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ADPH System Survey 2019 Report

November 22, 2019 in ADPH Updates, PH System, Publications

This summer, we conducted a survey of Directors of Public Health (DsPH) in the UK to gather their thoughts and experiences on a range of challenges and opportunities facing public health.

The survey was open throughout June and July to full members, including DsPH from the devolved nations. A total of 99 responses were received, the vast majority from England (representing 72% of English members). We were pleased to receive some input from the devolved nations and have highlighted responses that include their feedback.

Key findings are presented below. You can also view and/or download the report here: ADPH System Survey 2019 Report (PDF, 236KB)

Key Findings

  • 74% of respondents had substantive appointments (78% in 2017). There were 20% of respondents in an Interim or Acting role. Six said that their LA had not had a substantive DPH for more than a year and a further seven for more than six months, which is unchanged from 2017. 6% responded ‘Other’ due to differing local arrangements.*
  • Asked where they see themselves in 12 months, 80% said they would still be a DPH locally (85% in 2017) with only three saying that they would remain working within Public Health but not locally.*
  • Falling trend of DsPH reporting either directly to their CEO or equivalent or to a super director. This year it was 67%, down from 69% in 2017, and 73% in 2015. However, this masks a web of complex arrangements where line management does not necessarily reflect access, influence or accountability.
  • An increasing number of DsPH are taking on additional responsibilities. 53% manage other council services like adult social care, community development and leisure. Despite the time pressure, these extra roles are overwhelmingly regarded as positive, offering increased influence and credibility.
 
*includes responses from devolved nations
  • Just 55% of DsPH said they had sufficient access to data, down from 60% in 2017. Ongoing issues with access to NHS data, insufficient data sharing agreements and delays in intelligence sharing were highlighted as particular barriers.
  • DsPH have healthy and increasing levels of influence within local authorities. 97% said they had direct access to their CEO (up from 94% in 2017) and 99% said they had sufficient access to councillors. A greater number of DsPH reported having day-to-day control of the public health budget (96% from 88% in 2017). This likely reflects new arrangements strengthening the role of DsPH in signing off public health budgets.
 

“I have control of most of the public health grant, although approximately 22% is earmarked for ‘wider determinants’ work. I am working on my influence on this section of the budget.”

 
  • While the number of DsPH who said they were a standing member of their LA’s most senior corporate management team (CMT) increased slightly (60% from 57% in 2017), it is still low, particularly in comparison to other influencing measures.
  • DsPH have varying levels of satisfaction with key partners in the system. Their most positive relationships are within Local Authorities, with Directors of Adults Social Services (99% positive), Directors of Children’s Services (89% positive) and relationships with other LA directorates (88% positive).
 
  • Relationships with CCGs are improving: 83% felt positive about it, an increase from 2017 (79%). However, relationships with NHSE continue to be weak – just 27% felt positive about it (no change from 2017) and a greater proportion felt negative (26% from 15% in 2017).
 
  • Feelings aren’t as strong for the role of PH in their local ICS process (68% positive) and local integration process (65% positive). However, these are an increase from 2017, when 60% felt positive about the role of PH in STPs, and 53% felt positive about their role in the integration process.
 
  • Relationships with PHE Centres show a significant drop – 76% felt positive about it, compared to 87% in 2017. Comments about the added value of PHE Centres echoed those of the 2017 survey. Relationships with Centres are hugely variable and dependent on local relationships. Issues mentioned continue to be around duplication of work, an imbalance between local and national jurisdiction, and a lack of understanding from PHE Centres of the local government context.
 
  • Health Protection continued to be the most valued service provided by PHE Centres, closely followed by Knowledge & Intelligence services. Advice and support, including opportunities for professional development were also valued.
  • With respect to the impact of cuts locally to service, the most commonly redesigned service in the last three years was sexual health services. Less than 2% of those that had redesigned their service reported that the change had a negative impact. The other most commonly redesigned services were health visiting and school nursing.
 
  • Public health advice within councils was the most common function to have increased in provision over the last three years. Looking ahead, the services most commonly reported to be undergoing redesign over the next three years were health visiting and school nursing.
 
  • 56% negatively regarded the removal of the PH grant ring-fence. This masked a variety of reasons including concern that it could lead to further cuts as funding would be diverted to other competing priorities, and concern that funding may not be made available beyond the spend for statutory services. The impact would largely depend on the status of public health locally. Feelings towards the removal of the ring fence were also largely dependent on whether appropriate assurances (e.g. minimum spend on public health) and monitoring will be in place.
 
  • With the introduction of Business Rates Retention (BRR), opportunities DsPH highlighted included the potential for greater local flexibility and the potential to influence the wider Council budget and introduce a health in all policies approach within LAs. The main challenges reported, were around the potential for further cuts to public health funding, as well as the potential widening of inequalities.
 

“Opportunity to reprioritise our spend towards prevention as we shift to stronger local decision making.’’

“Opportunity to build ownership in the authority for health improvement.’’

  • DsPH were asked how they would like to see currently mandated functions changed in the future. Notably, Heath Checks had the least support from DsPH for continued mandation, with 54% of respondents saying they wanted to see no mandation of the function.
 
  • Health Protection, Sexual Health and 0-5 public health services received positive support for mandation to either stay the same or become more detailed.
   
  • With the Spending Review due to take place next year, DsPH were asked what their priorities for investment were, aside from public health. Nationally, poverty, early years, and education and skills were the top three priorities for DsPH. Early years, social care and housing emerged as the top three priorities locally.
*Includes responses from devolved nations.
  • Policies that received high levels of support from respondents included:
    • introducing a child poverty strategy with binding national targets to reduce child poverty (86% supported)
    • reducing promotions of foods that are high in fat, sugar and salt (85% supported)
    • introducing of a minimum price of 50p per unit of alcohol (83% supported)
    • prioritising active travel in transport policy and continued investment in infrastructure for active travel (81% supported)
    • amending licensing legislation to empower local authorities to control the total availability of alcohol, gambling, junk food outlets (80% supported)
    • implementing a tax or levy on tobacco manufacturers to help cover the cost of smoking to the NHS and wider society (73% supported)
 
  • Increasingly DsPH support the use of vaping as an aid to quit smoking with 75% of respondents supporting the use of e-cigarettes in smoking cessation services.
  • DsPH were asked what other policies they thought were needed to promote longer, healthier lives. Key themes that emerged from responses were the adoption of a health in all policies approach; move towards a budget for wellbeing; focus on population level policies which address the root causes of poor health and tackle health inequalities.
*Includes responses from devolved nations.
There is a lot more detail in the survey responses which ADPH will use to both tailor our offer to members and inform our policy and influencing work. We also make the following recommendations and commitments:  
  • Continue developing support for DsPH with expanded portfolios, to include facilitating networking with colleagues with similar portfolios and sharing good practice about matrix working.
  • Improve access to data and data sharing. ADPH will continue to work with partners including the NHS to ease pathways and develop processes that support improved and timely data sharing.
  • DsPH, as frontline leaders of public health should have a place at top level discussions and decision making. We will keep building and promoting strong relationships across the NHS, local government, public health, and voluntary and community sector to facilitate this.
  • Increased local investment in early years, social care and housing. ADPH will work more closely with key partners, including our counterparts in adult social care and children’s services - to make a stronger case collectively for this.
  • Prioritise national investment in early years, education and skills and tackling poverty. We will focus influencing work on making the case and engage with key stakeholders to support this call.
  • Introduce key public health policies supported by DsPH including binding national targets to reduce child poverty, introduction of a 50p minimum unit price for alcohol and taxing tobacco manufacturers to help cover the cost of smoking to the NHS and wider society. Further information about these and other public health topics can be found in ADPH’s policy positions.
  • Continue to promote a health in all policies approach whether from within local authorities, the NHS or across other public health services.
  • Concerted action to address the wider determinants of health and a move towards building wellbeing into the fabric of Government decision making – both in terms of policy development and funding allocation.
Additionally, in England:  
  • Work with PHE and PHE Centres in England to foster stronger and more productive working relationships, understanding of the local government context and avoid duplication of work.
  • Continue to work to improve links with NHS nationally and locally.
  • Engage with Directors Public Health on BRR reform in England to ensure that appropriate assurances are put in place to support local authorities carry out their duty to improve and protect population health.

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New Government must deliver on its public health promises

December 13, 2019 in ADPH Updates

ADPH responds to the result of the General Election 2019

The Association of Directors of Public Health welcomes the new Government into office. We know there is much to do ahead, but improving and protecting people’s health must be a priority.

While people are living longer, the number of years that they do so in good health is deteriorating, and health inequalities are increasing.

Now, more than ever, we need clear political will to put health and wellbeing at the heart of policy and spending decisions across Whitehall.

Dr. Jeanelle de Gruchy, ADPH President and Director of Population Health Tameside said:

“We urge the new Government to fulfil its promise of more funding for the NHS – which is very welcome – and build on the prevention agenda initiated by the previous Conservative administration. This includes progressing the Prevention Green Paper, producing the next chapter of the Childhood Obesity Strategy, publishing a Vaccination Strategy and developing a Sexual and Reproductive Health Strategy.

Crucially, the Government should commit to a three-year package of investment in public health through a Spending Review to deliver this. It must act quickly to clarify the Public Health Grant settlement and allocations for 2020/21, ensuring in particular that additional cost burdens associated with Agenda for Change and PrEP are properly funded.”

ADPH’s Manifesto for Public Health sets out our ambitions; not just what we want the Government to do, but the contribution Directors of Public Health will themselves make to improve wellbeing in their communities.

We look forward to working constructively with the Government to improve and protect our nation’s health in the coming years.

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Half way on – my reflections as ADPH President

November 29, 2019 in ADPH Updates, President's Blog

This blog is an adaptation of Dr Jeanelle de Gruchy’s opening speech at the ADPH conference on 22 November 2019

It’s half way through my three-year term as President of the ADPH. In the spirit of Sector-Led Improvement, I thought I’d do a stock-check of the priorities I set out at the start, to see how we’re doing on them. A reminder of what they are:

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

A critical part of that first priority has been highlighting the insidious normalisation of injustice or structural inequalities related to some or other characteristic of who we are – our class, race, nationality, gender, disability, sexuality.

At the same time, there is increasing poverty and inequality; and blame for it being the fault of the ‘other’ – the people not like ‘us’. This ‘othering’ leads us to deny the characteristics that we give to those who are not the ‘same’ as us – dignity, love, pride, heroism and ultimately any entitlement to human rights. This is unjust and profoundly damaging to our health and wellbeing.

Language is a key part of this process of ‘othering’. The language we choose to use, how we frame things, what we say – and don’t say – influences how people make sense of and engage with others, communities and society. Framing can be done for good – or for bad.

You’ll remember, a few years ago, the headlines that screamed: ‘Benefits system is broken – UK’s top scroungers on £300 a week more than the average family’. A framing of welfare was created that shamed and scapegoated people, perpetuating inequalities and facilitating a shift that made certain welfare policy decisions more possible.

The Joseph Rowntree Foundation believe that we need to tell a different story about poverty so that we can build public and political will to solve it. They’ve developed a new frame of compassion and justice, with a toolkit of recommended metaphors and words to use, to show that poverty matters, that we can solve poverty and that benefits are part of the solution not the problem. Already they can point to changes in the public narrative on poverty.

Efforts to reframe health is learning from this work. At our conference last year, Tim Elwell-Sutton spoke about the work the Health Foundation are doing with FrameWorks Institute to reframe the conversation around what makes us ‘healthy’ in order to develop new ways of focusing on the social determinants of health.

I wrote a blog on the ‘Lazy Language of Lifestyles’ and Tim and I ran a session at PHE’s conference, challenging ourselves and the public health community to stop using the language of ‘lifestyles’. We believe it frames health disproportionately about individual willpower and choice, over the social determinants of health – and leads to an overemphasis on individualistic behaviour change solutions.

We built on this at the UK Public Health Network summit in October, which centred around the theme ‘Reframing Public Health’. Among some of the conclusions we reached, was the need to establish a set of principles on public health language to create consistency of messaging.

This important work on reframing public health to challenge the current norm which helps perpetuate inequalities, to develop public understanding of the breadth of health, will continue through this next year.

My second priority was you, our members. This year’s conference was held in a new, larger venue, as last year’s one was over-subscribed; we are providing a place for people to come together to learn and share and get geared up for taking our work forward for the next year. Once again, I’m thankful for the contributions that our members make through our new Board, our strengthened Council and Policy Advisory Groups (PAGs). Many have also been active through our peer mentoring, our immersive days (on finance, ICSs and DsPH with expanded portfolios) and the workshops for new DsPH and for our Associate Members – please join in and be part of our growth.

Visits across DPH networks have continued and it has been great to get out to talk to you in your local places. I’m just embarking on my second visit to you all in England and Wales – and hope to get to Scotland and Northern Ireland in 2020.

What’s really striking is the strength of many of our networks and the importance you place on coming together to support each other. Our Sector Led Improvement work is continuing to evolve and we are developing ways to drive improvement in our practice and outcomes.

However, I do think we need to go much further on this – for reducing variability and having a really strong sector is a key element in my third priority: promoting our unique local system leadership role. I’d like to pick up how we do this when I come out to visit you over this next year.

Finally, my fourth priority – ensuring we are a well-respected voice for public health. We are getting our voice into the many spaces and places shaping our context and our role as DsPH within this.

We have raised our public voice and profile and showcased our successes – through social media, blogs and articles for the LGC, MJ and HSJ; through our conferences and workshops and hosting of local visits, for example, for our colleagues in the Department of Health and Social Care. And we’ve also continued our presence in parliamentary committees and engagement with our key partners.

We have also made the most of these opportunities, using them to push back in private or, when necessary, publicly – for example on funding, PreP, relations with the alcohol industry or in responding to those who choose to present a blinkered or siloed view of how we develop a strong public health system; our response to para 2.4 – and the subsequent successful outcome that followed – is an ideal example of our ‘edge’.

We have maintained and further developed our relationships with key partners like LGA, DHSC, FPH, Public Health Wales, existing alliances (Obesity Health Alliance and Alcohol Health Alliance) and PHE – continuing the regional visits with Duncan to all DsPH, and now co-hosting the gathering of DsPH and the PHE top team at the PHE conference this year.

As importantly, we are creating new links. For example, we are part of the coalition, along with CRUK, Health Foundation and King’s Fund among others, campaigning on public health funding and wider determinants spending.

We are working with sexual health charities such as Terrence Higgins Trust and BASHH to campaign for a new sexual and reproductive health strategy (win), working with children’s charities/professional organisations like IHV, SAPHNA and others on championing a good childhood and working with Collective Voice to align messages on drug and alcohol treatment.

We’ve joined up with our local government counterparts – ADCS, ADASS and ADEPT – to call for sustainable funding for local government.

Finally, we’re taking our local voice to national – meeting with Chris Witty, the new Chief Medical Officer, and with government, the Treasury, Home Office and Defra – and of course to the Secretary of State at the PHE conference.

In all this work, your voice is critical – through your comments on the Green Paper and spending round settlement, screening and immunisation reviews, particular issues with the services we commission, or the reorganisation of the NHS into regions – and PHE’s reorganisation too, with the new Regional DPH role.

So, half way through my Presidency, my assessment is:

  • Priority 1: With poverty and inequalities on the rise, 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: We’re becoming ever stronger as a vibrant member-led organisation, with more engagement and involvement
  • Priority 3: We’re maintaining good relationships and forging new ones, our voice is getting heard
  • Priority 4: I think we’re developing and perfecting our particular form of ‘edge’ – with results, for example the reaffirmation of our commissioning role and remit.

I think we’re doing really well, given the context in which we’re working; it’s testament to all of you, our members. I also want to give a shout out to our Chief Exec Nicola and the amazing ADPH team we have behind us. And I look forward to working with all of you on these priorities for the next half of my Presidency.

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A Manifesto for Public Health

November 22, 2019 in ADPH Updates, Publications

The state of health in the UK

The health and wellbeing challenges we face today are clear. While people are living longer, the number of years that they do so in good health is deteriorating, and health inequalities are increasing . People in the wealthiest areas of the country can expect to live 19 more years in good health, compared to those in the poorest.

Although the adage ‘prevention is better than cure’ is once again in ascendency amongst politicians and policy-makers, action and investment consistently fall short of what is needed. For too long, Government spending has focussed on treating illness, rather than keeping people healthy and preventing problems from arising in the first place.

This short-term strategy does little for the health of our nation. The potential of too many people and places is unfulfilled, hindering our economic success and putting a huge strain on our communities and public services.

Our health and wellbeing depends on many different factors.

A small proportion – just 10-20% – is determined by access to traditional health services, like the NHS. The remainder is shaped by the economic, social and environmental conditions of our lives: such as our income, the education we receive, the housing we live in, the transport we use and the air we breathe.

We need a long-term plan to address the root causes of ill health.

The health of the people is the highest good

Creating a society in which we can all be as healthy as possible, for as long as possible must be the fundamental mission of any Government. The Association of Directors of Public Health is calling for health and wellbeing to be the next Government’s top priority.

Below we set out the contribution we will make, as well as our asks of the future UK Government.

The role of Directors of Public Health

Directors of Public Health are ambitious about protecting and improving public health locally and nationally. We believe in the power of a genuine ‘public health partnership’ between the UK Government, the devolved nations, the NHS, local government, charities, professional bodies, businesses and individuals to make this happen.

To achieve this vision, we will:

Provide local place leadership on wellbeing and inequalities.

As independent advocates for public health, with unique knowledge and expertise about our populations, Directors of Public Health will promote health and wellbeing in all policies across local public services, from councils to the NHS to the police.

Deliver efficient and effective services.

Directors of Public Health have reformed services and achieved good outcomes and will continue to do so, despite what is an increasingly unsustainable balancing act. For example, in England, The Public Health Outcomes Framework (PHOF) tracks 112 health indicators. In the last six years, 80 percent of those have been level or improving ; notable, particularly as they have been achieved in a context of year-on-year cuts to the Public Health Grant.

Work collaboratively on joining up services and promoting population health.

Directors of Public Health are committed to working with local and regional NHS and local authority colleagues to ensure integrated pathways between the public health services provided in hospital settings and those offered in the community (e.g. stop smoking and alcohol treatment services); and to ensure that all parts of the health and social care system are focussed on population health outcomes.

Support efforts for healthy public policy at a national level.

As the national voice for Directors of Public Health, the ADPH will play its part in developing and promoting good policies across key agendas like early years, violence prevention, sexual health, alcohol and drug treatment, obesity, smoking cessation, mental health, healthy economic growth and air quality. We will work constructively with Government departments and agencies, professional bodies, commissioners, charities and other partners to implement approaches that work for our communities.

The change we need nationally

Improving the nation’s health requires a bold vision, strong leadership and political will. We ask the next Government to:

Make wellbeing a cross-government ambition.

Wellbeing should be built into the fabric of Government decision-making when it comes to both policy-making and funding allocation. Wales has already made a vital step towards realising this ambition, through the introduction of the Future Generations Wellbeing Act . Similarly, in Scotland, there is now a vision for national wellbeing in the form of the National Performance Framework . These efforts must be matched in England – the proposal to create a ‘health index’, alongside existing wellbeing data collected by the Office for National Statistics, could provide a framework to drive change and embed accountability across Whitehall.

Deliver a multi-year funding settlement for public health.

More investment is urgently needed in public health and prevention. In addition, further investment is needed across a wide range of policy areas including housing, transport and welfare to tackle the root causes of ill health. The ADPH supports the call from the Health Foundation and The King’s Fund for at least £1 billion more a year for the Public Health Grant in England.

Take a whole system and place-based approach to health inequality.

This includes wide-ranging action on the social determinants of health (including housing, the environment and skills), as well as acting on health inequalities caused by the commercial determinants of health such smoking, alcohol use and obesity, expanding the use of the ‘Polluter Pays’ principle.

Set binding national targets to reduce child poverty.

Poverty is the most significant determinant of children and young people’s health in the UK. Currently, 4.1 million children in the UK are living in poverty .

The Association of Directors of Public Health is excited about the opportunity to work with the next Government, other political parties and stakeholders to protect and improve public health in the years ahead.

Find out more about our policy work

Explore our policy position papers

Email policy@adph.org.uk to get in touch with the Policy team

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ADPH System Survey 2019 Report

November 22, 2019 in ADPH Updates, PH System, Publications

This summer, we conducted a survey of Directors of Public Health (DsPH) in the UK to gather their thoughts and experiences on a range of challenges and opportunities facing public health.

The survey was open throughout June and July to full members, including DsPH from the devolved nations. A total of 99 responses were received, the vast majority from England (representing 72% of English members). We were pleased to receive some input from the devolved nations and have highlighted responses that include their feedback.

Key findings are presented below. You can also view and/or download the report here: ADPH System Survey 2019 Report (PDF, 236KB)

Key Findings

  • 74% of respondents had substantive appointments (78% in 2017). There were 20% of respondents in an Interim or Acting role. Six said that their LA had not had a substantive DPH for more than a year and a further seven for more than six months, which is unchanged from 2017. 6% responded ‘Other’ due to differing local arrangements.*
  • Asked where they see themselves in 12 months, 80% said they would still be a DPH locally (85% in 2017) with only three saying that they would remain working within Public Health but not locally.*
  • Falling trend of DsPH reporting either directly to their CEO or equivalent or to a super director. This year it was 67%, down from 69% in 2017, and 73% in 2015. However, this masks a web of complex arrangements where line management does not necessarily reflect access, influence or accountability.
  • An increasing number of DsPH are taking on additional responsibilities. 53% manage other council services like adult social care, community development and leisure. Despite the time pressure, these extra roles are overwhelmingly regarded as positive, offering increased influence and credibility.
 
*includes responses from devolved nations
  • Just 55% of DsPH said they had sufficient access to data, down from 60% in 2017. Ongoing issues with access to NHS data, insufficient data sharing agreements and delays in intelligence sharing were highlighted as particular barriers.
  • DsPH have healthy and increasing levels of influence within local authorities. 97% said they had direct access to their CEO (up from 94% in 2017) and 99% said they had sufficient access to councillors. A greater number of DsPH reported having day-to-day control of the public health budget (96% from 88% in 2017). This likely reflects new arrangements strengthening the role of DsPH in signing off public health budgets.
 

“I have control of most of the public health grant, although approximately 22% is earmarked for ‘wider determinants’ work. I am working on my influence on this section of the budget.”

 
  • While the number of DsPH who said they were a standing member of their LA’s most senior corporate management team (CMT) increased slightly (60% from 57% in 2017), it is still low, particularly in comparison to other influencing measures.
  • DsPH have varying levels of satisfaction with key partners in the system. Their most positive relationships are within Local Authorities, with Directors of Adults Social Services (99% positive), Directors of Children’s Services (89% positive) and relationships with other LA directorates (88% positive).
 
  • Relationships with CCGs are improving: 83% felt positive about it, an increase from 2017 (79%). However, relationships with NHSE continue to be weak – just 27% felt positive about it (no change from 2017) and a greater proportion felt negative (26% from 15% in 2017).
 
  • Feelings aren’t as strong for the role of PH in their local ICS process (68% positive) and local integration process (65% positive). However, these are an increase from 2017, when 60% felt positive about the role of PH in STPs, and 53% felt positive about their role in the integration process.
 
  • Relationships with PHE Centres show a significant drop – 76% felt positive about it, compared to 87% in 2017. Comments about the added value of PHE Centres echoed those of the 2017 survey. Relationships with Centres are hugely variable and dependent on local relationships. Issues mentioned continue to be around duplication of work, an imbalance between local and national jurisdiction, and a lack of understanding from PHE Centres of the local government context.
 
  • Health Protection continued to be the most valued service provided by PHE Centres, closely followed by Knowledge & Intelligence services. Advice and support, including opportunities for professional development were also valued.
  • With respect to the impact of cuts locally to service, the most commonly redesigned service in the last three years was sexual health services. Less than 2% of those that had redesigned their service reported that the change had a negative impact. The other most commonly redesigned services were health visiting and school nursing.
 
  • Public health advice within councils was the most common function to have increased in provision over the last three years. Looking ahead, the services most commonly reported to be undergoing redesign over the next three years were health visiting and school nursing.
 
  • 56% negatively regarded the removal of the PH grant ring-fence. This masked a variety of reasons including concern that it could lead to further cuts as funding would be diverted to other competing priorities, and concern that funding may not be made available beyond the spend for statutory services. The impact would largely depend on the status of public health locally. Feelings towards the removal of the ring fence were also largely dependent on whether appropriate assurances (e.g. minimum spend on public health) and monitoring will be in place.
 
  • With the introduction of Business Rates Retention (BRR), opportunities DsPH highlighted included the potential for greater local flexibility and the potential to influence the wider Council budget and introduce a health in all policies approach within LAs. The main challenges reported, were around the potential for further cuts to public health funding, as well as the potential widening of inequalities.
 

“Opportunity to reprioritise our spend towards prevention as we shift to stronger local decision making.’’

“Opportunity to build ownership in the authority for health improvement.’’

  • DsPH were asked how they would like to see currently mandated functions changed in the future. Notably, Heath Checks had the least support from DsPH for continued mandation, with 54% of respondents saying they wanted to see no mandation of the function.
 
  • Health Protection, Sexual Health and 0-5 public health services received positive support for mandation to either stay the same or become more detailed.
   
  • With the Spending Review due to take place next year, DsPH were asked what their priorities for investment were, aside from public health. Nationally, poverty, early years, and education and skills were the top three priorities for DsPH. Early years, social care and housing emerged as the top three priorities locally.
*Includes responses from devolved nations.
  • Policies that received high levels of support from respondents included:
    • introducing a child poverty strategy with binding national targets to reduce child poverty (86% supported)
    • reducing promotions of foods that are high in fat, sugar and salt (85% supported)
    • introducing of a minimum price of 50p per unit of alcohol (83% supported)
    • prioritising active travel in transport policy and continued investment in infrastructure for active travel (81% supported)
    • amending licensing legislation to empower local authorities to control the total availability of alcohol, gambling, junk food outlets (80% supported)
    • implementing a tax or levy on tobacco manufacturers to help cover the cost of smoking to the NHS and wider society (73% supported)
 
  • Increasingly DsPH support the use of vaping as an aid to quit smoking with 75% of respondents supporting the use of e-cigarettes in smoking cessation services.
  • DsPH were asked what other policies they thought were needed to promote longer, healthier lives. Key themes that emerged from responses were the adoption of a health in all policies approach; move towards a budget for wellbeing; focus on population level policies which address the root causes of poor health and tackle health inequalities.
*Includes responses from devolved nations.
There is a lot more detail in the survey responses which ADPH will use to both tailor our offer to members and inform our policy and influencing work. We also make the following recommendations and commitments:  
  • Continue developing support for DsPH with expanded portfolios, to include facilitating networking with colleagues with similar portfolios and sharing good practice about matrix working.
  • Improve access to data and data sharing. ADPH will continue to work with partners including the NHS to ease pathways and develop processes that support improved and timely data sharing.
  • DsPH, as frontline leaders of public health should have a place at top level discussions and decision making. We will keep building and promoting strong relationships across the NHS, local government, public health, and voluntary and community sector to facilitate this.
  • Increased local investment in early years, social care and housing. ADPH will work more closely with key partners, including our counterparts in adult social care and children’s services - to make a stronger case collectively for this.
  • Prioritise national investment in early years, education and skills and tackling poverty. We will focus influencing work on making the case and engage with key stakeholders to support this call.
  • Introduce key public health policies supported by DsPH including binding national targets to reduce child poverty, introduction of a 50p minimum unit price for alcohol and taxing tobacco manufacturers to help cover the cost of smoking to the NHS and wider society. Further information about these and other public health topics can be found in ADPH’s policy positions.
  • Continue to promote a health in all policies approach whether from within local authorities, the NHS or across other public health services.
  • Concerted action to address the wider determinants of health and a move towards building wellbeing into the fabric of Government decision making – both in terms of policy development and funding allocation.
Additionally, in England:  
  • Work with PHE and PHE Centres in England to foster stronger and more productive working relationships, understanding of the local government context and avoid duplication of work.
  • Continue to work to improve links with NHS nationally and locally.
  • Engage with Directors Public Health on BRR reform in England to ensure that appropriate assurances are put in place to support local authorities carry out their duty to improve and protect population health.

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ADPH Prevention Green Paper consultation response summary

November 4, 2019 in ADPH Updates, PH Funding

The Government’s leadership in shifting the conversation, including through this Green Paper, towards a more preventative approach to health and wellbeing is a positive step forward. Directors of Public Health are committed to playing their part.

Prevention is now a widely used term, but different organisations often use, and interpret it, in different ways. There are three levels of prevention (primary, secondary and tertiary) – and all have a role to play. The ADPH response largely focusses on promoting primary prevention that seeks to implement population wide measures to support the health and wellbeing for everyone in society.

The ADPH’s view is making the mantra of ‘prevention is better than cure’ a reality for individuals and communities requires significant progress across four areas.

Taking a social determinants approach
Our health and wellbeing is overwhelmingly shaped by social, economic and environmental factors and this evidence should be fully reflected in the Government’s prevention agenda. This means going beyond a conversation about health which is focussed on hospitals, services and treatment. It is essential that the Government focusses on population level policies which address the root causes of poor health as these will make the biggest difference for the largest number of people.

Embedding wellbeing across Whitehall
Bearing in mind the impact the social determinants of health have, wellbeing should be built into the fabric of Government decision making – both when it comes to policy development and funding allocation. Too often health is a second order priority when it should be the foundation without which individual flourishing and economic prosperity cannot be realised.

Investing in sustainable, long-term funding for public health
Investment is needed across all the determinants of health. In respect of public health services specifically, at least £1 billion extra per year is required. The Government will need to work with the public health community to properly cost new commitments arising from the Prevention Green Paper. Considering spending through the social determinants lens should lead to significant new money for education, housing, transport and much more besides.

Strengthening collaboration and partnerships
It is only through strong partnerships that integrated service pathways and good outcomes can be achieved – the delivery of the NHS Long Term plan and proposals in the Green Paper depends on collaboration between the NHS, local government and the Voluntary and Community Sector. The NHS cannot do it alone. Links must be reinforced at every level.

Key recommendations

  • The Spending Review next year must deliver a sustainable package for public health in local government. The Public Health Grant needs at least £1bn more a year to reverse years of cuts to public health funding.
  • The Government should tackle the social determinants of health and building wellbeing into policy decision making and funding allocation a cross-government priority, supported by a new ‘health index’ and better utilisation of existing ONS wellbeing statistics.
  • The Government should adopt a whole system approach to health inequality and promote place-based approaches.
  • The Government should reintroduce binding national targets to reduce child poverty
  • The Government should address the fundamental role of planning, housing and place policies in the promotion of wellbeing and prevention of ill health across the life course.
  • NHS England needs to ensure that prevention forms a key, mandatory and funded part of all Sustainability and Transformation Partnership and Integrated Care System plans to ensure good health across the life-course
  • Directors of Public Health should have a place at both local and national decision-making tables in relation to discussions about designing and delivering prevention services – particularly in relation to the NHS Long Term Plan – and the implementation of system change, such as Integrated Care System.

We are also a signatory to the joint submission led by Cancer Research UK, urging the next Government to prioritise public health

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ADPH joins Public Health England and the Centre for Ageing Better to make England the best place to grow old

October 16, 2019 in ADPH Updates

The Association of Directors of Public Health is joining with over 60 high profile organisations in the UK’s health, housing, employment, research and voluntary sectors to launch a landmark shared vision on healthy ageing.

We’re pleased to commit to five key principles: prioritising prevention and public health; creating opportunities for people to contribute to society as they age; fostering accessible and inclusive homes and neighbourhoods so everyone can live where they want; narrowing inequalities in healthy ageing; and challenging ageist language, culture and practices.

This initiative is being led by Public Health England (PHE) and the Centre for Ageing Better. We will work together to make England the best country in the world to grow old, adding our voice to calls to tackle these issues and provide everyone with the opportunities and support they need to have a good later life.

We are asking other organisations to help us make this vision a reality. If you want to be involved in the next round of signatories or want to share the work you are doing, please contact ageingwell@phe.gov.uk

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ADPH responds to review of Adult Screening Programmes in England

October 16, 2019 in ADPH Updates, Health Protection

The Association of Directors of Public Health values the necessary focus on screening improvement that Professor Sir Mike Richards’ report provides.

We welcome the confirmation by the Secretary of State that Public Health England will provide the single source of expert advice on screening and his commitment to ensuring robust governance and accountability is in place for the different elements of screening.

We are concerned, however, that the local Director of Public Health role of oversight has not been highlighted and indeed strengthened.

Greg Fell, ADPH Board Member and Health Protection Lead, and Director of Public Health for Sheffield said:

“Directors of Public Health appreciated the opportunity to engage with Sir Mike Richards on this important review to address the challenge of delivering a more effective and accountable screening system.

However, we are disappointed that the report completely overlooks the importance of local leadership. This is a missed opportunity to strengthen the role of DsPH in providing this local leadership, using their knowledge of their population to tackle inequalities by improving screening coverage and uptake by all those who are eligible.

We look forward to further conversations with national and local partners in the NHS, public health and beyond to see stronger screening programmes and more lives saved.”

Further information

Click here to see the evidence ADPH submitted to the Public Account Committee’s inquiry on adult health screening in March 2019.

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Directors of Public Health back ‘bold action’ on childhood obesity

October 10, 2019 in ADPH Updates, Children, Young People and Familes, Obesity, nutrition and physical activity

ADPH responds to CMO’s report on Childhood Obesity

The Association of Directors of Public Health, and our members, welcome Professor Dame Sally Davies’ report on childhood obesity and her recommendation for further ‘bold action’ from the Government, to realise its ambition to halve childhood obesity by 2030.

Dr Jeanelle de Gruchy, President of ADPH and Director of Public Health for Tameside commented:

“The report clearly presents the evidence of the ways that social and commercial determinants of health overwhelmingly shape our weight. We support the recommendations to address these, particularly those tackling the production, supply, marketing and sale of high calorie sugar and fat foods. This is something our members have frequently called for, and we note there is strong public support for it as well.

We were also pleased to see the emphasis on creating healthy places that give children ample opportunity to be active and healthy. Directors of Public Health have long played a key role in promoting children’s health in their areas, including by leading whole system approaches to obesity, of which the built environment is a core part.

National action that supports this local leadership is much welcomed, and also requires more investment in local councils and public health to be truly effective.”

Professor Jim McManus, Vice-President of ADPH and Director of Public Health for Hertfordshire said:

“It should be a fundamental right for all children to grow up in an environment that promotes, rather than harms, their health. Yet, as this report shows, it is not the case in England.

Professor Davies has issued a comprehensive and credible wake-up call about the scale of childhood obesity in modern Britain and the impact not just on health but on our children’s life chances.

Returning the right to healthy, active lives to our children requires a renewed sense of purpose and bold, decisive action from the Government and industry. Without this, not only will we fall short of achieving the goal of halving childhood obesity by 2030, but also fail our children, their health and future.”

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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.

Suicide-Prevention-SLI-prospectusDownload

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

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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

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