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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 by admin

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 by admin

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 by admin

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 by admin

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

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

September 30, 2019 in ADPH Updates by admin

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

September 26, 2019 in ADPH Updates, Alcohol and Drugs by admin

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

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ADPH responds to Government Spending Round

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

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.”

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Government must end cuts and uncertainty

August 21, 2019 in ADPH Updates by admin

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.”

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Drug related deaths: getting some fundamentals right

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

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.

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Spending Review needs to deliver for public health

August 9, 2019 in ADPH Updates by admin

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.”