The NHS Long Term Plan – let’s stop the ‘us and them’

January 18, 2019 in ADPH Updates, President's Blog by Lucy Sutton

The NHS Long Term Plan has finally arrived. There is much in the plan that Directors of Public Health would support: 

  • The shift in focus to primary and community services
  • Extra funding for those places with the greatest health inequalities
  • Training of medics on nutrition in all hospitals 
  • Action on air pollution within the NHS fleet 
  • Action on screening and vaccination inequalities 
  • £30M for rough sleeping initiatives 
  • Additional NHS gambling clinics 
  • Important focus on children and young people, cardiovascular disease, musculoskeletal disease, mental health and falls prevention.  
  • Alcohol care teams to be developed in collaboration with local authority commissioners. 

We welcome too the strong focus on smoking; but this, and in fact every commitment above, needs to be done in collaboration with LA commissioners.  

Our members are less welcoming of the doubling of the Diabetes Prevention Programme, and I’m sure could have found a more effective use of the £105m already invested in it. 

The press release on the NHS Plan’s commitments on alcohol and tobacco preceded the full plan by two days. We responded positively to this as they heralded the good intention for the NHS to do more to prevent modifiable factors damaging patient’s health. However, we waved three red flags of concern – the plans were ‘undeliverable’ without a good spending review settlement for public health; bold national policy change is needed to address the social determinants of health; and thirdly, the NHS needs the support and contribution of local authorities and the Director of Public Health to deliver the plans efficiently – we need to operate as a public health system.  

Cuts are the issue – more restructuring is not the solution 

But let me turn to some of the disappointing aspects of this plan. Imagine our surprise when the full NHS plan arrived the day after our welcome with the proposal to: ‘consider the potential for a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be.’ 

Unacceptably, ADPH was neither involved nor informed about the inclusion of a review of our commissioning responsibility – by NHSE, another public sector commissioner. At best this is a well-intentioned but extraordinarily ham-fisted effort to deal with public sector funding cuts – at worst, it is an unwelcome distraction from cross-sector collaboration to manage those cuts to ultimately improve citizen’s health and wellbeing. Cuts are the issue – restructuring is simply not the solution.  

Fighting among ourselves will deliver a worse outcome; how you do things does matter. So in that spirit, and for the NHS’ own good, we’re pushing back and saying there can be no review of the commissioning of public health services without the full involvement of Directors of Public Health. Reviewing what we do can be productive in illuminating areas for improvement – and we would support a review which looked at how public health services could be sustained and improved.  

I have raised our concerns with DHSC and have been reassured that they want to work closely with ADPH and public health stakeholders on this review. 

System challenges 

Austerity has been a major driver of change for over a decade. In part it has driven necessary transformation and efficiencies within public services; but for the most part, it has driven unnecessary demands on those services and arguably is now costing the government more than it is saving – as well as leading to all sorts of distortions within the public sector. Indeed problems which properly funded public health teams could prevent are now being displaced to the NHS, with avoidable extra cost. 

It was within this challenging context that public health moved from the NHS to local government in 2013. The case for the transfer of public health responsibilities remains unchanged – indeed we would argue, it is stronger than ever. Directors of Public Health are providing leadership and expertise to tackle the social determinants of health and deliver strong place-based population health approaches – as well as leading the transformation of those services we’re responsible for commissioning – substance misuse, sexual health, 0-19 year old’s health and wellbeing.  

There is much more to public health than the NHS – the Clean Air Strategy published this week has significant roles for local government and the Serious Violence Strategy advocates a public health approach. We need to challenge this default ‘NHS first’ logic if we are to build a truly preventative system. 

Public health commissioning has delivered improved outcomes 

The completely false presumption in the Long Term Plan is that council commissioning is delivering worse outcomes. This is simply not true. It is not borne out by outcomes data. There are several national reports that show local government has been successful in delivering services under difficult circumstances and has prioritised increasingly scarce resources effectively.  

We’ve brought new energy and rigour to the commissioning of these community services, often transforming who delivers them, where and how, making integration and partnership-working real – and, in the context of rising demand and huge cuts, largely delivering good outcomes. Redesign in many areas has focused on integration – integration with other public services, such as criminal justice, adult services, children and young people services; and integration across the wider health economy. It has also looked to commission the community and voluntary sectors and to increase social value through its contracts.  

‘Be careful what you wish for…’ 

When public health was in the NHS, we know that the funding for prevention was always on a shaky footing – there in good times, the first to go in difficult. This was also true of the funding of many non-acute, preventative community services, including those now commissioned by local government. As Jim McManus has blogged: ‘it was not better in the glory days’. We inherited long-standing challenges – from the underfunding of school nursing and fragmentation in health visiting, including poor links with GPs – to overly medicalised and expensive sexual health services, or drug services focused on clinical treatment and not yet recovery; and Directors of Public Health have worked hard to innovate and introduce new models to deliver improved outcomes for less. Local authorities have also taken some decisions that the NHS could not or would not make.  

In December 2018, our successful ADPH conference focused on ‘disruptive leadership’ – the kind of leadership that understands that improving outcomes often needs challenge and change, that isn’t afraid of challenging ‘the norm’ to enable innovation, and that knows how to be pragmatic and savvy while doing this. This is the kind of leadership that we so desperately need in the public sector – leadership to enable the reforms needed to better serve a population with changing needs and expectations.   

But commissioning can be a thankless task; with a focus on improving population outcomes with efficiency, it’s not often that providers thank commissioners for their efforts. It can lead to experienced professionals being asked to do things differently, or to change a service skill mix or integrate with other providers, or to change the location or mode of the service to make it more accessible for residents and patients. Often, the best innovation comes through commissioners and providers working in creative tension together – and there are very many examples of this leading to fantastic services.  

Joint commissioning of local health and care services in integrated care systems is becoming increasingly important to enable local government and the NHS to shape effective services – and indeed is already happening in many areas. 

It’s time to work as a system. With each part funded appropriately and sustainably. We will focus on articulating that. We all need to join together and end the unhelpful “us and them” discourse. 

 

 

ADPH Press Release: Investment in public health is vital to stop the growth of drug resistant sexually transmitted infections

January 10, 2019 in ADPH Updates, Policies, Sexual and Reproductive Health by Lucy Sutton

Attached is a press release from the ADPH in response to the new cases of drug resistant sexually transmitted infections. The statement was published on 10th January 2019.

143 KBThe Association of Directors of Public Health – Response to drug resistant STI cases Jan 2019

ADPH Press Release: NHS Long Term Plan “undeliverable” without investment in public health

January 7, 2019 in ADPH Updates, PH Funding by Ben Wealthy

Attached is a press release from the ADPH in response to the NHS Long Term Plan, published on 7th January 2019. 448 KBADPH statement_NHS Long Term Plan

ADPH Press Release: NHS Long Term Plan action on alcohol and tobacco must link with local services

January 5, 2019 in ADPH Updates, PH Funding by Ben Wealthy

Attached is a press release from ADPH in response to an announcement about new alcohol and tobacco services as part of the NHS Long Term, set out on 5th January 2019.

446 KBADPH statement_NHS Long Term Plan_alcohol and tobacco

ADPH Press Release: Cuts to public health are “unnecessary, undesirable and unacceptable”

December 20, 2018 in ADPH Updates, PH Funding by Ben Wealthy

Attached is a press release from ADPH in response to the Government’s announcement of the public health grants to local authorities for 2019/20, published on Thursday 20th December. 445 KBADPH-statement-Cuts-to-public-health-are-unnecessary-undesirable-and-unacceptable

ADPH Policy Positions

December 19, 2018 in Active Travel and Physical Activity, ADPH Updates, Air Pollution and Climate change, Alcohol and Drugs, Built Environment, Children and Young People, Commercial Determinants of Health, Health and Social Care Services, Housing, Integration & Devolution, Mental Health, Obesity, PH Funding, PH System, PH Workforce, Policies, Policy Statements, Publications, Sexual and Reproductive Health, Sustainability and Climate Change, Tobacco by Lucy Sutton

In November 2017, ADPH published a series of policy position statements on eight key topics alongside a narrative document exploring roles and enablers within the public health system. These position statements have since been reviewed and updated.

These statements bring together the views and recommendations of our members on eight key public health topics: outdoor air quality, alcohol, tobacco, drugs, obesity, sexual health, housing, and mental health. The narrative is a collation of existing ADPH publications and views from the membership with key recommendations to ensure the public health system is fit for the future.

These statements will help us to drive our policy work forward and push for our members’ recommendations in all the policy work that we do.

If you would like to discuss anything in these documents please do contact the ADPH Policy Team by emailing enquiries@adph.org.uk.

370 KBADPH Policy Position – Air Quality (Nov 2018)

378 KBADPH Policy Position – Alcohol (Nov 2018) (1)

394 KBADPH Policy Position – Drugs (Nov 2018)

286 KBADPH Policy Position – Housing and Health (Nov 2018)

403 KBADPH Policy Position – Mental Health (Nov 2018)

387 KBADPH Policy Position – Obesity (Nov 2018)

433 KBADPH Policy Position – Sexual Health (Nov 2018)

279 KBADPH Policy Position – Tobacco (Nov 2018)

264 KBADPH Narrative on the UK Public Health System (Nov 2018)

ADPH Press release: Councils call for major extension of national HIV prevention trial 

December 14, 2018 in ADPH Updates, Sexual and Reproductive Health by Lucy Sutton

Attached is our press statement calling for the extension of the national HIV prevention trial.

146 KBADPH – PrEP statement Dec 2018
by admin

200 Days On – My Reflections as ADPH President

December 6, 2018 in ADPH Updates, President's Blog by admin

 

(given as the introduction to the December 2018 ADPH annual conference)  

It’s 200 days today since I was inaugurated as President of the ADPH. Usually Presidents get asked what they’ve achieved in their first 100 days – but I’m proposing that, seeing as I’m a part-time President, my time gets doubled. So, time to see how we’re doing on the priorities I set out in May:

  • Challenging the norm and advocating for equality in all its forms
  • Developing a vibrant, member-led organisation
  • Promoting our unique local system leadership role
  • Ensuring we continue to be well-respected as an organisation – but with an ‘edge’ 

My first priority was to seek to highlight the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, gender, disability. This normalisation of inequality in our society serves to protect the power of some groups over others, yet it is unjust and profoundly damaging to our health and wellbeing.  

When I spoke at my inauguration in May, the UN’s Special Rapporteur on racism had just published their report, which noted that racism in Britain was becoming ‘normal’ again. This week, analysis showed a record number of children are being excluded for racist bullying (The Guardian, 1 December 2018).  

And in November, we had the report of the UN’s Special Rapporteur on extreme poverty and human rights, which found that ‘for almost one in every two children to be poor in twenty-first century Britain is not just a disgrace, but a social calamity and an economic disaster, all rolled into one’. He noted that it was women and children and those most vulnerable who were being disproportionately impacted by recent tax and welfare reforms. The 49% real-term reduction in government funding from 2010/11 to 2017/18 was cited as a contributory factor, with people no longer having access to the vital services they needed. The UN’s Rapporteur’s view was that the UK government could end poverty if it wanted to. 

Many believe that austerity is now actually costing more to the UK government than it is saving, with the Rapporteur noting: ‘the many billions [taken from] the benefits system since 2010 have been offset by the additional resources required to fund emergency services by families and the community, by local government, by doctors and hospital accident and emergency centres, and even by the ever-shrinking and under-funded police force.’  

While the renewed focus on ‘prevention’ is welcome, the reality is that interventions to prevent poverty, poor outcomes and mental distress are being cut on a massive scale. And the money and focus continue to prioritise crisis management – rising A&E attendance, knife crime, suicide, homelessness.  

Increasingly, our members are shining a light on the negative impact that the changes in our public services are having on citizen’s health; this month the Guardian covered research commissioned by Alice Wiseman, DPH Gateshead, on the negative impact of the roll out of Universal Credit particularly on claimants with disabilities, mental illness and long-term health conditions, as well as homeless people, forces veterans and care leavers. The findings led Alice to make the damning comment that: ‘I consider universal credit, in the context of wider austerity, as a threat to the public’s health.’  

Our members have also been leading efforts to challenge the new cultural norms created in society by commercial interests, which perpetuate the concept that our major public health issues are down to a collective failure of individual willpower. In London, Danny Ruta, Steve Whiteman and Vicky Hobart have been key in the efforts to challenge what’s normal to impose on our children, with the ban on junk food ads across the Transport for London network; or Ruth Tennant’s work with ASH on reducing children’s exposure to smoking in their homes.   

Today, we are in the middle of the international 16 Days campaign to end violence against women and girls. The ability of those in power to maintain their positions through normalisation and victim-blaming is no better demonstrated than by this form of violence and control. We kick-started our ADPH policy work on violence (in all its forms) through a lively conversation at the ADPH Council in October – and hope many of you will be engaged as it evolves.  

And finally, I recently had a fantastically positive challenge to my own preconceptions of what’s normal, when Becky Rich, a Dance Leader and Ambassador for DanceSyndrome (http://dancesyndrome.co.uk/) – a dancer-led, disability-inspired organisation – spoke about her many years managing her heart condition, how she had lost 3 stone through dance and healthy eating, and how she wanted to support others to do the same. I celebrate Becky who inspires us all to challenge the norms that limit us from living our lives fully. 

  Becky Rich #dancer #activist 

My second priority was you, our membership. Today, our ADPH conference was over-subscribed for the first time, with a waiting list – that suggests to me a vibrant organisation, where people want to be a part of a body that learns, challenges and improves, together. I’m particularly thankful for the contributions that our members make through the Board, our strengthened Council and soon-to-be reinvigorated Policy Advisory Groups (PAGs); many have also been active through our peer mentoring, our immersive days (one on DsPH with expanded portfolios is coming up in March; do send ideas for further topics!) and the recent workshop for new DsPH – please join in and be part of our growth.  

I, with members of our brilliant ADPH team, have been visiting many of you across England – Cheshire and Merseyside, Yorkshire and the Humber, the east of England, the north east and the south east of England, and in Wales. I’ve enjoyed getting out to meet you and hear about your challenges and successes – you’re doing amazing work under increasingly difficult circumstances. What’s struck me is how committed you all are to improving the public’s health in our local places – but that we also have our heads raised to working to improve as a sector, respectively and collectively, in our regions and at a country level.  

I’m looking forward to connecting with those of you I haven’t yet met, when I complete this round of first visits early next year.   

I’ve also enjoyed hearing our members’ voices commenting on visions and plans and budget decisions, prevention, population health and public health interventions. For this contributes to what’s needed to deliver on my third and fourth priorities – promoting the unique leadership role of the DPH in local systems; and ensuring we continue to be a well-respected – and ‘edgy’ – voice for public health nationally.  

These priorities require a lot of relationship-building – with Public Health England and Public Health Wales, the LGA, ADASS, ADCS, the Faculty, Royal Society, and of course with the NHS. And the ADPH team and many of you, our members, have worked tirelessly to ensure that we get our voice into the many spaces and places shaping our context and our role as DsPH within this – from PHE’s and other agencies’ initiatives, to the NHS long term plan and the Secretary of State’s prevention vision, to the budget and forthcoming spending review. 

We need to – and are – raising our public voice and profile, developing our ‘edginess’ and trumpeting our successes – through tweeting and writing blogs and pieces for the LGC, HSJ, BMJ and elsewhere, and presenting our local work nationally, in the media, through social media, conferences or hosting visits. And we’ve also continued our presence in public hearings, parliamentary committees and other parliamentary bodies, and the many different summits and conferences.  

At November’s Health and Care Committee on the impact of the budget on health and care, the messages I gave were:  

  • Prevention – or health creation – needs investment in all the things that help make us happy, healthy and able to lead fulfilling lives – our childhoods, our friends and our play and learning, our houses and the places where we eat and live, and our occupation and income. Yet there has been a 40% cut to local government funding and a £700m cut to the Public Health Grant over the last 5 years (2014/15 – 2019/20)  
  • DsPH have been doing the best we can, and managed the cuts to the Grant through innovation and transformation of our teams and services (many provided by the NHS) and through a focus on integrating and strengthening local systems; but this is not sustainable   
  • We are local system leaders and ambitious for our population’s health, with proven positive impact – just think what more we could achieve if we were fully resourced. 

We need to continue to develop and strengthen our key messages and overarching narrative. We need you to help us do this with your examples of local successes – watch out for the requests for this, and please contribute yours.  

So, 200 days on: 

  • Priority 1: With Brexit on the horizon, there are many areas for concern in our society, and we need to keep calling these out and championing human rights and equity 
  • Priority 2: I’m loving the way we’re developing as a vibrant, member-led organisation 
  • Priority 3: We need to be much clearer on our impact and our successes 
  • Priority 4: As an organisation, we continue to be well-respected – but I definitely see our ‘edge’ developing. 

I look forward to working on these priorities over the next 200 days! 

by admin

LGA/ADPH Annual Public Health Conference and Exhibition 2019

December 5, 2018 in ADPH Updates, Headline Events, Upcoming events by admin

Supporting resilient communities: helping people to feel good and function well

Victoria Park Plaza, London, SW1V 1EQ
Thursday 21st March 2019

Our annual flagship conference on public health will explore and build on the challenging, innovative work being undertaken by local authorities, their partners and communities as they continue to make progress on improving the nation’s wellbeing and tackling health inequalities.

This year’s conference will focus on developing and supporting resilient, healthy communities. We will hear from expert speakers, councils and partners on key local and national strategies for promoting health and wellbeing and strengthening resilience to health problems.

Join us at our most popular health conference of the year to hear the very latest thinking on key policy and improvement agendas. This is your opportunity to put your questions and comments to those involved in shaping and implementing them at strategic and community levels, and to network with your peers on the public health issues that matter to you locally.

Confirmed speakers include:

  • Ruth Sutherland, Chief Executive, Samaritans
  • Imelda Redmond, National Director, Healthwatch England
  • Nathan Dennis, Director and Community Engagement Consultant, First Class Legacy
  • Rob Trimble, Chief Executive, Bromley by Bow Centre
  • Professor Dame Sue Bailey, Consultant Child and Adolescent Forensic Psychiatrist and Professor of Child and Adolescent Mental Health
  • Diane Lee, Head of Public Health, Barnsley Metropolitan Borough Council
  • Andy Bell, Deputy Chief Executive, Centre for Mental Health
  • Professor Jane South, Professor of Healthy Communities, Leeds Beckett University
  • Jude Stansfield, National Adviser – Public Mental Health and Healthy Communities, Public Health England
  • Deborah Harkins, Director of Public Health, Dudley Council
  • Bev Taylor, Social Prescribing Development Manager, NHS England
  • Cllr Ian Hudspeth, Chair, LGA Community Wellbeing Board and Leader, Oxfordshire County Council (Chair)
  • Jim McManus, Vice-President, ADPH and Director of Public Health, Hertfordshire County Council (Chair)

To register and for more details visit the LGA page.

ADPH response to the proposal to end the sale of energy drinks to children

November 27, 2018 in ADPH Updates, Children and Young People, Obesity by Lucy Sutton

Please find attached the ADPH response to the consultation on the proposal to end the sale of energy drinks to children. The response was submitted on the 21st of November 2018.

196 KBADPH response – energy drinks ban