Get out more!
Reflections on the ADPH Annual Conference 2015
As things get busy and finances more difficult, it can be hard to avoid becoming inward looking. But perversely these are the very times when it becomes most important to look outwards. The DPH role can be quite an isolated one if we are not careful. It was therefore encouraging that our Annual Conference on 2nd November was oversubscribed.
Part of the conference’s attraction was no doubt the excellent speakers we had lined up. Dr Anna Dixon, Chief Executive of the Centre for Ageing Better, kicked us off with the challenge and the opportunity of our changing demography. She rightly questioned some of the negative language around older people such as ‘bed blockers’ and ‘demographic time-bomb’. As a ‘what works centre’, the Centre for Ageing Better will be looking for evidence on how people can age more healthily, with more financial security and be more socially connected. Please send any ideas you have for action or where evidence is needed to firstname.lastname@example.org.
A panel discussion, chaired by Tim Allison, with key figures from Public Health England, NICE and the King’s Fund led to a lively debate around the tables on making the economic case for public health. Public health comes out incredibly well on any objective economic assessment. Over 70% of the public health interventions assessed by NICE are cost effective, and 15% are cost saving. Return on investment is the icing on the cake, but it isn’t the cake. The point was made throughout the day that whilst the economics of public health are important we shouldn’t oversell it. The compelling moral and policy arguments are just as crucial. Prevention and early intervention are the right things to do. Economic analyses often don’t reflect inequalities, and to rely on them alone could lead to inequitable outcomes.
In his first engagement as the newly appointed chair of the NHS Confederation, Stephen Dorrell proved to be an inspirational speaker to energise us after lunch. He was very clear on the value of public health – the promotion of health and not the treatment of illness should be our national priority. He described the role of public health as putting “a bit of yeast in the mixture” and saw devolution as an opportunity to change the way government works both nationally and locally. Stephen said he failed to see how public sector reform could work without considering health and care, given the scale of this sector.
On the relationship between public health and the NHS, Stephen Dorrell described two main opportunities. Firstly, challenging unacceptable variations on important health issues such as stroke or diabetes. And secondly, challenging the way NHS resources are used so that the NHS becomes more efficient and equitable, for example, in caring for those with multiple, complex needs.
Devolution was the topic of our final panel debate and table discussion. Mary Black from the Public Health Agency in Northern Ireland described the considerable progress that has been made in their devolved arrangements despite the very difficult political context. There are important lessons to learn from Northern Ireland, and Wales and Scotland, as England begins to think about devolution.
Deborah Cadman, Chief Executive of Suffolk County Council, talked of how public health had become a central ‘change agent’ to the way they do business. The Joint Strategic Needs Assessment is a key driver, and demand management a crucial strategy in their effort to reduce costs and improve outcomes. She noted that ‘making good on the public health opportunity’ was one of Simon Steven’s five tests for government.
Steven Pleasant, Chief Executive of Tameside Metropolitan Borough Council, continued this theme. He said that supply side efficiencies would deliver less than half the required savings required by Manchester’s health and social care economy. Better demand management based on prevention and earlier intervention is critical if their devolution deal is to work. Steven also reflected on the scale of the challenge – 80% of people on the work programme have an underlying health problem, and 60% have a mental health issue, none of which is addressed by the programme.
Jim McManus chaired the session and asked the panel to describe the ideal characteristics of a DPH to respond to these challenges. The answers ranged from cloning Suffolk’s DPH (her Chief Executive is clearly and understandably a fan) to moving outside our comfort zone. Steven Pleasant noted that he normally saw DsPH together but not often enough in some of key meetings where some of these big issues are decided. He challenged us all to get out more!
In my reflections on the day I quoted from the opening lines of Charles Dickens’ A Tale of Two Cities, “It was the best of times, it was the worst of times”. In many ways these are extraordinarily difficult circumstances for DsPH across the UK. But my sense from the day and from meeting ADPH members is that we are a resilient bunch. We need to look out for one another so those in the most difficult circumstances do not feel alone. But there is a prize to be had if we can make public health fundamental to the way the public sector works across the UK. To quote Churchill, “Never let a good crisis go to waste”.