Health Service Focus

04.08.17

Pursuing the best possible health for the people we serve

Source: NHE Jul/Aug 2017

Professor John Middleton (pictured), president of the Faculty of Public Health (FPH), looks at the opportunities and challenges facing public health reform in the UK.

The FPH is the standard-setting body for specialist public health in the UK. We define public health as “the science and art of promoting and protecting health and wellbeing, preventing ill-health and prolonging life through the organised efforts of society”. When I talk about ‘public health’ I tend to split it into two distinct but related areas: ‘the health of the public’ and the ‘public health system’. 

The Faculty has a key role in the public health system, developing the professionals who work in it. But we are also advocates for improving and protecting the public’s health. Our ethical code requires us to pursue the best possible health for the people we serve, according to the best standards of evidence we have. We describe three domains of public health: health protection – control of communicable disease and environmental risks; health improvement – healthy public policy and health promotion; and service improvement – assessing the effectiveness of clinical and social care services.  

There is a substantial evidence base to all these domains. In the field of health improvement, there is now a massive evidence base on inequalities in health. It has grown from the Black report through two Marmot reports: unequal economic, environmental and educational opportunities cause inequalities in health. We have published a report on the role of public health in preventing violence, recognising that it has not been given the priority it requires and recognising the new evidence around adverse childhood events. 

In our 2017 election statement, we called for the next government to make meaningful policy changes which will seriously reduce inequalities in health, rather than add to them. In health protection, there has been a long and celebrated history of the sciences of infectious disease and epidemiology enabling us to mount effective responses to outbreaks and control and monitor the more common preventable infections. The appalling terrorist attacks in Manchester and London and the Grenfell Tower disaster have led us to review the public health role in emergency preparedness. The public health implications of Brexit are also greatly exercising us – all the rights to health that have been built over many years are at risk – in consumer protection, soil, air, food quality, workplace health and safety and working conditions, and environmental protections. These may be lost in new trade deals unless we argue for better protections, not a race to the bottom. 

In the field of healthcare evaluation, our members have been at the forefront of the evidence-based medicine and evidence-based policy agendas over many years. Population health insights help us to decide how health and social care can work together better and how to create the best care pathways. Critical appraisal of high-cost drugs and new technologies helps to decide which treatments are affordable and effective. Comparative analyses help us to interpret where some health systems are working better – in terms of patients living or dying, or in terms of patients being treated better for less time in hospital, less intensive care, less unnecessary care.  

Condemnation of cuts to public health 

The move of public health to local authorities in England is a historic one. Many local authorities have welcomed and embraced public health services and adopted a ‘health in all policies’ approach. However, even for the best, there is still the imperative of national government budget cuts so it is tough everywhere. Health service commentators have been united in their condemnation of cuts to public health and preventive care. This criticism has come not just from the public health community but from the King’s Fund, Local Government Association, NHS Confederation, the Health Select Committee and even the chief executive of NHS England. One of our priorities is to demonstrate the massive return on investment potential of public health interventions and to influence national spending priorities for health at the next comprehensive Spending Review. We estimate around 18% of public health consultant capacity has been lost through the UK health changes in the last three years at local and national levels. 

We want to ensure that the skills of our members in healthcare analysis are rebuilt, and we are working with Public Health England, NICE and others to develop training programmes and accredited attachments where public health specialists can hone their skills in critically assessing which health services work, which provide the best value, and which have unacceptable levels of side effects and harms. In relation to the English health system reforms, we are arguing for the full and effective use of public health analysis and priority setting in the sustainability and transformation plan process. Whilst there are notable examples of good practice in tests, with clear commitments to preventing illness, they are not generalised across the NHS and won’t yet be delivered at sufficient scale to make a real reduction in demand on the health service.   

The potential of public health skills to contribute to reducing ill-health and reducing pressure applies whatever the health system – similar problems are being experienced in all four nations of the UK and elsewhere across the world. Our international members grapple with even worse resource constraints and demonstrate often heroic achievements in preventing and controlling disease. The challenge for all of us is to improve and protect the public’s health. It is everybody’s business, but it will always need the catalysts, the stimuli for that collective action, through the expertise that my members have. If you are interested in public health, do join us.

FOR MORE INFORMATION

E: info@fph.org.uk

W: www.fph.org.uk

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

London trust told to improve for third time in three years

17/08/2017London trust told to improve for third time in three years

A major London NHS trust has been told by inspectors that it needs to urgently improve after it received its third ‘Requires Improvement&rs... more >
Third of trainee GPs not planning to work in NHS general practice

17/08/2017Third of trainee GPs not planning to work in NHS general practice

Only two-thirds of trainee GPs are planning to go on to work in general practice in the NHS, a new study has today warned. The research carr... more >
Longest serving NHS chief executive sacked for ‘gross misconduct’

17/08/2017Longest serving NHS chief executive sacked for ‘gross misconduct’

The NHS’s longest serving CEO Sir Leonard Fenwick has been sacked by Newcastle upon Tyne Hospitals NHS FT (NUT) for “gross misconduct... more >

editor's comment

13/06/2017Tackling the major challenges facing the NHS

As you will have gathered from the front cover, a theme that runs throughout this edition of NHE is about empowering and involving the workforce in order to deliver innovative change across the system.  Professor Jane Dacre, president of the Royal College of Physicians, highlights on page 16 the importance of sustainability and trans... read more >

last word

Your personality, your leadership

Your personality, your leadership

Deirdre Wallace, clinical skills manager at UCL Medical School, discusses the importance of learning about leadership and self while at medical school. Approximately five years ago, I was ch... more > more last word articles >
681 149x260 NHE Subscribe button

the scalpel's daily blog

Turbo-boosting STPs? It’s time we got serious about ‘partnership’

27/07/2017Turbo-boosting STPs? It’s time we got serious about ‘partnership’

Merron Simpson, chief executive New NHS Alliance, argues we’re missing the point of what ‘partnership working’ truly means if we refuse to recruit help from those outside the health service. Jeremy Hunt and Simon Steven’s recent announcement to ‘turbo-boost’ sustainability and transformation partnerships (STPs) provides a welcome shot-in-the-arm for those across the system who are ... more >
read more blog posts from 'the scalpel' >

comment

Changing our digital culture and safeguarding patient data

08/08/2017Changing our digital culture and safeguarding patient data

Joanna Smith, chief information officer at Royal Brompton & Harefield NHS FT (RBHT), says that as the NHS becomes more digital it has to get ... more >
A centre for medicines optimisation research and education

04/08/2017A centre for medicines optimisation research and education

Dr Yogini Jani, a consultant pharmacist at University College London Hospitals NHS FT (UCLH), discusses a collaboration with UCL School of Pharma... more >
Unlocking the benefits of age-friendly cities

04/08/2017Unlocking the benefits of age-friendly cities

Stefanie Buckner, Calum Mattocks and Louise Lafortune from the Cambridge Institute of Public Health, alongside Melanie Rimmer from the School of ... more >
A community service

04/08/2017A community service

Louise Watson, NHS England director of the New Care Models programme, discusses the emerging success stories from the vanguard areas across the c... more >
Diabetes Professional Care launches 2017 Conference programme

03/08/2017Diabetes Professional Care launches 2017 Conference programme

An outstanding line-up of practitioners and thought leaders will share their expertise and knowledge with healthcare professionals from across th... more >

interviews

Improving care at the touch of a screen

08/08/2017Improving care at the touch of a screen

When it comes to dementia, having a calm and safe environment can have a substantial impact on a patient’s quality of life. NHE’s Jos... more >
A new approach to talent management

25/07/2017A new approach to talent management

Martin Hancock, national lead for talent management at NHS Leadership Academy, and Gill Rooke, the organisation’s senior operations manager... more >
Enabling greater integration through ACSs

25/07/2017Enabling greater integration through ACSs

At this year’s NHS Confed, Simon Stevens revealed the first wave of accountable care systems (ACSs). NHE speaks to Ian Dodge, the director ... more >
How NHS organisations can protect themselves against cyber crime

25/07/2017How NHS organisations can protect themselves against cyber crime

On 12 May, a global cyber-attack occurred on an unprecedented scale. It affected organisations across the globe and, though it did not specifical... more >
Working collectively to improve cancer outcomes for patients

20/06/2017Working collectively to improve cancer outcomes for patients

Last year, the cancer vanguard established the Pharma Challenge. Rob Duncombe, pharmacy director at the Christie NHS FT, gives NHE an update on t... more >