member of FPH’s Academic and Research Committee.

ph-dashboard1-2

The purpose of the Public Health Dashboard (PHD), developed by Public Health England, is to support local decision-making by bringing existing comparative data into one place and making it accessible and meaningful to a wide audience. Its development is part of a wider Government drive to support transparency and local accountability for delivery across all public services and not just public health.

The PHD contains data on public health service areas that local authorities lead. These include mandated functions. The majority of data included in the PHD is already in the public domain, but by summarising the data the dashboard will help stakeholders understand how local authorities compare to one another. The PHD provides a summary of data in seven service areas: best start in life, child obesity, drug treatment, alcohol treatment, NHS health checks, sexual health services, and tobacco control. Alongside these is a single headline indicator on air quality. The dashboard is aimed at local decision-makers, such as senior council officers, to help inform their investment decisions and better support them to prioritise resources when it comes to improving the public’s health.

Tools like the PHD will be especially needed once the public health grant ring–fence is removed, to help non-public health professionals make good public health investment decisions. It is also intended that members of the public, the voluntary sector and service providers will use the dashboard to learn more about service provision in their area and how it compares to other areas.

The dashboard was released in ‘shadow’ form in October 2017, prior to a more formal release in July 2018. During the shadow period PHE invited feedback on the tool. Users suggested that data on the wider determinants of health would be a useful addition to the tool. At this time the Faculty also contacted PHE to discuss how we could work together to help develop the tool further. PHE and the Faculty agreed that the wider determinants was an important area that we could collaborate on.

It was agreed that we would seek views on the addition of the wider determinants through a survey, which the Faculty publicised to their members. We also jointly hosted two workshops to discuss the results in more detail. Working with the Faculty allowed us to do something far more user-centred i.e. ensure that we were able to speak directly to potential users of the tool and those who are responsible for local decision making.
Being able to tap into the expertise of the Faculty in running these types of events has been extremely beneficial. By being able to send out the questionnaire to all of their members, a far larger and more diverse audience was potentially able to participate.

Instead of those we traditionally seek views from (for example public health analysts) we were able to access people working in all areas of public health. Additionally, the Faculty’s endorsement of the Dashboard as a tool that could be used to facilitate discussion on investment in public health services with local decision makers is also extremely beneficial, as is the interest that they have helped to generate in the tool.

Over the course of two afternoon workshops in London and Birmingham, vibrant discussions were had with an extremely engaged audience. Participants were able to express their views and discuss the pros and cons of adding wider determinants into the Public Health Dashboard, the specific indicators themselves, and feedback on the tool itself.

The work is complex, but the workshops proved fruitful in providing some guidance as to what users find useful and would like to see. Work will now be undertaken to consolidate the outcomes of these discussions, with a view to creating a number of options for further discussion. Collaboration will continue with the faculty to share these options and seek further feedback and implementation into the tool in due course.

Written by Nicholas Coyle, Principal Public Health Analyst, Public Health England