interviews

Co-production and intergration

Dr Alison Hill, managing director of Solutions for Public Health, speaks to NHE about a new report into the delivery of public health services at a time of economic and structural upheaval in the NHS.

Widening health inequalities between and within communities at a time when the NHS is having to make unprecedented efficiency savings and having its whole structure reformed mean that new methods are required to deliver sustainable health services.

‘Co-production for health: a new model for a radically new world’, is a report based on the findings from a national summit in November 2011, and published by the NHS Alliance, NHS Solutions for Public Health, the Chartered Institute of Environmental Health, Association of Directors of Public Health, and Association of Directors of Adult Social Services.

It suggests that local authorities should commission public health services on a local scale, maintain successful aspects of the current system and decommission those that are proved inefficient.

The report calls for local authorities and health providers to join together with local communities to deliver necessary and effective healthcare services to the public. As levels of preventable health problems such as obesity continue to rise, costing the NHS in resources and loss of productivity, and threatening health and life expectancy, the aims of the scheme outlined in the report are to educate communities and thereby help persuade them to make healthy lifestyle choices.

The report states that “actions must be universal but with an intensity and scale that is proportionate to the level of disadvantage”.

Defining inequality

Dr Alison Hill, managing director of SPH, explained to NHE who the target ‘disadvantaged’ sub-groups included, saying: “Often ‘disadvantaged’ is about income deprivation, sometimes it’s about material deprivation, and then there are vulnerable groups which need to be targeted – people with particular learning disabilities, or mental health problems, or physical disabilities, or certain ethnic minorities where there is a poor health experience.”

Dr Hill explained that these ‘local’ communities would be relatively specific groups of people below local authority level. She said: “There’s considerable variations of deprivation within a local area. You want to target services where there is greatest need, which tends to be those populations in the more deprived areas.”

The report highlights the need for local communities to be involved in the development and delivery of their own healthcare services.

Methodology

Dr Hill said the findings arose from a number of sources: “You look at the data to see how it compares for that population against other populations. You also consult with the public about what they think are the gaps in the services and what would make the service a better experience for them. You also talk to the clinical staff and local authority staff.”

The need for the prioritisation of aspects of public health is a key element of the report. Dr Hill explained that there are some priority areas that will remain similar across all localities, saying: “The lifestyle areas obviously will rate very highly as they are going to impact on the future health of the population – things like smoking, alcohol, drug misuse, nutrition and physical activity in terms of obesity, and sexual health – those are things likely to get very high priority, as will children’s services.

“These are long-term programmes that have to be maintained. For example, things like smoking cessation – the director of public health in local government will be commissioning smoking cessation services through the NHS or through other private sector companies in order to ensure that that’s a free a service available, and targeted at those populations most in need.”

Lifestyles

Of course, many of the priority areas for public health essentially come down to personal lifestyle choices, something Dr Hill acknowledges: “Every government is aware that you can’t force people to make lifestyle changes – actually, they’ve got to know what the evidence is and they’ve got to want to make that change. But there are areas of public health where you can help people make that change. Doctors and other healthcare workers all have a contribution to make in raising issues around lifestyle choices.”

The report plans to make use of social marketing methods to help persuade individuals to make healthy lifestyle choices.

For instance, there will be work through schools to encourage activities such as cycling, offering children new skills and ways into a more physically active lifestyle.

Dr Hill also highlighted some of the other ways the new healthcare system will try to deal with issues like smoking: “There are things like trading standards, so that’s complying with regulation trying to stop underage sales, and then there’s other work going on in tobacco in relation to illicit tobacco and trying to stop the sale of illicit tobacco through work with the UK Border Agency, for instance. Then there’s also the marketing on the packaging; no longer having branding on it, but also the other messages that reinforce that smoking is bad for health.”

New way of working

Obviously, the co-production of public health services between the individual, the healthcare provider and local government will mean change for those already employed in these areas. Dr Hill said: “The public health staff moving into local government will definitely have to learn a new way of working, a new culture. There’s a whole raft of leadership training beginning to be rolled out as well. A lot of it is about learning about the new culture and working with councillors and local authority officers.

“Quite a lot of it will be joint learning, because local government has got to learn more about what public health means: the language of public health, and the impact the services in local government have on health.”

Nonetheless, Dr Hill sounded optimistic about the transition of public health staff from the NHS into local government, saying it was a success so far in terms of working together to achieve the best possible outcomes. She said: “I’ve already heard of examples where people have come together from public health service and local government to have joint learning sessions.”

Dr Hill said: “The report welcomes the role of local government contributing more to public health, because so many of the services local government provides have an impact on health.”

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