Your views: The NHS’s role in the public’s health

How can we ensure that the public’s health remains at the heart of the NHS?

We are interested in your views in this area, including:

  • What role could NHS and health and care professionals effectively play in systematically delivering improved population health outcomes, including tackling inequalities?
  • What are the mechanisms that commissioners, providers and the wider system could use to help support professionals in improving outcomes?
  • How can we ensure that the NHS’s role in the public’s health aligns with the roles of Public Health England and local authorities?
  • How can the NHS contribute to people’s health and wellbeing in its role as a large employer?

The NHS Future Forum’s work on the NHS’s role in the public’s health is led by Vicky Bailey and Ash Soni.

In NHS Future Forum

5 Responses to Your views: The NHS’s role in the public’s health

  1. Dr Graham Watkinson says:

    I apologise my feedback does not specifically address the four consultation questions, but it does express concern over the potential loss of system expertise which has experience in addressing each of these aspects. The majority of public health specialists in England are employed and trained within PCTs. The movement of PH specialists out of PCTs therefore represents a radical change of employment for the future of the profession and for each of us individually. The implications of this change are unclear, and risk a number of negative impacts upon the NHS commissioning system, the NHS as a whole, and the public health profession.

    The wider changes in public health – creation of Public Health England as an arms length body of the civil service for example, is happening gradually over the coming year, and will be formalised by March 2013. We have not had any clarity over its constitution, its relationship to local authorities and local health service commissioning or how we will hand over many aspects of our present PCT roles to the new workforce in PH England. Indeed the Health Bill has not yet been agreed to make these a legal entity yet, but I assume the NHS is increasingly confident the bill will be passed in its current form, and wants to get on with change as rapidly as possible.
    The creation of a new public health system completely outside the operational and commissioning functions of the NHS is a radical change in our way of working, and arguably the most radical part of the health reform. Few of us can understand how this is likely to work in future, and fewer can explain it presently. I hope very much that the unique role of public health, and the specific skills and hard won experience among public health professionals will continue to support and lead on aspects of NHS commissioning in future – it will be a huge waste of talent otherwise.

    • Rod Whiteley says:

      PCTs have skilled and experienced public health specialists? They’re well hidden, it seems to me. I’m looking forward to Public Health England leading much more visible, coordinated, evidence-based and accountable public health policies, accountable in particular for specific local outcomes that will provide plenty of scope for all that talent.

  2. 1. What role could NHS and health and care professionals effectively play in systematically delivering improved population health outcomes, including tackling inequalities?

    There is a great danger that in the new world, paradoxically, when roles for each part of the health system are specified (even over specified) that each organisations might forget what can be achieved collaboratively, through the wisdom of crowds and through combined and consistent efforts. For instance, one rather large threat looming is one of climate change and the need for all individuals and communities to act sustainably. Many people are looking at the health sector as to how one of the world’s largest organisations is coping with not only the challenge but also the many opportunities (better models of care, more empowered patients and public, better IT and social networking, improved community resilience, localism….). If the NHS does not respond to these opportunities, we will be wasting a huge opportunity for PHE and the NHS to have a combined approach to future challenges where we are already considered to be leading (in thought if not in action).

    2. What are the mechanisms that commissioners, providers and the wider system could use to help support professionals in improving outcomes?

    Commissioners need to understand that the process is not just about this service for that need for these people. Without a systems level approach, we will not get genuinely effective commissioning for the health of the population: only for the illness needs of multiple overlapping subpopulations. Commissioners need to remind themselves that they have a population responsibility which means taking prevention very seriously for financial, health, an sustainability reasons. The RCGP, the NHS SDU have consulted widely and published commissioning guidance in these areas.

    3. How can we ensure that the NHS’s role in the public’s health aligns with the roles of Public Health England and local authorities?

    Imperative that the mandate for the NHSCB from the DH and the equivalent direction from the centre for PHE are consistent and that no essential, strategic functions fall through the gap. Where there are overlapping and mutually reinforcing tasks (such as the health sector’s responsibility to addressing climate change and sustainability for instance), there should be a systems based approach with cross representation from both NHSCB and PHE to ensure that the core objectives are aligned.

    4. How can the NHS contribute to people’s health and wellbeing in its role as a large employer?

    By taking its iconic status as the country’s largest employer seriously. If the NHS becomes a loose federation of unlinked organisations, we will not realise we have lost a system-wide approach until we don’t have it. Even in these times of earned autonomy and localism, there is a profound need not to lose what we might not realise we have, and that is a hugely impressive and relatively integrated system of health care where inequalities in access and outcome are a lot less than they might be. The key issue is to do no harm in the reforms and risk losing what we already have, but may neither appreciate, understand or value.

  3. Anonymous says:

    How can we ensure that the public’s health remains at the heart of the NHS?

    Public health should be an integral part of all NHS and local authority business. Too often public health is seen to be an NHS responsibility but it is everybody’s business. Public health should have a ‘cradle to grave’ philosophy it should work with and understand communities and what makes them ‘tick’. I believe one of public health’s roles should be to translate health benefits into simple language, to encourage the public to take ownership of their health but this will only be achieved if the whole system works together. Public Health can not and will never do it on its own.

    We are interested in your views in this area, including:

    What role could NHS and health and care professionals effectively play in systematically delivering improved population health outcomes, including tackling inequalities?

    I believe that to improve health outcomes and tackle inequalities the whole system must work together. Too often organisations work in isolation to each other: if the whole system worked together and this is not the same as integration, the outcomes would be much greater and health inequalities would reduce. For example why is it that rehabilitation takes place in hospital or social care settings, when it could be achieved working in partnership with local authority leisure services? Why do we need allied health professionals to deliver falls prevention programmes when this could be achieved using physical fitness instructors? We need to understand what make communities behave the way they do, we must move away from a ‘one size, fits all’ model of delivery and move towards person centred delivery at a neighbourhood level. Public health has a major role to play in shaping the way health services are delivered but health needs to learn how to work with colleagues in housing, education, leisure, environmental health, other emergency services, and the private and third sector. Too many health professionals believe that if it’s not a medical model it won’t work. Local evidence suggests otherwise but the big issue is getting decision makers in health to be open to this way of working. Public Health should be everyone’s business, therefore I personally don’t believe that public health should sit in any one ‘camp’ it should have the ability to influence delivery in all. Public Health reports should set priorities for commissioners and commissioners should report back to public health if they fail to deliver against set priorities.

    What are the mechanisms that commissioners, providers and the wider system could use to help support professionals in improving outcomes?

    Mechanisms need to change; there is a reliance on ‘safe systems’. Commissioners need to build commissioning intentions on the needs of communities rather than budgetary or safe system needs. I also believe that stakeholders and ‘market research’ should play an important role in how services are commissioned. Too often we ask stakeholders to get involved but unfortunately they are not listened to and are certainly not permitted to contribute to decision making. The example I use relates to large business organisations. They would not consider putting a product on a shelf or in a showroom if they had not carried out market research. Why is it that health thinks it knows what people want to ‘buy into’ or is it that there is nothing else on offer, so its a case of take it or leave it.

    Current mechanisms within health are not flexible. They do not offer opportunity for new and innovative solutions to long standing problems. Going back to the business sector they have a product life cycle. When the product is at its peak, organisations are already planning a replacement. This does not mean that they scrap the old one they simply refine it and launch it in plenty of time to get people to want to buy the new model. We could learn a lot from the business sector.

    How can we ensure that the NHS’s role in the public’s health aligns with the roles of Public Health England and local authorities?

    Stop thinking that the centre knows best. Start listening to communities and start working with each other. That does not mean integration it simply means learning about each other and working together for the benefit of all.

    How can the NHS contribute to people’s health and wellbeing in its role as a large employer?

    As a current large employer the NHS is doing very little for the health and wellbeing of its staff. Staffs are stressed, worried and angry. They haven’t got a clue what the future holds and unfortunately this is now being translated out to the wider public. The NHS needs to portray a positive self image to promote health and wellbeing. At present from where I sit there is very little to be positive about.

    The NHS Future Forum’s work on the NHS’s role in the public’s health is led by Vicky Bailey and Ash Soni.

  4. Sarah O'Sullivan says:

    Public health needs to embrace the role of the school nurse, who offer services to children and young people from 5- 19 years. The role of the school nurse has been an invisible service, but it needs the same recognistion as Health visitors from 0-5 years service, as the same role and level of expertise and specialist practitioner degree level care is provided. School nurses tackilng inequalities in society, are advocates and tackle broad issues, for children and young people, some of which are below:

    family disputes
    safeguarding children
    domestic abuse
    emotional well being – reduction of self harm / depressed young person , increasing the young persons emotional well being and resciliance
    Increasing confidence and self esteem- in a number of creative ways using research based methodolgy such as the ‘ Solihull apporach’ and ‘ Storm’ priniciples in tackling self harm
    referrals to a number of other agents- such as CAMHS and knowing when to refer, by accurate health assessments
    Identify a need in local areas and addressing that need I.e reduction in teenage pregnancy, obesity, drugs / alcohol
    Being creative
    Working with local schools, communities, parents, voluntary groups, education
    Offerring nurse led drop in clinics on a number of topics
    tackling long term medical conditions in schools
    tackling enuresis – enuresis clinics
    care planning for children in schools with teachers with long term conditions
    sexual health and smoking cessation clinics
    the skills of offerring services to 5 – 19 years rather than just 0-5 years wide interpersonal skills in this area!
    liasion with GPs / Gp consortias- the way forward!
    school assemblies / health promotion / PSHE lessons
    immunisation programmes
    home visits
    safeguarding report writing
    domestic violence support and advice
    A&E follow up care and advice
    new parent talks
    strategy meetings / CAF meetings / TAF ,meetings / Child Safeguarding conferences.
    This list is not inclusive of every aspect, there is still more!!!

    School nursing is an invisible service that needs to have its profile raised in mass media for the work school nurses do and the poublic health roile they play, other health practitioners need to understand the value of the school nurse, but school nursing needs to be uniform across all areas as each area works in a slightly different way, which may confuse staff of the role of the school nurse and what school nurses can do and acheive….. school nurses need to be at the helm of future public health England……