A few weeks ago I started some work with local government and NHS colleagues on the different models which people operate around public health, and what each different field has to offer, and bring to the table. As part of some research, I have been run a few joint NHS-Local Government focus groups on this issue.
This is building on the “find strengths not deficits” approach I have blogged about earlier.
I’m working this up for publication, but here are the immediate things which have come out of it, in the form of some simple propositions:
Public health in local government is alive and well in different forms than in the NHS. It takes a variety of forms from very recognisable (environmental health roles) to the less recognisable (seasonal deaths work) but can always be fitted into the “three domains of public health” model
- Health Improvement – examples – healthy schools, planning strategies,
- Health Protection – examples – food hygiene, public protection, trading standards,
- Service Quality – examples – integrated care pathways in social care, models of service quality, reviewing services against evidence
The opportunity for us is about taking NHS public health strengths to these local government strengths, adding those NHS strengths to what is there already, and from this to create a model of public health which works in local government. That means we need to recognise both the local government public health family and the NHS public health family have things to bring to the table, and things they need. I’m not going to talk about the things they need for now, that can be done later. I am going to focus on what we can both bring to the table.
NHS trained public health specialists do have a formidable range of skills. That’s no insult or poor reflection on local government, it’s just recognising that these folks have a range of domains of competence they can bring to the table. And they can be applied outside public health across the whole authority. I have deliberately not put these solely in the realms of public health (e.g. immunisation uptake or other functions which might transfer) I have tried to put them in the sense of how they can impact positively on the business of the whole council. So what are the skill domains? Well, they are the following:
- Understanding the key drivers of health and wellbeing, and the interventions to improve population health
- Understanding the principles of how to target programmes, interventions and policies
- Understanding and managing the conflicts between population and individual concerns (equity)
- Finding, assessing and applying evidence
- Understanding and applying structured ways of doing needs analysis
- Applying decision analysis and helping with decision and economic analyses of policy
- Supporting effective commissioning using 1 – 6 above
- Identifying likely prospective policy impact when the evidence is silent
- Understanding research and evaluation and applying this to council business
- Supporting the evaluation of commissioning
- Supporting the understanding of complex variables (e.g. different influences on childhood mental ill health) and their interaction in policy and decision making
These sets of competencies could have a wide and strong application across the NHS and also across local government. Leaving aside the debates about salaries, terms and conditions and risk, those authorities who are having this discussion seem to be developing an ever stronger desire to incorporate public health.
And here is an acid test of them: Take one of your council’s thorniest issues and work out what the public health competencies above could add to help. Then tell me public health consultants do not have riches to bring to local government.
People already in local government have a range of domains of competence they can bring to the table, and public health specialists who learn these skills to add their portfolio, or combine their skill sets with these, could be really powerfully placed to have a major impact in local government:
- Working in political systems
- Understanding the complex stakeholders engaged in the policy process
- Multiple stakeholder relationship building (good for working with GPs)
- Working with multiple policy frameworks from different government and other influencers and stakeholders who feed into local government (much more than the NHS often does)
- Policy skills (there is usually a policy unit in local authorities)
- Pragmatic research skills (there is usually a research team)
- Programme management
- Large scale service and intervention delivery
- A strong sense of place and its impact on interventions
Interestingly, much of the work on Intervention Mapping as a set of techniques in delivering public health programmes (see Bartholomew et al, Kok et al) and an increasing amount of the research points to the salience of these local government skills in determining whether public health programmes are as effective as they could be.
In social care, for example, there is a significant range of opportunity to benefit from the kind of approach public health has taken with NHS commissioning, using the domains of skills above.
While both of these lists are shorthand,you can see that there are significant opportunities for skills to be used across systems and we should avoid a situation where we might be minimising the skills of someone without close enough consideration of what they can bring to the table.
I’ll share more of this work as I write it up.