LGA/ADPH suicide prevention SLI programme

October 9, 2019 in ADPH Updates, Mental Health, Publications, Sector Led Improvement

The LGA and ADPH are pleased bring to your attention the suicide prevention sector led improvement programme prospectus. The following support is available 2019/20:

  • National: a series of tools, products and events designed to provide wider and easier access to the good practice, learning and existing resources. This includes a series of webinars and a masterclass in Spring 2020.
  • Regional: grant funding allocated to ADPH networks to build on and support regional suicide prevention SLI activity
  • Local: bespoke expert support for up to twelve local authorities and partners who self-identify as facing significant delivery challenges locally around suicide prevention.

This prospectus provides more detail on each of the elements.

Expressions of interest in bespoke support are now open, closing 5PM 1st November 2019. The two-page-long submissions should cover the following two areas:

  1. Describe the suicide prevention delivery challenge to be explored by the bespoke support
  2. Provide evidence of local need

If the number of expressions of interest exceed the current level of support, priority will be given to areas whose significant local challenges would not be successfully addressed by other elements of the programme, in conjunction with the two elements set out above. Further details of each aspect can be found in the attached prospectus and on the website: www.local.gov.uk/suicide-prevention

ADPH responds to King’s Fund publication ‘Creating healthy places’

September 30, 2019 in ADPH Updates

ADPH welcomes the publication of the King’s Fund report Creating healthy places: perspectives from NHS England’s Healthy New Towns programme.

The insights offered by those involved in the sites articulate well the value of taking a place-based approach to population health, as well as the importance of planning and health working closely together.

We were especially pleased to see the contribution made by Virginia Pearson, member and Director of Public Health for Devon, who eloquently notes the critical and complex role Directors of Public Health play. Not only in the expertise and knowledge they provide to improve their population’s health and wellbeing, but also as systems leaders, influencing and fostering collaboration among the many different place players, to engage whole system action that addresses the wider determinants of health.

“Public health is all about places – and the people in those places” Virginia notes in her essay. And as frontline leaders of public health, Directors of Public Health, and ADPH as their representative body, look forward to working closely and forging connections with the NHS and the many other partners needed to effectively build healthy places, where people can thrive.

Click here to go to the Creating healthy places: perspectives from NHS England’s Healthy New Towns programme webpage on the Kings Fund website

Click here to read ADPH’s narrative on the UK Public Health system, including our recommendations for ensuring a public health system that is fit for the future

ADPH responds to impact of Minimum Unit Pricing for alcohol in Scotland

September 26, 2019 in ADPH Updates, Alcohol and Drugs

An assessment of the immediate impact of the introduction of minimum unit pricing (MUP) on alcohol in Scotland found it was successful in reducing the amount of alcohol purchased by households in Scotland.

Responding to the findings, ADPH CEO Nicola Close said:

“ This is a valuable study that clearly demonstrates the impact national policies that reduce the affordability of alcohol can have on reducing alcohol-related harm.

There are health inequalities associated with alcohol harm. Lower socioeconomic status is associated with higher levels of alcohol-related ill-health and alcohol-attributable mortality.

The biggest drop in alcohol purchases was in lower income households, which shows the targeted effect such measures can have on reducing health inequalities.

Alcohol harm costs both individuals and society; one of the most effective and cost-efficient ways of reducing it is through national policies like MUP and our members strongly support its introduction.”

Click to read our policy position on alcohol and recommendations for national and local activity

ADPH responds to Government Spending Round

September 4, 2019 in ADPH Updates, PH Funding, PH System

Responding to the Government Spending Round announced today, ADPH President Dr Jeanelle de Gruchy said:

“We welcome the real-term increase in the Public Health Grant. Alongside a range of charities and professional bodies, we have strongly campaigned for increased funding for public health if people are to live better, healthier lives. We are pleased that our message appears to have been heard.

The public health grant is £850 million lower in real terms than initial allocation in 2015/16 and Directors of Public Health are managing growing demand for public health services, including sexual health. The real-term increase is a positive step in the right direction, and we look forward to receiving more detail on what it entails.

We don’t believe this Spending Round will be the end of tough decisions for public health. But we do hope it is the start of a conversation with the Government (particularly in the lead up to next year’s Spending Review) about significant and sustainable investment in public health that delivers on the Government’s ambitions for prevention and better health and wellbeing for the nation.”

Government must end cuts and uncertainty

August 21, 2019 in ADPH Updates

The Housing, Communities and Local Government Committee report on local government finance is welcomed by the Association of Directors of Public Health.

This timely report highlights the red flags that we, and indeed the whole of local government, have been waving about the consequences of cuts to the health and wellbeing of communities.

Directors of Public Health have been walking a tightrope, balancing the delivery of high-quality preventative services and innovative approaches with rising demand and a shrinking public health grant.

However, the reality is that Directors of Public Health are reaching the outer limits of what is possible to deliver on shoestring budgets.

Local government, and the Directors of Public Health within them, plays a key role in shaping healthier places in which we all can live, work and play. The lack of adequate, sustainable local government funding will see inequalities widening even more than they are now, and poorer health – the very opposite of prevention.

ADPH President Dr Jeanelle de Gruchy, who gave evidence to the Committee on the impact of cuts on public health and prevention, said:

“Echoing the Chair of the Committee, Clive Betts MP – it is time for the Government to get real with local government funding.

We agree that local government needs a long-term, multi-billion pound funding settlement through a Comprehensive Spending Review; of that, at least an extra one billion a year is needed for public health to effectively protect and improve the health of communities and people.

Yet, as things stand, public health budgets will be cut by a further £50m next financial year. The Government must act in the Spending Round to stop these cuts and show that it really means it when it says prevention is better than cure.”

Drug related deaths: getting some fundamentals right

August 15, 2019 in ADPH Updates, President's Blog

ADPH Vice-President Prof Jim McManus argues for the importance of getting the fundamentals right when it comes to tackling the complex issue of drug-related deaths

Today the Office for National Statistics published the latest figures on drug related deaths. And we have seen an increase. In particular, on top of the news about accidental poisoning a couple of weeks ago, we have cause for concern.

But as usual with this topic people will seize on it to provide easy solutions to what is a complex problem. So let’s bust some myths before we get down to the fundamentals we need to get right to stop people dying.

Myth 1: It’s all down to the changes in commissioning in England

This is simply not true. Scotland has had no changes in commissioning of drug treatment and has seen numbers of deaths rise far beyond England rates, and continue to rise, year on year. Similarly, the rise in England started in 2011, well before transfer of responsibility.

A major national review of drug related deaths concluded there were multiple factors including the age, immune system and respiratory health of some cohorts of opiate and opioid users, access to a range of treatment including NHS treatment and supply of drugs. We also know overdosing becomes more likely if your treatment is not properly calibrated and you use drugs on top of what is prescribed.

This is not about who commissions drug treatment. It is about how we ensure people get into the right services for their needs. And this means clear pathways for drug treatment needs, and for other needs like physical health, mental health and housing.

Myth 2: There is no residential rehabilitation left

Despite the efforts of one or two for-profit companies including UKAT (UK Addiction Treatment Centres) to convince us that this is all down to residential rehabilitation placements, this simply isn’t true.

First, the Scottish and English experience have both seen significant rises in drug-related deaths so the attempt to claim a move away from residential rehabilitation centres is the cause simply does not stack up.

Second, no amount of residential rehabilitation will treat people who need lung or chest treatment because of long term respiratory suppression from smoking and opiate use, plus multiple other conditions. In and of itself this is not the solution.

The examples of service innovation in the 2017 Collective Voice report demonstrate more appropriate approaches to preventing and managing overdoses than an approach based primarily on residential rehabilitation. One clearly effective intervention is ensuring Naloxone is available for appropriate use – this will save lives.

We know residential rehabilitation doesn’t work for everyone. For some it works well as part of a pathway of care. But it isn’t, never was, and never will be the main way we need to address this public health challenge.

Does that mean nothing can work?

No, there are things which can work. But in order to get to them we need to set aside the self-interested myths put about by people who stand to profit from them while the issues remain unaddressed. I mentioned above the Collective Voices approach, which collected a range of innovation from various places in reducing drug related deaths. Some of these are being adopted elsewhere. Some of these tools and methods are slow to roll out.

We can reduce drug-related deaths, but there are two vital ingredients we need. The first is proper funding – this is an area that has experienced severe cuts over the last 11 years (see Commissioning Impact on Drug Treatment report and Drug and Alcohol Services in Scotland publication). And the second is for public health commissioned services and NHS commissioned services to work together – integration is the way we will succeed.

So what should be done?

Here are my key steps:

  1. Identify the populations at highest risk – we do know mostly who they are, and we will typically find they have multiple needs , many are ageing, many have suppressed immune and respiratory systems and they are vulnerable for a number of reasons including housing and social support
  2. Ensure they all have good primary care which understands the complexity of their needs and ensures they can access services appropriately
  3. Ensure they get good quality drugs treatment
  4. Get every commissioner and provider together and build a pathway around this population, with a range of treatment. Specific lung and chest health, for example, needs to be included in this. So does housing
  5. Continue to make Naloxone more available and more usable
  6. Ensure clear joined up pathways from custody into the community. NHS England has often been conspicuous by its absence and people have often been discharged from prison without clear links into community services or given Naloxone. This is failing them.
  7. A national review of what works and roll out of evidence-based practice and innovation where we don’t know what works best
  8. A national strategy for drugs and one for alcohol which focus on saving lives and keeping people healthy.

This needs funding, and both the cuts in public health funding and the lack of anything about drugs in the NHS Long Term Plan should give us major cause for concern.

Drug treatment remains almost absent from the heath policy debate. While the NHS Long Term plan suggested a greater say in commissioning of sexual health, it was telling it didn’t mention drug treatment. It was telling that the Green Paper on prevention mentioned sexual health, but didn’t mention drugs. This is not policy which is focused on burden of disease to people and society. If it was, we’d have drugs higher up the agenda.

People who use drugs and who have complex needs as a result are still fellow-citizens whatever some may think of them. They have rights, and the NHS constitution applies every bit as much to them as it does to anyone else. Intervening effectively will save lives.

Spending Review needs to deliver for public health

August 9, 2019 in ADPH Updates

The Association of Directors of Public Health appreciates the clarity for spending and planning that the Government’s one-year ‘fast track’ Spending Round brings.

Responding to the announcement, ADPH President Dr Jeanelle de Gruchy said:

“With the launch of the Prevention Green Paper, the Government has signalled its commitment to prevention being better than cure. This one-year Spending Round, as well as the full Spending Review that follows, is the opportunity for the Government to walk the talk on prevention by investing in public health.

The public health grant needs at least £1 billion more a year to reverse decades of cuts to public health funding. The Spending Round must consider this, and 2020’s Spending Review needs to ensure a sustainable funding package for local public health.

Not doing so would mean a failure to tackle the root causes of ill health – such as poor housing, toxic air, inequalities in education and employment – which Directors of Public Health do, in our role as local public health leaders.

Only by investing in public health can the Government turn prevention rhetoric into reality, and genuinely enable people to live better, healthier lives.”

We need to rebuild our social fabric

August 5, 2019 in ADPH Updates, President's Blog

ADPH President Dr Jeanelle de Gruchy and Charlotte Augst, Chief Executive, National Voices look at what the recently published Green Paper means for patients and the VCSE.

We have got far too used to Brexit drowning out work on the key issues that really affect the wellbeing of our population. So much so, that it was a surprise for many when the Government managed to push out its consultation paper on prevention just before Theresa May left office.

The Green Paper contains many good proposals that are hard to argue with: making Britain smoke free by 2030 and halving childhood obesity by the same year, are goals that would have a significant impact on people’s lives if they were achieved. We also welcome the ambitious target of adding five healthy years to people’s life expectancy. This commitment offers the opportunity for bold action to make health and wellbeing a cross-government priority, like in Wales and New Zealand.

However, there is an overall lack of ambition and little to offer in terms of how these goals can be delivered. The paper gets carried away with its own rhetoric on ‘targeted’ and ‘intelligent’ prevention (as if public health hasn’t always been a data driven practice, using scarce resources where they matter). It suggests genetic testing, apps and ‘lifestyle’ advice will make the difference and will be the main driver for change.

But – as local government and voluntary and community sector (VCSE) organisations, which support people to have better, healthier lives – we strongly believe that this way of thinking will lead to a dead end. Although some diseases are due to genetics, these play a much smaller role in shaping a person’s health than where they are born, grow up, live, work and age. It is simply not the case that poorer people are genetically different from their better off neighbours. Rather it is the unequal social, economic and environmental circumstances throughout people’s lifetime that contribute to widening health inequalities. This imbalance has only been made worse by the years of austerity and sustained cuts to local authority and VCSE provided services and interventions – including youth clubs, children’s centres, social care and much more.

The consultation paper says nothing about funding for such social infrastructure and little about the role of places and communities. This shows a lack of understanding of the things that good, healthy lives are made of and what is needed to rebuild the social fabric that enables us to thrive: attractive places that help us to connect to each other, advice and support when we encounter difficulties, activities that create relationships, purpose and resilience. A healthy society is not one that waits for people to become ill, but one that sees how health is shaped by social, cultural, political, economic, commercial and environmental factors, and acts on these.

As we enter another turbulent chapter of national politics, we are disappointed that we haven’t succeeded in landing these insights with enough policy makers on the national stage yet. But now is the moment to redouble our efforts. Locally, we will continue doing what we do best – enhancing wellbeing and creating social value. Nationally, we will continue to make the argument for investment in social infrastructure and services that benefit those whose lives are blighted by inequality, economic decline and lack of connection. This work hasn’t stopped, and neither will we.

Charlotte Augst, Chief Executive, National Voices and Jeanelle de Gruchy, President, Association of Directors of Public Health


About National Voices
National Voices is the umbrella body bringing together health and care charities large and small in England. National Voices stands for people being in control of their health and care, through person-centred care. Its aim is for people to have as much control and influence as possible over decisions that affect their own health and care and to be partners in the design of services, research, innovation and improvement.

National Voices helps people and organisations to gain the knowledge, understanding, skills and confidence they need to engage more effectively and to make their approaches more person-centred. It has expertise in what matters to people relating to health and care, how to involve people, and how to work with the Voluntary Community and Social Enterprise sector.

Prevention proposals are welcome but require funding public health to make an impact

July 23, 2019 in ADPH Updates

We welcome the publication of the Government’s green paper on prevention, including the recognition of the integral part local authorities play.

Only by putting prevention at the centre of all policy and funding decisions can we create the conditions for improvements in population health.

We will be working closely with Directors of Public Health to ensure their experience and recommendations feed into the forthcoming consultation.

ADPH President Jeanelle de Gruchy said:

“For too long ‘prevention is better than cure’ has been a commonly used mantra rarely matched with deeds. It is time for that to change.

We welcome ambitions to stub out smoking entirely by 2030 and ensure that people can enjoy at least 5 extra healthy, independent years of life by 2035.

But words are no substitute for actions. The scale of the prevention challenge will require investing once again in public health – with at least £1 billion more a year to reverse years of cuts – and strong, effective leadership across Whitehall to address the root causes of ill health, from poverty of money to poverty of opportunities.

We must remember, too, that it is the wider determinants of health – housing, employment, education, environment – that overwhelmingly shape our health and wellbeing, alongside health services, and Directors of Public Health play a critical role in addressing these.

This green paper must be at the top of the Secretary of State for Health and Social Care’s reading pile – and their to do list.”

ADPH Statement: Tackling violence as a public health duty

July 15, 2019 in ADPH Updates

The Government has announced plans to legislate for a new public health duty on local councils and other public bodies to tackle serious violence. This follows a consultation which the ADPH responded to.

Responding to the results of the Government’s consultation, ADPH Vice-President Jim McManus said:

“We welcome efforts by the Home Office to deepen its understanding of how a public health approach to violence can deliver safer communities.

Lessons from Scotland, London and across the UK, show the value of partnership working across local public services and there are some great examples of how this place-based, voluntary approach is preventing violent crime and replacing despair with hope.

Directors of Public Health are contributing their expertise and leadership to this collective action – and will continue to do so.

However, we have to be honest about the mismatch between the Government’s word and its actions. Whilst talking about a public health approach to violence, it continues to cut the public health grant to local government – amounting to £850 million since 2014/15. This funding is vital to deliver many of the services that transform prevention rhetoric into reality, such as drug treatment and early years services.

A duty without the funding to deliver it – and to tackle the causes of crime – risks being an empty gesture.”