Directors of public health as ‘a protected species’: qualitative study of the changing role of public health professionals in England following the 2013 reforms

Jehu, L.M. et al. Journal of Public Health, https://doi.org/10.1093/pubmed/fdx154

Published: 07 November 2017

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Background

The Health and Social Care Act 2012 gave councils in England responsibility for improving the health of their populations. Public health teams were transferred from the National Health Service (NHS), accompanied by a ring-fenced public health grant. This study examines the changing role of these teams within local government.

Methods

In-depth case study research was conducted within 10 heterogeneous councils. Initial interviews (n = 90) were carried out between October 2015 and March 2016, with follow-up interviews (n = 21) 12 months later. Interviewees included elected members, directors of public health (DsPH) and other local authority officers, plus representatives from NHS commissioners, the voluntary sector and Healthwatch.

Results

Councils welcomed the contribution of public health professionals, but this was balanced against competing demands for financial resources and democratic leverage. DsPH—seen by some as a ‘protected species’—were relying increasingly on negotiating and networking skills to fulfil their role. Both the development of the existing specialist public health workforce and recruitment to, and development of, the future workforce were uncertain. This poses both threats and opportunities.

Conclusions

Currently the need for staff to retain specialist skills and maintain UKPH registration is respected. However, action is needed to address how future public health professionals operating within local government will be recruited and developed.

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Right care: wrong answers

Dropkin, G. Journal of Public Health, https://doi.org/10.1093/pubmed/fdx136

Published: 03 November 2017

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Background

NHS RightCare is an NHS England programme describing itself as ‘a proven approach that delivers better patient outcomes’. It identifies opportunities for savings and quality improvements, comparing each Clinical Commissioning Group (CCG) with the ‘Best 5’ of a fixed set of ‘Similar 10’ CCGs chosen using equally weighted demographic and deprivation indicators. This article tests whether these indicators are sufficient and equal weighting is appropriate, and evaluates significance.

Methods

Robust public data on lung, colorectal, and breast cancer mortality is modelled using the indicators and incidence. Peers chosen using the preferred models are compared with the Similar 10. Confidence intervals are obtained for comparator group averages. RightCare significance is simulated.

Results

Preferred models have unequally weighted covariates. Incidence is the strongest predictor of lung cancer mortality. The ‘Similar 10’ are inappropriate comparators. RightCare significance ignores variability of comparator outcomes, causing 12% Type I errors. Whilst RightCare shows 1842 annual avoidable lung cancer deaths in 80 CCGs, only 168 deaths in 8 CCGs appear exceptional using appropriate peers and CIs.

Conclusion

CCGs cannot expect to match the average performance of the RightCare ‘Best 5’. Until the methodology is examined with data of known quality, claims that RightCare is a ‘proven approach’ are unsubstantiated.

 

Current, future and avoidable costs of stroke in the UK – Societal costs of stroke in the next 20 years and potential returns from increased spending on research

By The Stroke Association (2017)

This report estimates that the current cost of stroke to the UK is £26 billion every year, a threefold increase from the previous estimated cost of £9 billion. The figures also predict that a growing and ageing population, increasing numbers of stroke survivors, and rising care costs are crucial factors behind the increasing financial burden of stroke over the next 20 years.

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The regulation of e-cigarettes

By The House of Commons Library (2017)

This briefing provides an overview on the regulation of e-cigarettes in the UK and across Europe. It also outlines new product requirements for e-cigarettes and identifies where national regulations have gone beyond what is in EU regulations.

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Public Health: Everyone’s business

by NHS Providers (2017)

NHS Providers has published Public health: everyone’s business? This second report in the Provider Voices series uses 12 interviews with health leaders from across the NHS and local government, as well as academics, to help gain an understanding of NHS providers’ role in shaping and delivering public health and care

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Sector-led improvement for public health, prevention and early intervention

By Local Government Association (2017)

The LGA is working with partners at Public Health England and the Association for Directors of Public Health to deliver sector-led improvement activity in 2017/18 for public health, prevention, and early intervention through the care and health improvement programme funded by the Department of Health.

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Sustainability and transformation plans and partnerships

by House of Commons Library (2017)

Click here to view this briefing paper from the House of Commons Library