The New Public Health – Emerging Practical Ideas

Solutions for Public Health published an important document just before Christmas.  Co-Production for Health: A new model for a radically new world (National Colloquium) helps us keep our eye on the longer term ambition we will need if we are to use the opportunity created by the transfer of public health from the NHS to local government to modernise our approach to public health and health inequalities.

The document has credibility for three reasons:

First, it comes from a number of key organisations who are tasked with improving public health on the ground – the Chartered Institute for Environmental Health; Association of Directors of Public Health; the NHS Alliance; and the Association of Directors of Adult Social Services.

Second, it reminds us of what the big issues are:

• health Inequalities are widening and the gradient needs to be addressed.
• Its important to have a system that delivers the Marmot recommendations
• the impact of the recession and its implications for practice – resilience of communities in particular.

Third, it sets out 9 priority areas to focus on. Some are pretty obvious and should be familiar to leaders in any partnership or set of organisations working in complex systems such as the need for:

1. Focussed agreed priorities which have meaningful outcomes for partners
2. Delivery mechanisms in place to implement HWB decisions
3. New funding mechanisms to drive change – don’t spend money on what does not work – decision makers need advice on how to proceed when evidence is strong and weak.

Others are more insightful, strategic and creative and start to carve out the basis for a new more inclusive approach to public health. These include:

1. Intelligence – Using it intelligently – “JSNAs currently do not always access the wealth of data available at a local level. JSNA of the future need to link with intelligence held for example, by the fire and police services as well as the whole range of local government departments inufficient use has also been made of qualitative intelligence held within neighbourhoods and communities”.
2. Assets – Asset-based approach to communities – “use communities positively to understand and harness their assets and resource, particularly around personalisaiton of budgets. There is … much statutory bodies can learn from … the voluntary sector in securing effective local involvement.
3. Local Politicians – Elected members must buy in – the model will fail without elected members. “the reforms present an opportunity to secure engagement of elected members in more productive ways and create new champions for health and well being. …. It is crucial to create relevant narriatives and understanding for members about how they can make a real difference to health and wellbeing.”
4. Partnership – A new partnership and leadership model – “the traditional model of the DPH as the sole advocate and champion for health must be consigned to the past” “We need a new conceptual model with the DPH working corporately alongside their colleagues in the local authority”
5. Practical – Decisions for the future need to be practically based. The Public Health Workforce hs to change – “placing NHS public health teams within local government is not ‘click and drag’. Local Commissioners need pragmatic solutions based on the best evidence available – they need to know the implications and impact of different commissioning decisions.
6. Capacity – Public Health Capacity on an industrial scale. “Achieving public health outcomes cannot rest with a relatively small specialist and practitioner public health workforce”

So the colloquium report starts to offer us a modernised view of public health that might be like this:

• More local
• Has a more inclusive view of public health capacity
• Puts a greater emphasis on partnership skills and on offering practical advice to commissioners
• Expects a more sophisticated view of intelligence
• Requires a re-balancing of the relationship with communities and citizens

What do you think?