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The Project

Barnet Public Health Team, RCN, and Middlesex University worked together to develop a local authority hosted public health placement specifically for pre-registration nursing.

Nursing Context

It is increasingly important for nurses to understand and recognise their role and contribution to public health. Nurses make up a significant body of professionals working in public health, supporting communities with disease prevention, assessment, education, and evaluation of population health. This move from nursing an individual or small group to the wider community is an opportunity to influence change at a strategic level.

To prepare pre-registration learners for the future workforce a variety of learning experiences in practice including public health is essential. While this has always been implicit within curricula there is a need for more emphasis and direct learning opportunities. The NMC (2018) Standards framework for nursing and midwifery education require all registrants to have an understanding and knowledge of public health agendas and associated health promotion strategies . It is in this context that the pilot project was devised.

First placements

Two child health field student nurses have both completed five weeks placements. With more planned for other field students. The placements were positively evaluated by the students and the public health team.

The students reported

“When out in placement we need to use evidence-based practice to give rationale to the care we are giving to our patients. When the opportunity to spend five weeks of our placement in Public Health we jumped at the chance…

Public Health is all about our community. The decisions made for healthy eating in schools, prevention of diseases through immunisation programmes, flu vaccinations, community centres and support for families, social prescribing, smoking cessation to name just a few…

Listening to the impact that the healthy schools project has had on school children was inspiring. Growing their own vegetables at school AND being able to eat the produce! Healthy lives start with healthy children. Educating from young the importance of a nutritious diet will have positive outcomes for future generations”.

The Learning

The students reported the whole system learning was key to understanding the needs of local families and provided an opportunity to consider more expansive learning regarding the young people who will be in their care:

  • Attending foodbanks
  • Understanding infection control on a local population level
  • Focussing on the health promotion and illness prevention occurring in Barnet
  • National initiatives related to the wider social determinants of health.

The Public Health perspective

Having students on placement in public health is a learning opportunity for staff as well as the students. The students bring their recent theoretical learning and the staff can find this interesting and learn too for example discussions about the projects they undertook meant that staff could update themselves on breastfeeding support or staff retention practices in the NHS.

The University perspective

The evident success of this placement as a learning environment for the 2 students so far is exciting. Both considered the transferable skills gained, including enhanced communication, developing a more social model of health and being aware of the public health team roles. This includes the knowledge that public health may be a career choice in the future.

Widening the learning opportunities for the learners is a key objective for the university. With the main campus located in Barnet, the collaborative working with our local authority supports a key university aim to be actively involved in the community.

Benefits for Nurses in Public Health

It can be a challenge for nurses working in public health to meet the NMC revalidation requirements and thus retain registration.

Facilitating student nurse placements is one way of demonstrating how they meet The Code’s requirement to support learners.

This full placement was only possible as there was an NMC registered nurse to undertake the Practice Assessor role within the public health team.

Conclusion

The local authority and HEI were committed to the project and demonstrated the benefits of this collaboration.

This pilot was a success. All involved were able to see the value and reciprocal learning for everyone.

Next steps

  • To continue to offer this experience to more nursing students in Barnet.
  • To present this experience to public health teams and HEIs in the hope to inspire others to consider this student placement opportunity.
  • To develop a toolkit for other localities to support the introduction of this type of placement

 

Written by Pam Hodge, Middlesex University

Poem by Toomfoolery

An enduring memory from my time as a Public Health Registrar was the Director of my local Health Protection Agency telling me (during a particularly interesting and high profile outbreak) that Public Health was the arena where “medicine meets politics.” At the time, I thought that he was mainly referring to the fact that he was getting phone calls every 5 minutes from local politicians wanting assurances that this outbreak was under control, and that the very successful and globally renowned local business would not be shut down permanently. But in hindsight, as my career has taken me increasingly in to the political arena, I have begun to appreciate just how much of my work as a public health professional overlaps with the world of politics.

My involvement in all things Political began fortuitously as my love of working in a Local Authority declined. I have never been very good at keeping opinions to myself, and the move from an NHS training programme (where I was generally allowed to argue my case, and decisions were more often than not made on available evidence) into a Consultant post in a Local Authority (where the arguments I made were filtered through Political persuasion) was always going to be tricky. I worked with a great Public Health team in the County Council, many of whom had weathered the Political arena for some years already and were far wiser than me when it came to working with our allocated Cabinet Member. Our Cabinet Member was also well seasoned and knew what she wanted and how she wanted it – I frequently disagreed, both from a Political (ideological) standpoint and from the available evidence base. When the 2015 election saw another defeat for my Political Party of choice, I threw in the officer towel (continuing to be very grateful to all colleagues who stayed the course!) and decided to play to my opinionated strengths. I became active in my local Labour party, and in 2017 was elected as the first Labour Councillor on Worthing Borough Council for 41 years.

In Politics, one of the first things I learned is that our evidence base in Public Health will only get you so far. The arguments that you make to achieve your goals are as much about the relevance to your audience and the zeitgeist of the day, as they are about what the data tell us. I am eternally grateful for my instructions in the art of reading statistics (lies, damned lies etc.), but I have had to learn that my local constituents need to know what that statistic will mean for their family, not a thousand families. Our understanding of the wider determinants of health (I am constantly recommending anything written by Sir Michael Marmot to any colleague who will listen) is one of the areas that I treasure most from my training and work in both the NHS and Local Authorities, but there is nothing quite like sitting with a local family who are about to go in to emergency accommodation because they cannot find any affordable housing in the area, to nail the lesson that a home is at the heart of a human’s wellbeing.

In our area, as with most of the UK, we have seen an increasing use of foodbanks as austerity and the introduction of Universal Credit have cut people’s ability to provide for themselves and their families. A National Government has enforced austerity for 10 years now, leaving Local Government finances at an all-time low. In spite of the frequent soundbites from Government benches that the deep cuts to the public purse were absolutely necessary, there are numerous economists who have argued that this drastic response to the financial crisis was unnecessary and has penalized the poorest in our society for the problems of our deregulated financial system.

Local Authorities like mine, now find themselves in a bind. The pairing down of the State might fit with the councils ideology, but the reality on the ground is that we are hugely under-resourced and failing to provide adequate social care, education, public health, housing, waste management, or transport infrastructure. As a Public Health Consultant, seeing on a daily basis in my local area what this Political ideology has taken from our population’s health and wellbeing, I find that the translation of our statistics, reports and research is more pressing and relevant than ever. Public Health needs a strong voice in the Political arena, and it is my privilege to be one of those voices.

Written by Rebecca Cooper, Public Health Consultant

On the 7th November 2019, the Children (Equal Protection from Assault) (Scotland) Act 2019 received Royal Assent. This Act abolishes the defense of reasonable chastisement, thereby prohibiting the physical punishment of children, and so brings Scotland in line with its obligations under the UN Convention of the Rights of the Child to protect children from all forms of violence.

On the day of this legal change, I traveled from Scotland to England, and crossing the border I was very aware that while children in Scotland would benefiting this Act, children in England would not. English children will continue to be denied full legal protection from violence.

Changing the law is a tool to improve public health – this is my experience of the process that led to this change in legislation.

Finding allies

A group of children’s charities – NSPCC Scotland, Barnardos Scotland, Children’s 1st, and the Children and Young People’s Commissioner for Scotland came together in a coalition and together they commissioned a systematic review, published in 2015, on the effects of physical punishment of children (https://learning.nspcc.org.uk/media/1117/equally-protected.pdf)

The systematic review showed that the evidence could not be any clearer – physical punishment has the potential to damage children. The number one recommendation of the report was that all physical punishment of children should be prohibited.

In 2016, shortly after the Scottish Parliament election, the coalition of children’s groups approached John Finnie, a Member of the Scottish Parliament (MSP), to consider taking forward a Members Bill to give children equal protection from assault – by prohibiting physical punishment of children. They chose to approach John Finnie because he had previously showed support for this issue before the end of the previous Parliament session by trying to get an amendment into a different Bill.

Using public health evidence & responding to consultation

In 2017, John Finnie’s proposal for a Bill to give children equal protection from assault went out for consultation. At that time the Scottish Government did not support legal change to give children equal protection from assault. However, the consultation had over 650 responses – 75% of these were supportive and many submissions cited the 2015 systematic review on the effects of physical punishment of children, and other public health evidence. After this consultation the Scottish Government changed their position and decided to support the Bill. I heard it said that it was the public health argument – rather than the children’s rights perspective – that influenced the Scottish Government to change their position.

Further engagement in the political process & working with the media

In September 2018, the Bill was introduced into Scottish Parliament and in the year that followed there was much public health advocacy in support of the Bill as it made its journey through the Parliament. This advocacy fit with the Faculty of Public Health (FPH) in Scotland’s Healthy Lives, Fairer Futures Call to Action (https://www.fph.org.uk/about-fph/board-and-committees/a-call-to-action/) priority on preventing adverse childhood experiences, which enabled the FPH to support the Bill. Advocacy on behalf of the FPH included submitting written evidence in support of the Bill, sending a briefing paper to all MSPs ahead of a key debate, as well as sending an open letter to the leaders of all the Scottish political parties before the final debate on the Bill. I found writing a first-person article in one of the Scottish national newspapers (https://www.thenational.scot/news/17502438.tamasin-knight-a-law-that-justifies-assaulting-children-harms-health/) helpful in increasing awareness that protecting children from physical punishment is a matter of public health concern.

On the morning of the final debate, several FPH members attended a gathering outside Parliament to demonstrate our support for the Bill, and this gathering was featured in the national print and broadcast media. The passing of the Bill was reported positively in the press, with calls for the rest of the UK to follow Scotland’s lead and introduce similar legislation (https://www.theguardian.com/commentisfree/2019/oct/03/the-guardian-view-on-scotlands-smacking-ban-follow-the-leader)

Wales has since passed legislation to protect children from physical punishment (https://endcorporalpunishment.org/wales-prohibits-all-corporal-punishment/). While the children of Scotland and Wales will have their rights under Article 19 of the UN Convention on the Rights of the Child upheld, children in England and Northern Ireland will not. The difference living a few miles apart can make.

Written by Dr. Tamasin Knight
Consultant in Public Health Medicine
NHS Tayside

I and my wife have been adopting strict social distancing practices for a week. We are both in the group that has been told that it needs to be shielded for at least 12 weeks.

I have been following the evidence about Covid19 very closely and because of my assessment of the literature, I and my wife started strict social distancing shortly before it became national policy.

Part of my response to a feeling of some helplessness as a pensioner confined to home has been to ensure that I have contributed on-line to the professional debate about how to combat the pandemic. My portfolio career in retirement has included roles with the Faculty – I am the Treasurer – and with the BMA on many committees and this has facilitated this aforementioned activity. Indeed I agreed today to join another BMA committee on Covid19. Gradually my diary which had been a sea of cancelled meetings is being replaced by on-line (unpaid) work!

I am deeply appreciative of the work done by PHE and other public health staff in planning for the epidemic and attempting to control it. The pressure on the public health and national health service will be immense over the coming weeks and months but I am confident they will rise to the challenge.

The goodwill shown by my local community in suburban London has been heartwarming. It looks like we may have secured a mechanism to reliably receive a home delivery of food. My wife and I were quite emotional about the support that has been arranged by the United Synagogue and offered to all sheltered members in its community.

Social isolation is a real issue. I have made a point of trying to contact all people we know who are also in the moderate to high risk groups requiring sheltering. I am preparing for seeing many repeats on TV.!

My wife is a pianist and musician and thought she may not be able to continue working. However virtually all the people she teaches have already agreed to have their lessons by Skype or Facebook! Maybe her choirs might also be able to reform!?

My sons and their partners live some distance away but are in regular contact. My 5 year old granddaughter whose school closes tomorrow, has begun regularly calling us from Leeds after she returns from school. Seeing her happy face is always a comfort.
Ellis Friedman
March 19 2020

So I have made it through DAY 1 of social isolation…

This followed heavy pressure from our (grown up) children that we should not come back to London to fulfil various commitments or attend meetings that we had in London this week – so here we are in Lyme Regis.

All this because of COVID-19, now designated a pandemic by WHO.

As a retired public health doctor I am proud of the fantastic work public health professionals are doing to try to get on top of things and to protect the public. Similarly as a Non-Executive Director of an NHS Foundation Trust, I am proud of what the NHS is doing to prepare for this epidemic; one of the benefits of the ‘command and control’ system that we have in the NHS – even though in normal times we mutter about lack of autonomy.

We are fortunate that for the past 20 years we have divided our time between London and Lyme Regis in Dorset and we have homes in each, so we have decamped for now to the ‘country’.

Day 1 was ok, for one thing we had some sunshine, so we did some gardening; planted some seeds, tidied up the vegetable beds and sat in the sun. Later on we went for a walk by the sea, getting chillier but still nice and we got some exercise and improved our mental health – alas the ice cream shop was not open or we could have indulged!

And now the news tonight – 16th March 2020 – and government reiterating that we/ I am in the ‘vulnerable group’ and that more draconian measures are needed and we must self-isolate and reduce social contacts; everyone to avoid pubs, restaurants, theatres and non-essential travel, work from home if they can, more flights cancelled. Goodness knows what will happen to the economy.

And all us oldies (over 70) and ‘vulnerable’ may need to go into self-isolation and be ‘shielded’ from social contacts for 3 months!

Jigsaw opened, and one of our children signed us up for Netflix!

We will just have to take it a day at a time…

Sue Atkinson
16.3.20

Social media is ever present in today’s society, and levels of interest in the use of social media to support action to promote and protect health, alongside understanding and protecting against potential harms is growing. To help harness social media to support health we need to better understand who, and how, people engage with the platforms available to them, and the impact of those actions.

In 2018 in Wales, Public Health Wales in collaboration with Bangor University, carried out a nationally representative survey amongst adults (aged 16 years and above). The household survey was delivered face to face and collected the views from over 1,200 people on their access and use of digital technologies, including social media, and demographics and levels of health and wellbeing.

Our findings were surprising. Overall, 77% of the adult population in Wales reported using social media, with 65% using it on a daily basis (weighted to the demographic distribution of the Welsh population). The most frequently used platforms were Facebook, followed by WhatsApp, and YouTube. Of those remaining, approximately 10% had access to the internet but did not engage with social media, and a further 10% did not have access to the internet at all.

Digital exclusion (not having access, skills or digital literacy needed to use internet enabled technology) has been highlighted before in Wales and across the UK, and is recognised to be higher amongst older populations those in more deprived areas, and in poorer health. Given the increasing reliance on internet and technology across society, digital exclusion could be considered as a new social determinant of health.  The continued efforts of many organisations such as Digital Communities Wales to support everyone to have the opportunity, skills and capability to engage with online platforms is essential – ensuring a progress on digital is not inadvertently widening inequalities.

Back to our survey – where our findings challenged the preconception that social media is only for the young. We found that, amongst those who do have access to the internet, use did decrease with increasing age but a high proportion of the older age groups were using social media – 76% of those aged 60-69 years and 60% aged 70+ years. We also found higher engagement with social media amongst women than men – but differences across platforms. For example, more women used social networking, photo content and messaging platforms, whereas a higher proportion of men used video content platforms.

When considering differences by health status, we found that people with lower self-reported health and those who engaged in health-harming behaviours (smoking, inactivity and/or high levels of alcohol consumption) were less likely to engage with social media. Many studies have explored how social media offers people the opportunity to communicate and interact with others and find and receive information about health conditions – but not all may be interested or able to engage.

Collectively, these findings highlight the importance of understanding the audience, where they are (or not) on digital platforms, to inform and target relevant information.

alisha1

Lastly, we found that engagement in social media was similar across deprivation quintiles (see figure below), with the exception of Twitter and Whatsapp which had a lower level of engagement in those least affluent. The potential for social media to reach more deprived populations has also been reported elsewhere, and warrants further exploration to better understand how we can use social media to reach and engage all communities in health.

alisha2

Back to my question – can social media offer a way to engage across social groups?

Possibly.

First there is the challenge of digital exclusion, recognised to be higher in more deprived areas, older populations and those in poorer health.  There remains the need to overcome structural, educational and behavioural barriers contributing to digital exclusion. Should this be achieved then our findings pose some interesting areas for further exploration, given that we found no difference in engagement in some social media platforms across deprivation groups.

However, in this short blog I have somewhat simplified a complex challenge, and one that includes questions of trust, quality and reliability of information online, better understanding the relationship with well-being, and the need to build in evaluation – all in a fast-paced environment.

There remains much to learn about the role of social media in health, both beneficial and harmful. But as public services move to digital channels, continued efforts are needed to understand and address inequalities in access, alongside recognising that social media may offer a platform to reach a wider audiences and engage differently with populations about health.

 

Written by Dr. Alisha Davies FFPH PhD  Head of Research & Evaluation, Public Health Wales

NOTE:

This report is the second in a series called Population health in a digital age, the first published in 2019 and explored the use of digital technology to support and monitor health in Wales.  Both reports and infographics are available here

Health in All Policies (HiAP) is a way of working with policy makers in other sectors that aims to build the social, economic and physical conditions that support good health and prevent health inequalities. Healthy Lives, Fairer Futures, the call to action from the Committee of the Faculty of Public Health in Scotland, calls for a strong commitment to this approach to ensure that all public policies help everyone in Scotland to realise their Right to Health. As partnerships in several areas of Scotland are using HiAP, several colleagues attended a workshop in early December to share our experiences. The workshop was organised by the Scottish Health and Inequalities Impact Assessment Network, which is part of the Scottish Public Health Network.

WHO describes Health in All Policies as ‘an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity’. In public health we often work with partners to address defined public health priorities. HiAP differs from this because the starting point is a proposed policy and the aim is to identify all the likely effects on health, rather than focusing on one priority issue. This can help identify how to achieve the best overall health outcome from the policy. It often involves a formal approach like Health Impact Assessment, integrating health into other assessments or using other tools. The approach fits well with Scotland’s National Performance Framework, which places Wellbeing as a central purpose of government and recognises the contribution of the other national outcomes to that purpose.

Participants at the workshop shared their experiences of HiAP so far and discussed what is needed to develop and support this work. The group recognised that HiAP should be based on good working relationships and an openness to build understanding of constraints and opportunities in all policy areas. Every local authority area in Scotland has a Community Planning Partnership that brings together public, private and third sectors to agree how to meet the needs of their communities. These are an excellent platform for HiAP and other forms of partnership working and some Community Planning Partnerships have now developed formal governance structures to support HiAP in their areas. We also discussed the place of HiAP within the developing Whole System Approach being taken to the Scottish Public Health Priorities, and noted the need for alignment of national and local approaches and policies.

The workshop identified enthusiasm and commitment to this way of working across partnerships in Scotland. Participants agreed to continue to share experiences and develop our understanding of how use HiAP to achieve better outcomes. The Faculty can also support this, by continuing to advocate for Health in All Policies, at both local and national levels, and encourage Faculty members to adopt this approach. We are optimistic that by working collectively we can create public policies that allow people to thrive, improve health and reduce social and health inequalities.

Written by Dr Margaret Douglas, University of Edinburgh

Further information

Faculty of Public Health in Scotland (2017) Healthy Lives Fairer Futures: a call to action    https://www.fph.org.uk/about-fph/board-and-committees/a-call-to-action/

WHO (2013) Helsinki Statement on Health in All Policies https://www.who.int/healthpromotion/conferences/8gchp/8gchp_helsinki_statement.pdf

Scottish Government (undated) National Performance Framework                     https://nationalperformance.gov.scot/

Scottish Government and Confederation of Scottish Local Authorities (2019) Public Health Reform. Scotland’s Public Health Priorities – Local Partnerships and Whole System Approach                                        https://publichealthreform.scot/media/1570/whole-system-approach-for-the-public-health-priorities.pdf

Scottish Health and Inequalities Impact Assessment Network resources on HiAP and HIA: https://www.scotphn.net/networks/scottish-health-and-inequalities-impact-assessment-network-shiian/shiian-resources-information/reports/

Time is running out.

There is a climate emergency and we have only a few years left to keep global warming at safer levels, beyond which we may cross tipping points and activate feedback loops it is near impossible to reverse.

2019 may well be the year the world’s collective consciousness was finally awoken to the reality of the climate and ecological emergency and the pressing need to act decisively. Many social movements have begun to appear and raise their voices to protest at the lack of political leadership on this, the defining issue of our time. This includes an increasing number of health professionals, who are clear that the climate emergency is a health emergency and are demanding decisive action from organisations and political leaders. Impacts of climate change, including extreme weather events, the spread of infectious diseases, and food and water insecurity, will affect the vulnerable the most.

Whilst the UK government has declared a climate emergency, the underpinning policy ambition to respond to this remains unclear and ill-defined. The UK is not on target to meet its international obligations under the Paris Agreement. There is a strong social justice argument that due to high historic emissions, the UK should go faster and further on its commitment to achieve net zero.

The next few years may be the last in which we, and our political representatives, still have the opportunity take decisive and timely action on the climate emergency.

We are a group of UK health professionals who have come together to highlight the link between health and climate. We have worked to scrutinise manifestos of the main political parties in England, Scotland, and Wales and score them on their commitments relating to climate and health. With reference to the Lancet Countdown and UK Health Alliance on Climate Change policy recommendations, we developed a list of policy areas, which was refined through discussion and a shortlist agreed. Each manifesto was scored independently on our final five criteria of clean air, low carbon economy, transport, food and farming, and green homes. We have produced an infographic demonstrating how party manifesto commitments fare on plans to tackle the climate and health emergency.

CLIMATECHANGE

Good health for our families, our patients, our communities, and our population depend on a stable climate and healthy ecosystems. The next Government’s policies must reflect these pressing concerns and we must hold them to account for any promises made in their manifestos.

Blog written by Dr Sarah Gentry and Dr Ruth Speare in conjuction with Dr Yas Barzin, Dr Isobel Braithwaite, Dr Anya Göpfert, Dr Chris Newman, Alexander Crane, Michael Baldwin, Dr Oytun Babacan (Imperial College London) and Dr Iain Staffell (Imperial College London)

jacqui

Jacquie White, NHS England Director, explains why Public Health teams are needed at the top table of Integrated Care System discussions on Population Health

“The physicians surely are the natural advocates of the poor and the social problem largely falls within their scope.”

Reading this lovely quote from Rudolf Virchow on the front of the Faculty of Public Health’s Curriculum for Medical Schools made me think how many more opportunities we now have to tackle the fundamental issues impacting on our health and wellbeing by working together in Integrated Care Systems.

While local health and care teams are faced with the reality and consequences of ill-health daily, the partnerships in local systems are enabling and encouraging collective responsibility and action to start to solve some of the underlying determinants driving this.

And I believe we’re starting to see fresh shoots.

The NHS England and Improvement Population Health Management programme is trying to move our shared efforts in that direction and we really need your help.

The aim of the programme is to support local health and care systems and their emerging Primary Care Networks to work in partnership to improve care, and consequently to improve people’s lives, by designing local solutions to address the needs of local people.

I’m inspired daily by the enthusiasm and wealth of skills in public health teams who are driving a focus on proactive, preventative approaches to improve outcomes and reduce inequalities.

To help people struggling with health problems stemming from societal issues such as employment, environmental issues like air pollution, and behaviours like smoking, we need to learn from what’s already been achieved in public health.

With this in mind, the new Population Health Advisory Board, which includes your faculty’s President Maggie Rae and other public health expertise, will be key to guiding the programme and its ambitions over the coming months and years.

So much work has already been done, and the advent of Integrated Care Systems means we can now go further faster bringing together more skills in these partnerships and expanding our collective capacity.

With the NHS, councils, VCSE and other public services all around the table looking at new and very rich linked datasets and predictive analyses we’ve got a huge opportunity to tackle common problems together to maximise the impact and reduce duplication of already stretched resources. It allows systems to have a shared understanding of who their population are, and what is best for them in the long term.

For anyone not familiar with the NHS England and Improvement PHM programme, it’s the NHS’ commitment to working with local authorities and particularly public health colleagues to understand current, and predict future, health and care needs.  

It aims to help local systems and their providers design and deliver anticipatory and personalised care and support for individuals, more joined up and sustainable health and care services for local populations and make better use overall of public resources.

It’s the first time we’ve been able to bring together and analyse the right data to generate  local discussions in systems by the right groups of people about improving the health and well-being of communities. This includes health professionals, managers, commissioners, providers, data analysts, business intelligence, social care and of course public health colleagues.

So far, wave 1 of the programme has made some fantastic and very speedy achievements locally with more than 1,000 people being better supported, teams designing and starting to deliver new models of care for populations and inspiring the local workforce to feel re-energised about their jobs.

In Lancashire and South Cumbria for example, they focused on the wider determinants of people’s health using their links with the community and borough councils.

Primary Care Networks (PCNs) with their wider multi-disciplinary teams initially segmented their population and then asked analysts to bring in further insight – for example on assisted wheelie bin collections or where people are living in houses of multiple occupation – to help narrow down a specific at risk and impactable cohort of patients for initial action.

From the data – and following further predictive modelling on costed population segments –  they found people with needs not met by existing models of care, who are likely to experience a greater deterioration in health than others within similar population groups and who are likely to account for significant utilisation of health and care services in the next few years. They then worked together with local communities to design and agree a proactive tailored care model, including support for health, psychological and social needs.

The Public Health teams at LSC have been leading this work and were a fundamental part of its delivery.

Given that the potential for opportunity is greatest in influencing the wider determinants – and that we know only a small fraction of the factors that impact our health come down to our access to health services – we need more leaders from public health to help us in this mission. To succeed we must connect this work in systems with local teams and communities, and the leadership and expertise from Public Health is invaluable.

If your area is taking part in our programme or beginning to join up action on PHM then please get involved – we want this to be the kind of social movement Rudolf Virchow would be proud of.

Join the PHM Academy for lots more information and news on the development of PHM around the country.