“Deafness separates people from people”  Helen Keller  

Karen SaundersHearing loss is highly prevalent and can have profound effects not only on communication, but also on health, wellbeing and quality of life for individuals, families and communitiesOn Thursday 6 December 2018, at the Curzon Cinema in Oxford, the Public Health Film Society in conjunction with the Faculty of Public Health (FPH) Special Interest Groups (SIGs), Public Health England  and Oxfordshire County Council kicked off the start of the 3rd Public Health Film Festival with a screening of the Oscar winning film “The Silent Child”. The aim was to raise awareness of hearing loss in children and its potential for significant personal, social and economic impact 

The short film was introduced by the film’s writer and producer Rachel Shenton. It explores the tensions and differences in expectations between the hearing family of a young deaf girl and her specialist teacher who attemptto nurture and improve the child’s communication skills and ability to interact and connect with others.  The family however remained resistant to learning sign language and did not have high expectations for their daughter.   

Following the film, a panel of experts engaged in discussion with the audience and the film proved most effective in galvanizing debate on this important public health priority. The ensuing debate covered issues including: 

  1. Policy: at national level there is PHE’s screening and prevention programme offering hearing tests to newborn babies and children to identify any problems early on in their development along with PHE’s wider work around speech and language.  NHS England and others produced an Action Plan on Hearing Loss” to support services for deaf people and others recommending ways that services can be improved. 
  2. Partnerships: further integrated and holistic approaches should be developed with more joined up approaches across services to reduce, for example, developmental and educational gaps and to increase personalised care planning.   
  3. Awareness and understanding: work to strengthen understanding amongst the public and professionals including dispel the myth that deafness is a learning disability given deaf children have the potential to achieve the same as any other child with the right support 
  4. Data and intelligenceenhance the quality of data collection and monitor this more effectively to better understand social, financial and personal health implications. 
  5. Resources: the direct cost to the NHS of managing hearing loss is estimated to cost up to £450 million a year. The Minister of State for Children and Families reported councils were given £223m extra funding to pay for the biggest reforms to special needs education in a generation, with new education, health and care plans tailored to the needs of every child; however the Consortium for Research into Deaf Education reported the number of teachers of the deaf had been cut by 14% in the past seven years, at the same time as a 31% increase in the number of children requiring support.  

The panel was chaired by Uy Hoang, President, Public Health Film Society. The experts on the panel were: 

  • Richard Kuziara, Health Improvement Practitioner, Oxford County Council 
  • Karen Saunders, Health and Wellbeing Programme Lead/Public Health Specialist, Public Health England (West Midlands)  
  • Alison Kahn, research and tutorial fellow in material culture and film at Stanford University in Oxford and Director of the Oxford Documentary Film Institute 

This briefing will be shared widely and feedback is welcomed. If you’d like to read the briefing, please contact Uy via email: publichealthfilmsociety@gmail.com. 

Written by Karen Saunders, Health and Wellbeing Programme Lead/Public Health Specialist, Public Health England (West Midlands) and Co-Chair of FPH’s Children and Young People Special Interest Group. 

The second Wessex Public Health Conference, to be held on March 15th at St Mary’s Football Ground in Southampton, poses the question ‘Are we getting serious about prevention?’, as per the Five Year Forward View and the NHS Long-Term Plan.

Our annual conference draws colleagues from across the breadth of the public health
community in Hampshire, Dorset, Isle of Wight and Channel Islands, including staff in local authorities, NHS services and academics from our local universities. The conference is organised by a Wessex-wise public health collaboration and is led by Health Education England (HEE) and this year we have been greatly
oversubscribed with 250 delegates confirmed to attend.

The conference themes pose critical questions to our professional community. Are we doing enough to act on basic needs, mitigating the effects of poverty and ensuring access to basic requirements of food, clean air and housing? What are the threats and opportunities in public mental health and what more should we be doing? Given our skills in system leadership how can we use these to influence the direction of policy and service reconfiguration towards prevention? We are delighted that three eminent and influential keynote speakers have agreed to introduce the debates around
these issues:

  1. Professor Richard Wilkinson, co-author of ‘The Inner Level: how more equal societies
    reduce stress, restore sanity and improve everyone’s well-being’;
  2. David Buck, Senior Fellow of Public Health and Inequalities at the Kings Fund;
  3. Dr Julie Rugg from the Centre for Housing Policy, University of York.

We will have four streams of workshops and oral paper sessions running throughout the day, including in addition to the three above, a fourth open stream on local public health action. There was an enthusiastic response to the call for abstracts so we have a full programme of four workshops on System Leadership, Air Quality, Mental Health in Teenagers, and Housing and Homelessness; and over 30 oral presentations in other sessions. There will also be 40 posters which will be judged to award the Best Poster Prize of the day, as well as a full range of Exhibition stands.

We are also very pleased to welcome FPH President, Professor John Middleton, and FPH CEO, James Gore, who will be running a lunch time meeting for all delegates to have
the opportunity to discuss professional issues with them. Also this year we have teamed up with the Saints Foundation, the charitable arm of the football club, who will be offering lunchtime fitness activities.

The conference is seen as a key development opportunity for our Specialist Registrars, some of whom have helped in planning and ensuring that we have a clear sustainability policy to minimise the environmental effects of the conference. The planning committee has been a collaboration across our public health teams, academics and PHE colleagues and we are grateful for their involvement and all the contributions to make a success of the day.

Written by Dr Viv Speller on behalf of the Wessex Public Health Conference 2019 Planning Committee. The agenda for this year’s conference is available here. 

At FPH’s Annual Conference 2017 in Telford, I learned about recent medical evidence and forthcoming research that widely acknowledges the value of Animal Assisted Intervention (AAI) –  including Animal Assisted Therapy (AAT). 

Animal-assisted therapy is an alternative therapy that involves animals as a form of treatment to improve a patient’s social, emotional, or cognitive functioning. According to Nagasawa et al, social interaction with dogs can increase the level of oxytocin – the happy hormone – in humans. This is known as amazing gaze, or oxytocin gaze. 

Dr Sigmund Freud, a pioneer in the field of psychology, often had his pet dog, Jofi at his side during psychotherapy sessions with patients. According to several reports on the topic, Freud himself was more relaxed when the dog was with him but he noticed that the presence of the dog had a positive impact on his patients too. 

However, the concept of pet therapy was conceptualised by child psychologist, Dr Boris Levinson. According to several reports on the topic, he noticed by chance that sessions with one of his patients were more productive when his dog Jingles was in the room.  

While there are more than 50,000 Therapy Dogs in the United States and Canada, the role of Therapy Dogs in the UK is slowly but surely gaining popularity; namely in airports, schools and even hospitals. 

Here are some examples of our furry friends helping humans in their role as therapy dogs across the UK: 

  1. Harley was the first therapy dog to be introduced at Aberdeen Airport to calm passengers before their flights 
  2. Bella the Staffordshire bull terrier is a former stray dog who spends four days per week at  Shirebrook Academy in Derbyshire. The dog – who has her own tie and timetable  helps children with mental health issues and those on the autism spectrum.  
  3. In Eastbourne, another dog called Bella won the ‘Inspiration’ Award at the More Radio Eastbourne Awards 2017, by the brother of a patient who had suffered a stroke. On her ward round the hospital, Bella visits patients across all the departments but is particularly appreciated on the stroke and dementia wards. Donna Bloodworth, Stroke Unit Matron said: Research has suggested that introducing a companion animal into therapy session can result in patients feeling more at ease, enhancing communicative tendency and motivating to engage in therapy. Bella and [her owner] Barry have touched many people’s lives by coming into the ward.” 

All of these stories show that pet therapy or pet ownership can have significantly positive effects on a person’s mental health and well-being. I can see how a dog could also play an important role in helping people struggling to find a sense of community – particularly in cities like London where demanding lifestyles, unjustifiably high rents and a lack of social housing make it hard to find a place to call home.  

Sharon Hall of Noah’s Art  has been extremely helpful in enlightening me about the unique approach in AAT for a variety of needs: empathy, stress, emotional comfort and mindfulness. Moose, a spaniel and the centre’s resident dog therapist was absolutely captivating. Personally, I had an amazing experience with a brilliant Dalmatian called Mr Bond who I photographed as part of a photo competition. I was introduced to Mr Bond by David Allen, formed CEO of FPH, who commissioned me to photograph former FPH President, Professor John Ashton, for his President’s Portrait. 

Written by Ray of Light, London Photographer and a friend of FPH. Click here to read more about Ray and how you can commission him.  If you’d like to learn more about the positive impact that dogs can have on the public’s health, click here. 

Uy HoangThe third edition of the Public Health Film Festival recently took place in Oxford and was host to award-winning films from the International Public Health Film Competition supported by the Faculty of Public Health, Public Health England, The Oxford Research Centre for the Humanities and the Wellcome Trust Centre for Ethics and Humanities.

The public health film competition was more popular than ever, with over 550 films from 72 countries submitted for consideration. Members of the Public Health Film Society scored the films using a list of ten criteria previously published in the Journal of Public Health and a shortlist of 15 films was put forward for consideration by a committee of experts from the world of film and public health, including Professor John Middleton from the Faculty.

The judges’ award for the best health film this year was shared jointly by Budh (Awakening) a powerful film and directorial debut of Indian Director, Prashant Ingole, that tells the story of three women from different corners of India and their struggles against barriers that bind women in this vast country; and Buddy Joe, an entertaining animation from French director, Julien David that imagines how an elderly artists suffering from Parkinson’s Disease tells his step-son about his disease.

The highly commended award was given to Sarah Holloway for her documentary film, Lucy: Breaking the Silence which movingly recalls the story Lucy Rayner who took her own life, the effect on her family and the issue of mental health among young people in the UK.

The film festival offered audiences the opportunity to see most of these films for the first time in UK, to talk with film-makers about their motivations for making them and share the journey they have taken to make and showcase their films.

In addition this year, The Public Health Film Society (PHFS) in collaboration with the Wellcome Centre for Ethics and Humanities introduced an award for the health film that was most well received by the audience at the festival. This inaugural audience award was won by Lucy: Breaking the Silence and was presented by Professor John Middleton to Sarah Holloway, the film’s director.

On behalf of the FPH Public Health Film Special Interest Group (SIG), I can say that we are delighted with the success of the International Public Health Film Competition this year. It clearly shows that there is a high level of interest in health films among the artistic community and a global pool of talent working on health films and we are honoured to provide these films-makers with a platform to showcase their award winning work and share their experience.

Written by Dr Uy Hoang, Chair of the FPH Public Health Film SIG and President of the Public Health Film Society

The government has announced a consultation on its future proposals for local government funding and our analysis shows that these proposals would take more money from poorer local authorities and give it to richer ones – widening social and health inequalities. If we are going to address the huge inequalities this country faces we must allocate a greater share of local government funding to areas that have been economically ‘left behind’.

The proposals, currently out to consultation until 21 February 2019, are for new funding formulae that will be used to assess how much funding each local authority needs to provide essential services. Under the proposals a new “foundation” formula will determine the share of funding that each council receives for services to improve the environment in which people live (e.g. parks) , housing and preventing homelessness, leisure facilities (e.g. swimming pools, libraries), culture (e.g. museums) and planning as well as community and economic development.

Extensive research has shown that these services have a major impact on people’s health and that greater investment in these is needed in more disadvantaged communities who have poorer health, if we are to address the huge and widening health divide that blights this country. These foundation services – largely provided by district councils, are the foundation for good health. Indeed, the current formula, adjusts for levels of socioeconomic deprivation allocating 20% more resources per head to disadvantaged local authorities to provide these services. But the government’s new proposal is that differences in need should not be taken into account in the future. Rather they propose that each council in England should receive the same funding per head for these foundation services, regardless of differences in need.

In England there is a long history of allocating local government and NHS resources to local areas based on an objective assessment of their needs. This has led to more resources for these services going to the poorest areas with the greatest needs, which we have shown has resulted in a narrower gap in health between these areas and the rest of the country than would otherwise be the case. The government’s proposals would bring this to an end for these council services. If implemented today, figure 1 shows that the new allocation formula would lead to the most deprived 20% (quintile) of councils losing £35 per head per year – a total of 390 million per year, whilst the most affluent 20% of councils would gain £24 per head – a total of 260 million per year. (Click here for an interactive map showing the impact for each council.)

graph 1 final

Assessing differences in needs between areas is complicated, and the consultation document is highly technical, the serious implications of these proposals therefore, could easily have been missed. The standard practice used for assessing differences in need is to investigate the factors that are associated with differences in historical spending per capita between places and to use these as a proxy for need. One of the key predictors of need is the level of socioeconomic deprivation in an area, an indicator which is well developed and established in England for use in resource allocation and public health needs assessment.

But the consultation erroneously justifies not including socioeconomic deprivation as a measure of need for these foundation services by claiming that it only explains 4% of the variation in historical spend on these services. This is based on a flawed analysis that investigates predictors of total spend, rather than per capita spend, as would be standard practice. In fact, using the correct analysis, socioeconomic deprivation is a very strong determinant of variation in historical per head spend on foundation services. Using 2016 data – we show that social and economic deprivation explains 16% of differences in spending per head on foundation services. Even this is an underestimate of how much deprivation is a driver of need for these services, as the budget has been severely cut during recent years due to the government’s austerity programme. These cuts have been far more severe in deprived areas than in more affluent areas, leading to significant unmet needs in the most deprived areas. Figure 2 shows that since 2009 the poorest councils have lost on average £160 per head for these foundation services, whilst the richest councils have lost £50 per head.

Graph 2 final

A better estimate of the extent that deprivation predicts need for foundation services would be to use data from 2009 before these cuts were applied. On this basis deprivation explains 40% of the differences in spend per head between councils of these foundation services. In other words we estimate that deprivation is a 10 fold greater driver of need for these foundation services than has been estimated in the government’s consultation document. Figure 2 (below) shows that applying a formula that took into account this difference in need would allocate an additional £28 per head to the most deprived areas and a reduction of £24 per head for the most affluent 20% of local authorities.

graph 3 final

Changes to the way public funds are allocated to the NHS and council areas have consequences for people’s quality and length of life. The new NHS long-term plan has a focus on prevention and addressing health inequalities that is difficult to reconcile with a council funding allocation proposal that will lead to poorer health and bigger inequalities.

Following the cuts in funding to councils in recent years – for the first time on record we are seeing life expectancy declining and infant mortality increasing in the poorest areas, widening health inequalities. To us, as public health experts, these are seriously concerning trends suggestive of something going very wrong with the current system of resource allocation. These trends have reversed progress that had been made to decrease inequalities between 2000 and 2010.

Implementing the government’s new proposals would further fuel these adverse trends, ending the tradition of allocating resources to areas according to need and replacing it with a new, unjust, norm. Even if the overall funding envelope for these services increased in the future, the proposals would mean that poorer councils received a diminishing share of these funds. If further cuts were implemented – it would mean that these cuts would hit poorer councils harder. In a country that is divided, with widening inequalities, these proposals would further cast adrift the health and life chances of people in those areas, who already feel they have been abandoned by government. It’s time to take action on inequality, by ensuring fair funding for local government, increasing investment in the communities that have the greatest needs.

Written by Ben Barr, Senior Clinical Lecturer at University of Liverpool, Professor David Taylor-Robinson, University of Liverpool and Professor Dame Margaret Whitehead, University of Liverpool.

Rob V MSF picHow can we apply the principles of human rights to our work in Public Health? While many of us have some training in medical or bio ethics, few of us have more than a superficial understanding of human rights. In advocacy work around migration I have often found myself quoting from various documents such as invoking the ‘right to the highest attainable standard of health’ from the Committee on Economic, Social and Cultural Rights but rarely have I fully understood the context. Therefore when the opportunity came to attend a seminar in Salzburg on ‘Human Rights in Patient Care’, I jumped at the opportunity. Expanding on the concept of ‘Patient Rights’, the seminar took a broader viewpoint to capture all stakeholders in the delivery of care. 

Alongside doctors and lawyers from such places as Sudan, Vietnam and Slovakia I spent a week studying international human rights law and practice, gaining a better overview of these tools and frameworks. A highlight was meeting the UN Special Rapporteur on the Right to Care, Dainius Pūrus, who gave us his perspective on the major global issues facing health care today. These ranged from the lack of access to services for vulnerable groups, to the overuse of interventions in ever more settings. 

While a week may not be long enough to become an expert in human rights, I was left with an appreciation of the landscape. However in order to ensure that this knowledge could be easily called upon, the course organisers and many of the attendees have been working on developing ‘practitioner guides’ for both doctors and lawyers. These guides, give an overview of the laws, alongside practical examples of their application and I highly recommend anyone interested in framing health issues around human rights to explore them. The guides are country specific but start with the international frameworks and are therefore relevant globally.  Sadly there is no specific guide for the UK, but developing this could be a project for a small team. In fact considering such a process was an exercise at the seminar and there is much support available. 

Human rights should be an essential consideration in health care delivery at all levels, not least public health. Indeed many of our approaches are strongly aligned with the human rights agenda. Of concern in my work is the treatment of undocumented migrants in the NHS, where many are denied or deterred from accessing essential treatment, with concerning ethical and public health consequences. Better knowledge of human rights law gives us another string to our bow in order to better advocate for a more equitable, rights based approach to care.   

Robert Verrecchia is a London-based, public health registrar with an interest in international public health and migration and health. He is currently working with the FPH on their 5 year strategy and on migration, health and ethics. He also works with Chatham House, Public Health England’s Global Health Division and co-chairs the Médecins Sans Frontières UK Take Action Group. You can follow Robert on Twitter @Rob_Verrecchia.

This is the second in a two-part blog that lays out our thoughts on the recently-published #NHSLongTermPlan, and where the NHS could focus its prevention efforts. If you haven’t read the first part yet, click here to read it.

Gus headshot

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

6. NHS staff health and wellbeing

While noting that the NHS recently published the NHS Health and Wellbeing Framework, the Plan goes further by committing to “make the NHS a consistently great place to work” including the redoubling of efforts to address discrimination, violence, bullying and harassment. However, much of the detail is still to be set out in a workforce implementation plan to be published “later in 2019” with a new Chief People Officer leading the work. We hope the implementation plan not only talks about how it will improve the health and wellbeing of NHS staff but about how those 1.4 million people can model and champion healthy behaviours within their local communities.

Verdict: wait and see what the implementation plan contains.

7. Mental health and wellbeing

The Plan makes a renewed commitment that mental health services will grow faster than the overall NHS budget, with funding for children and young people’s mental health services growing faster still. This investment will enable further service expansion and faster access to community and crisis mental health services for both adults and particularly children and young people. We welcome the commitment for NHS-funded Mental Health Support Teams in schools and colleges but there’s still much more to do to encourage better mental health and wellbeing at a population level.

Verdict: clear and very welcome commitment to improving mental health services but more to do on the public mental health side.

8. Smoking

The Plan makes clear that smoking still accounts for more years of life lost than any other modifiable risk factor. It commits the NHS to ‘a significant new contribution’ to making England a smoke-free society with new support targeted at in-patients who smoke, expectant mothers, and their partners, who smoke and smokers using specialist mental health services or learning disability services. The change in tone in how the NHS should treat people who smoke is also welcome. Smoking isn’t a lifestyle choice. It is a dangerous addiction that not only kills but significantly impacts on the health and wellbeing of friends, family, colleagues and neighbours. Importantly, the Plan also states that funding and availability of smoking cessation services (and drug and alcohol services, sexual health, and early years support for children) in local government will directly affect demand for NHS services. That’s a pretty clear, if diplomatic, way of saying to the Treasury that the NHS would like to see more money going into local government public health services in the Spending Review.

Verdict: well done NHS!

9. Alcohol

The Plan identifies alcohol as a key priority for its NHS prevention programme and commits to ensuring that, over the next five years, those hospitals with the highest rates of alcohol dependence-related admissions will be supported to fully establish Alcohol Care Teams. As outlined above, the Plan also makes the case – in diplomatic tones – for more funding for alcohol services in local government. One of the key questions is whether the NHS needs to play a bigger role in encouraging behavioural change across the whole patient population, across the national population, and be more vocal in calling for national policy reform. For example, should the Plan have mentioned MUP?

Verdict: a focus on the ‘crisis’ end of alcohol treatment but more to do when it comes to establishing healthier relationships with alcohol amongst the wider patient and national populations.

10. Early years

The Plan commits the NHS to playing a crucial role in improving the health of children and young people while making clear that better healthcare can never compensate for the health impact of wider social and economic influences on children’s and young people’s health. There are a number of ‘public health’ commitments including the roll out and expansion of the Saving Babies Lives Care Bundle (SBLCB), reducing smoking rates during pregnancy, better access to mental health services, improving breast-feeding rates and childhood immunisation. But having highlighted the wide range of social and economic influences on children’s health, it is questionable whether the Plan does enough to integrate the NHS effort with these wider forces or to recognise the urgency and scale of the health challenge.

One of the more controversial aspects of the Plan was the announcement that the NHS would consider whether there is a stronger role for the NHS in commissioning health visitors and school nurses. The response from the public health community has been pretty universal. The issue is not about the quality of local government commissioning but simply the lack of funding.

Verdict: positive but more needed and the commissioning proposal sent the wrong signal, no doubt unintentionally, to the public health community.

11. Health promotion

The Plan highlights that every 24 hours the NHS comes into contact with over a million people at teachable moments in their lives. It sets out practical action to do more to use these contacts as positive opportunities to help people improve their health. For example, one of the ways set out in the Plan is a commitment to ensure staff on the frontline feel equipped to talk to patients about nutrition and achieving a healthy weight.

The commitment to do more to support secondary prevention is very welcome. The diplomatic call for more funding for the local authority public health grant as part of the Spending Review is also greatly appreciated. The NHS desire to draw a distinction between the role of the NHS vs the government, NHS England vs Public Health England, and the NHS vs local authorities is also completely understandable.

However, the scale of the prevention challenge, and the importance of the NHS as an ‘anchor institution’, means that the NHS can’t not play a clear leadership role in promoting and championing good mental and physical health in local communities and at national level.  The Plan’s commitment to work in partnership with the Health Foundation to identify and encourage the take-up of good practice in local areas across the country is welcome but the scope of the ambition feels limited (at least at this stage) for a ten-year, transformative plan.

A month after the Plan was launched, NHS England has been willing to make the case in public for greater social media regulation to protect the public’s health.  In some ways this makes it even more curious that it did not use the opportunity of the Plan itself to actively champion reform of key public health policies – particularly those policies directly related to the key risk factors identified in the Global Burden of Disease study.

Verdict: very welcome commitments but the NHS needs to play an even more significant role in championing action to keep people happy and healthy.

Verdict overall: the NHS Long Term Plan puts tackling health inequalities at its heart and for that alone it needs to be loudly applauded. But alongside this landmark commitment there are a host of other very positive and welcome proposals. What’s needed now is an even greater shared commitment from the NHS and the public health community to collaborate and co-create the specifics of how to narrow health inequalities and shift the NHS’s balance still further from curing illness to preventing it. If the Long Term Plan ends up being the ‘NHS’s plan’ and the forthcoming Prevention Green Paper becomes the ‘local authorities’ plan’ then we may well look back at 2019 as an opportunity missed.

If you haven’t already, please read the first part of my blog by clicking here and also consider sharing 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.